Re-emergence and clinical management of monkeypox: insights into viral biology, therapeutics, and vaccination.

Abstract

Monkeypox (Mpox) is a re-emerging zoonotic disease caused by the monkeypox virus (MPXV), a double-stranded DNA virus of the Orthopoxvirus genus. Initially confined to Central and West Africa, Mpox has recently spread to non-endemic regions, raising global health concerns. This review provides a comprehensive update on the virus's structure, transmission, replication, clinical features, diagnostic methods, treatment options, and vaccination strategies. The Mpox virion is brick-shaped, enveloped, and replicates entirely in the cytoplasm using virus-encoded enzymes. Transmission occurs through close contact with infected individuals or animals, respiratory droplets, fomites, and potential vertical transmission during pregnancy. Clinically, Mpox presents with fever, lymphadenopathy, fatigue, myalgia, and progressive skin lesions that evolve from macules to pustules and scabs. Diagnosis relies primarily on polymerase chain reaction (PCR), supplemented by virus isolation, serology, and electron microscopy. Antiviral therapies such as tecovirimat (TPOXX), cidofovir, and brincidofovir are under consideration, with tecovirimat showing the most clinical promise. Vaccination remains the most effective preventive measure. Currently approved vaccines include ACAM2000, LC16 KMB, and JYNNEOS (MVA-BN), with JYNNEOS preferred due to its safety profile, especially for immunocompromised individuals and pregnant women. Preventive strategies, public education, and international surveillance are essential to mitigate further outbreaks. Understanding the biology, clinical behavior, and control measures of Mpox is critical for informing future responses and improving global preparedness.