# From neglected to notoriety: a review of Mpox clinical features, virology, epidemiology, treatment and prevention strategies

## TL;DR

This review summarizes the evolving understanding of mpox, including its changing transmission patterns and treatment approaches.

## Contribution

The paper highlights recent shifts in mpox epidemiology and evaluates updated treatment and prevention strategies.

## Key findings

- Recent outbreaks show sustained human-to-human transmission among specific populations.
- Tecovirimat is the first-line treatment for severe mpox despite mixed trial results.
- Modified Vaccinia Ankara vaccine shows promise in preventing clade IIb mpox.

## Abstract

This narrative review aims to provide an overview of current knowledge on mpox, emphasizing updated epidemiology and recent advances in treatment and prevention strategies, in light of the latest outbreaks.

We searched PubMed and Google Scholar for publications on ‘Mpox’ and ‘Monkeypox’ up to June 5, 2025. Grey literature from governmental and health agencies was also accessed for outbreak reports and guidelines where published evidence was unavailable.

Recent outbreaks have redefined mpox epidemiology. Whereas previous regional outbreaks were mainly driven by zoonotic spillover with limited household transmission and often affecting children, more recent outbreaks have involved sustained human-to-human transmission. Such transmission has occurred among men who have sex with men for clade IIb and within heterosexual networks for clade Ib outbreaks, and more recently clade Ia outbreaks, primarily through sexual contact. Clinical features have also shifted toward more localized lesions, prominently in the anogenital area. While mpox is usually self-limited, severe cases may occur in pregnant women, young children, and immunocompromised individuals. Mpox management primarily relies on supportive care. In patients with severe mpox, or at risk of, tecovirimat was widely recognized as the first-line therapy, although it has failed to demonstrate its effectiveness in recent randomized controlled trials. The Modified Vaccinia Ankara vaccine (two-dose regimen) has shown a favorable safety profile and promising efficacy data in preventing clade IIb mpox, including immunocompromised individuals.

Mpox has transitioned from a neglected zoonosis to a re-emerging global health threat. Sustained surveillance, robust and targeted public health interventions, and equitable access to diagnostics, vaccines, and antiviral treatments are critical to managing potential future mpox outbreaks.