Mpox (Monkeypox): From Neglected Tropical Disease to Emerging Global Pathogen

Dear Colleagues,

The monkeypox virus (MPXV) has become the most potentially lethal member of the family Poxviridae since the eradication of its close relative, the smallpox virus (variola virus, VARV), in 1977. Since its first identification as a human pathogen in the Democratic Republic of the Congo (DRC) in 1970, mpox (monkeypox) has caused sporadic clusters and small outbreaks of infection in the endemic areas of West and Central Africa caused by two genetically distinctive strains, or clades, termed Clade I and Clade II. Since then, the epidemiology and demographics of infection with the mpox virus (MPXV) have dramatically changed. There have been increasing numbers of individuals and outbreaks occurring, especially in the DRC, with escalating transmission by sexual contact, shifting from mostly affecting children to affecting adults, and with outbreaks outside of the endemic African countries. These changes were evident in the 2022 multi-country mpox outbreak that affected approximately 87,000 persons in 110 countries, mostly through sexual transmission among networks of gay, bisexual, and other men who have sex with men. This was caused by a newly described genetic variant of Clade II, termed Clade IIb. In December 2022, the DRC declared a national outbreak of mpox, followed in September 2023 by an outbreak in South Kivu Province, which has spread to other regions and is driven by sexual transmission. Significantly, the South Kivu outbreak is associated with a novel strain of the Clade I MPXV that indicates adaptation to human transmission. This outbreak has confirmed that Clade I MPXV is especially dangerous when it occurs in pregnant women, demonstrating a fetal loss rate of 50 percent.

There are significant concerns in the medical and public health communities that mpox may become an even greater threat to global health in the near future. The present dangers of mpox are clear—the capability of human-to-human transmission via several routes, the lack of immunity within the global community, a natural wildlife reservoir, and multiple genetic variants that are adapting to a human host.

This Special Issue of Viruses will address a spectrum of topics on mpox and the MPXV including epidemiology, clinical features, molecular genetics, immunology, virology, diagnosis, treatment, prevention, and vaccination. Articles describing the MPXV in natural animal hosts and experiment animal models of infection are welcomed. Submissions which discuss the infection among special groups, including immunocompromised persons, pregnant persons, children, and commercial sex workers, and its association with sexual transmission are encouraged. Submissions can be in the form of original research articles, reviews, communications, viewpoints, case reports, and editorials. Illustrative and graphic materials including photographs are encouraged when possible.

Submissions from investigators working in the endemic and outbreak areas are encouraged to contribute to this issue regardless of financial concerns—please contact Dr. Schwartz for more information.

Dr. David A. Schwartz
Dr. Robert Colebunders
Dr. Patrick Katoto
Guest Editors

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• monkeypox
• mpox
• monkeypox virus
• mpxv
• poxvirus
• Poxviridae
• Africa
• DR Congo
• outbreak
• epidemic
• stillbirth
• sexual transmission
• vaccination
• emerging infection