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Updated: Aug 22, 2025

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Monkeypox: How Globalization, Host Immunity, and Viral Evolution Create a New Pathogen.

Theresa Barton, Regina Oladokun

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    Monkeypox, an Orthopoxvirus, is spreading globally with increased person-to-person transmission. The 2022 outbreak highlights new transmission patterns, primarily affecting younger, unvaccinated individuals and men who have sex with men.

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    Area of Science:

    • Virology
    • Epidemiology
    • Public Health

    Background:

    • Monkeypox is an Orthopoxvirus endemic to West Africa and the Congo Basin, causing fever, rash, and lymphadenopathy.
    • Historically, smallpox vaccination provided cross-protection, but declining immunity has contributed to increased endemicity.
    • Sporadic imported cases have occurred in the US, but a large 2022 global outbreak signifies a shift in epidemiology.

    Purpose of the Study:

    • To describe the epidemiology and characteristics of the 2022 global monkeypox outbreak.
    • To identify changes in transmission patterns and affected populations.
    • To inform public health responses to the evolving monkeypox situation.

    Main Methods:

    • Surveillance data analysis from global and US reporting agencies.
    • Review of clinical presentations and demographic information of reported cases.
    • Epidemiological investigation of transmission pathways.

    Main Results:

    • As of October 7, 2022, over 71,000 cases were reported globally in 107 countries, with over 26,000 in the US.
    • The majority of cases occurred in younger individuals without prior smallpox vaccination.
    • A significant proportion of cases were identified among men who have sex with men, indicating a novel mode of transmission.

    Conclusions:

    • The 2022 monkeypox outbreak demonstrates altered epidemiology with increased person-to-person spread.
    • Public health strategies must adapt to recognize and address new transmission dynamics, particularly in key affected populations.
    • Continued surveillance and research are crucial for managing the global monkeypox outbreak.