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Area of Science:

  • Epidemiology
  • Mathematical Modeling
  • Virology

Background:

  • Declining population immunity to poxviruses post-smallpox eradication.
  • Reduced vaccinia immunization impacts immunity against related viruses like mpox.
  • Increased mpox spillovers and human-to-human transmission are observed.

Purpose of the Study:

  • To explore factors influencing mpox evolutionary emergence.
  • To model the transition to sustained human-to-human transmission.
  • To assess the impact of transmissibility versus spillover events on mpox emergence.

Main Methods:

  • Utilized simple mathematical models.
  • Simulated evolutionary dynamics of mpox.
  • Analyzed factors affecting transmissibility and spillover.

Main Results:

  • Increased human-to-human transmissibility significantly elevates mpox emergence probability.
  • Zoonotic spillover frequency has a lesser impact on emergence compared to transmissibility.
  • Mpox requires a reproductive number slightly above one to become endemic, with potential for further adaptation.

Conclusions:

  • Enhanced human-to-human transmissibility is the primary driver for mpox evolutionary emergence.
  • Post-emergence control requires substantially higher vaccination levels than pre-emergence prevention.
  • Mathematical modeling provides insights into mpox pandemic potential and control strategies.