An integrated review of monkeypox: from pathogen and epidemiology to diagnostics, control, and challenges

Monkeypox (Mpox) is a zoonotic disease caused by MPXV and remains a threat to global public health. MPXV Clade Ib has higher mortality, whereas Clade IIb exhibits widespread international transmission. WHO has twice designated mpox epidemics as a Public Health Emergency of International Concern (PHEIC). This highlights that the virus is not only pathogenic but also has the potential to cause a global pandemic, posing a challenge to the international public health system. The rapid transmission of MPXV between and within hosts is related to two key virus particles: IMV and EEV. Antigenic proteins (A29L, M1R, B6R, and A35R) on these particles mediate viral invasion, dissemination, and immune evasion. Clinical management of mpox remains supportive, and there is a lack of specific antiviral drugs. Although smallpox-related drugs (such as tecovirimat, cidofovir, and brincidofovir) show potential, their clinical efficacy needs to be verified. The existing vaccines recommended by the WHO are facing challenges, such as side effects or limited duration of immune protection in application, prompting the research and development of novel vaccines and antibody therapeutics. Research on the mechanism of invasion and surface proteins of viruses will continue to provide a scientific foundation for the development of medications and vaccines. Prevention and control rely on a stronger monitoring system, timely risk warnings, and public health education. This article reviews the recent progress in MPXV detection, vaccine development, and antibody-based therapy, providing new insights for mpox prevention and control.