DrMcPharma ep. 22. MPXV: The Comprehensive Review of Mpox Virus Epidemiology, Pathophysiology, and Treatment

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The History of Mpox Research

• 1958: The monkeypox virus (MPXV) is first identified during two outbreaks of a pox-like disease in research monkey colonies in Copenhagen, Denmark.
• 1968: Smallpox is officially eliminated in the Democratic Republic of Congo (DRC).
• 1970: The first documented human case of mpox is recorded in a 9-month-old boy in the DRC, a region where smallpox had recently been eliminated.
• 1970-Early 2022: Mpox cases are primarily reported from rural communities in Central and West Africa, with the DRC reporting the majority of cases. A total of eleven African countries report human mpox infections during this period.
• Around 1980: Routine smallpox vaccination programs are discontinued globally following smallpox eradication. This leads to a growing population immunologically naive to orthopoxviruses.
• 2003: The first documented mpox outbreak outside Africa occurs in the United States, with 47 cases across six states. The outbreak is linked to contact with pet prairie dogs infected by imported small mammals from Ghana. No person-to-person transmission is documented during this outbreak.
• 2010 onwards: The Democratic Republic of Congo consistently reports over 1,500 suspected mpox cases annually, indicating sustained high levels of endemic transmission.
• Around 2017: A noticeable increase in mpox spread begins, particularly in Africa.
• 2017-2018: A significant mpox resurgence occurs in Nigeria, larger and more geographically widespread than previously observed. This signals increased viral activity and potential for human-to-human transmission in West Africa.
• Early 2022: Prior to May, mpox is recognized but largely confined to specific African regions.
• May 2022: A pivotal shift occurs as cases of mpox (later identified as Clade IIb) begin to be reported from multiple countries where the disease is not historically endemic, occurring concurrently across diverse WHO regions.
• July 23, 2022: The World Health Organization (WHO) declares the mpox outbreak a Public Health Emergency of International Concern (PHEIC) in response to the escalating global spread and novel transmission patterns.
• Late 2022: The WHO officially recommends renaming the disease from "monkeypox" to "mpox" to mitigate stigma and racist connotations.
• May 10, 2023: The WHO lifts the PHEIC for mpox following a significant decline in newly reported cases globally.
• 2024: Human mpox cases attributed to Clade IIa are reported in Côte d’Ivoire, Ghana, Guinea, and Liberia, suggesting repeated zoonotic spillover events followed by limited human-to-human transmission.
• January 1, 2024 - May 18, 2025: Significant Clade I outbreaks continue in Central and Eastern Africa, with countries like DRC, Uganda, Sierra Leone, and Burundi reporting thousands of confirmed cases.
• January 1, 2024 - Early June 2025 (CDC data) / Late May 2025 (WHO data): A growing number of countries outside of Africa report travel-associated cases of Clade I mpox, including the United States (4 cases), United Kingdom (12 cases), Germany (10 cases), India (10 cases), China (9 cases), and others.
• Early 2025: A new, potentially more transmissible variant of Clade Ia is detected in the Democratic Republic of Congo (DRC).
• Early-Mid 2025: Global mpox epidemiology shows ongoing Clade I outbreaks in Africa causing significant concern due to higher severity, persistent low-level circulation of Clade IIb globally, and increasing travel-associated cases of Clade I internationally. The African region accounts for the vast majority (88.7%) of new confirmed cases globally in April 2025.