1887
Volume 2025, Issue 2
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Monkeypox (Mpox) was identified as a virus endemic to Central and Western Africa. Since 2022, the virus has gained global attention due to increasing cases in non-endemic countries among patients having no link to travel to endemic areas. The virus is primarily transmitted through animal-to-human contact but has increasingly spread via human-to-human transmission. A comprehensive understanding of the epidemiology of Mpox in the Middle East and North Africa (MENA) region is essential for effective disease prevention, diagnosis, surveillance, and control.

This review investigates historical data and recent global and regional epidemiological trends of Mpox. The review discusses the clinical features, public health challenges, and preventive measures relevant to the MENA region using updated data from World Health Organization (WHO) reports, national health statistics, and additional relevant resources.

Mpox cases significantly spread globally during the 2022–2024 period. The MENA region has a relatively low number of documented cases, with 857 confirmed cases by August 2024. Saudi Arabia and the United Arab Emirates (UAE) reported the highest case numbers, reflecting effective surveillance and case detection. However, new cases of Mpox were announced in September 2024 in Morocco and Jordan following the WHO’s declaration of Mpox as a public health emergency of international concern.

The current number of cases in the MENA region could be underestimated due to underreporting, stigmatization, limited resources, and ongoing conflicts in several countries. It is essential to prioritize the containment of the outbreak, exploring all possible strategies to protect vulnerable communities.

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2025-06-30
2025-07-20
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References

  1. Magnus PV , Andersen EK , Petersen KB , Birch-Andersen A . A pox-like disease in cynomolgus monkeys. Acta Pathol Microbiol Scand. 1959; 46:(2):156–76.
    [Google Scholar]
  2. Doty JB , Malekani JM , Kalemba LN , Stanley WT , Monroe BP , Nakazawa YU , et al. Assessing Monkeypox virus prevalence in small mammals at the human-animal interface in the Democratic Republic of the Congo. Viruses. 2017; 9:(10):283.
    [Google Scholar]
  3. Ladnyj ID , Ziegler P , Kima E . A human infection caused by Monkeypox virus in Basankusu Territory, Democratic Republic of the Congo. Bull World Health Organ. 1972; 46:(5):593–7.
    [Google Scholar]
  4. Di Giulio DB , Eckburg PB . Human Monkeypox: an emerging zoonosis. Lancet Infect Dis. 2004; 4:(1):15–25.
    [Google Scholar]
  5. Rimoin AW , Mulembakani PM , Johnston SC , Lloyd Smith JO , Kisalu NK , Kinkela TL , et al. Major increase in human Monkeypox incidence 30 years after Smallpox vaccination campaigns cease in the Democratic Republic of Congo. Proc Natl Acad Sci U S A. 2010; 107:(37):16262–7.
    [Google Scholar]
  6. Weinstein RA , Nalca A , Rimoin AW , Bavari S , Whitehouse CA . Reemergence of Monkeypox: prevalence, diagnostics, and countermeasures. Clin Infect Dis. 2005; 41:(12):1765–71.
    [Google Scholar]
  7. Centers for Disease Control and Prevention (CDC) . Human Monkeypox—Kasai Oriental, Zaire, 1996-1997. MMWR Morb Mortal Wkly Rep. 1997; 46:(14):304–7.
    [Google Scholar]
  8. Preventing Monkeypox. FDA Consum. 2003; 37:(5):3.
    [Google Scholar]
  9. Centers for Disease Control and Prevention (CDC) . Multistate outbreak of Monkeypox—Illinois, Indiana, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep. 2003; 52:(23):537–40.
    [Google Scholar]
  10. Sejvar JJ , Chowdary Y , Schomogyi M , Stevens J , Patel J , Karem K , et al. Human monkeypox infection: a family cluster in the Midwestern United States. J Infect Dis. 2004; 190:(10):1833–40.
    [Google Scholar]
  11. Centers for Disease Control and Prevention (CDC) . Update: multistate outbreak of monkeypox—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep. 2003; 52:(27):642–6.
    [Google Scholar]
  12. Shchelkunov SN , Marennikova SS , Moyer RW . Orthopoxviruses pathogenic for humans. Cham: Springer Science & Business Media; 2006.
    [Google Scholar]
  13. Ulaeto D , Agafonov A , Burchfield J , Carter L , Happi C , Jakob R , et al. New nomenclature for mpox (monkeypox) and monkeypox virus clades. Lancet Infect Dis. 2023; 23:(3):273–5.
    [Google Scholar]
  14. WHO monkeypox: experts give virus variants new names; 2022Aug12. Available from: https://www.who.int/news/item/12-08-2022-monkeypox-experts-give-virus-variants-new-names (Accessed 28 September 2024).
    [Google Scholar]
  15. Kibungu EM , Vakaniaki EH , Kinganda-Lusamaki E , Kalonji-Mukendi T , Pukuta E , Hoff NA , et al. Clade I-associated mpox cases associated with sexual contact, the Democratic Republic of the Congo. Emerg Infect Dis. 2024; 30:(1):172–6.
    [Google Scholar]
  16. Petersen E , Abubakar I , Ihekweazu C , Heymann D , Ntoumi F , Blumberg L , et al. Monkeypox—enhancing public health preparedness for an emerging lethal human zoonotic epidemic threat in the wake of the smallpox post-eradication era. Int J Infect Dis. 2019; 78:: 78–84.
    [Google Scholar]
  17. Ait Addi R , Benksim A , Kasmaoui FE , Cherkaoui M . Monkeypox in Morocco: a perspective. J Clin Exp Invest. 2022; 13:(4). https://doi.org/10.29333/jcei/12375
    [Google Scholar]
  18. Alakunle E , Kolawole D , Diaz-Cánova D , Alele F , Adegboye O , Moens U , et al. A comprehensive review of monkeypox virus and mpox characteristics. Front Cell Infect Microbiol. 2024; 14:: 1360586.
    [Google Scholar]
  19. DeWitt ME , Polk C , Williamson J , Shetty AK , Passaretti CL , McNeil CJ , et al. Global monkeypox case hospitalisation rates: a rapid systematic review and meta-analysis. EClinicalMedicine. 2022; 54:: 101710.
    [Google Scholar]
  20. Mbala PK , Huggins JW , Riu-Rovira T , Ahuka SM , Mulembakani P , Rimoin AW , et al. Maternal and fetal outcomes among pregnant women with human monkeypox infection in the Democratic Republic of Congo. J Infect Dis. 2017; 216:(7):824–8.
    [Google Scholar]
  21. Saxena SK , Ansari S , Maurya VK , Kumar S , Jain A , Paweska JT , et al. Re-emerging human monkeypox: a major public health debacle. J Med Virol. 2023; 95:(1):e27902.
    [Google Scholar]
  22. Derhab N . Human monkeypox virus: a systematic critical review during the pandemic peak. Indian J Med Microbiol. 2024; 51:: 100704.
    [Google Scholar]
  23. Yon H , Shin H , Shin JI , Shin JU , Shin YH , Lee J , et al. Clinical manifestations of human Mpox infection: a systematic review and meta-analysis. Rev Med Virol. 2023; 33:(4):e2446.
    [Google Scholar]
  24. Singh P , Sridhar SB , Shareef J , Talath S , Mohapatra P , Khatib MN , et al. The resurgence of monkeypox: epidemiology, clinical features, and public health implications in the post-smallpox eradication era. New Microbes New Infect. 2024; 62:: 101487.
    [Google Scholar]
  25. Yao K . The diversity of clinical manifestations of human monkeypox should be emphasized in practice. Pediatr Investig. 2022; 6:(3):224–5.
    [Google Scholar]
  26. Pinto-Pulido EL , Fernández-Parrado M , Rodríguez-Cuadrado FJ . Atypical clinical features of mpox (monkeypox): a diagnostic challenge - reply. An Bras Dermatol. 2023; 98:(5):734–5.
    [Google Scholar]
  27. Public Health England . Cases of Monkeypox Confirmed in England. Available from: https://www.gov.uk/government/news/monkeypox-case-in-england (Accessed 02 October 2024).
    [Google Scholar]
  28. World Health Organization . Disease outbreak news; monkeypox - United Kingdom of Great Britain and Northern Ireland; 2022May16. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381 (Accessed 02 October 2024).
    [Google Scholar]
  29. World Health Organization . Disease outbreak news; multi-country monkeypox outbreak in non-endemic countries; 2022May29. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON388 (Accessed 02 October 2024).
    [Google Scholar]
  30. World Health Organization . Disease outbreak news; multi-country monkeypox outbreak in non-endemic countries: update; 2022Jun4. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390 (Accessed 02 October 2024).
    [Google Scholar]
  31. WHO Director-General’s statement at the press conference following IHR Emergency Committee regarding the multi-country outbreak of monkeypox. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-ihr-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022 (Accessed 02 October 2024).
    [Google Scholar]
  32. WHO Director-General declares mpox outbreak a public health emergency of international concern. Available from: https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern (Accessed 02 October 2024).
    [Google Scholar]
  33. The WHO Global Clinical Platform for mpox. Available from: https://www.who.int/tools/global-clinical-platform/monkeypox (Accessed 02 October 2024).
    [Google Scholar]
  34. Adepoju P . Mpox declared a public health emergency. Lancet. 2024; 404:(10454):e1–2.
    [Google Scholar]
  35. Africa Centres for Disease Control and Prevention . Epidemic intelligence weekly report. 2024August. Available from: https://africacdc.org/download/africa-cdc-weekly-event-based-surveillance-report-august-2024/ (Accessed 02 October 2024).
    [Google Scholar]
  36. 2022–24 Mpox outbreak: global trends. Geneva: World Health Organization; 2024. Available from: https://worldhealthorg.shinyapps.io/mpx_global/ (Accessed 02 October 2024).
    [Google Scholar]
  37. UAE reports first case of monkeypox in the Gulf. Available from: https://english.alarabiya.net/News/gulf/2022/05/24/UAE-reports-first-case-of-monkeypox-in-the-country (Accessed 02 October 2024).
    [Google Scholar]
  38. Our world in data: mpox. Available from: https://ourworldindata.org/mpox (Accessed 02 October 2024).
    [Google Scholar]
  39. Alarifi AM , Alshahrani NZ , Sah R . Are Saudi healthcare workers willing to receive the monkeypox virus vaccine? Evidence from a descriptive-baseline survey. Trop Med Infect Dis. 2023; 8:(8):396.
    [Google Scholar]
  40. Assiri AM , Alserehi H , Abuhasan MY , Khalil EAA , Al-Thunayan MH , Alshehri MS , et al. Epidemiology, clinical presentation, and outcome of Mpox: a study of 381 cases in Saudi Arabia. IJID Reg. 2024; 11:: 100358.
    [Google Scholar]
  41. Gao L , Shi Q , Dong X , Wang M , Liu Z , Li Z . Mpox, caused by the MPXV of the clade IIb lineage, goes global. Trop Med Infect Dis. 2023; 8:(2):76.
    [Google Scholar]
  42. Public Health Ministry: No new cases of mpox have been recorded in Lebanon since March. Available from: https://www.lbcgroup.tv/news/lebanon-news/790340/public-health-ministry-no-new-cases-of-mpox-have-been-recorded-in-leba/en (Accessed 02 October 2024).
    [Google Scholar]
  43. Bahrain confirms close monitoring of mpox threat. Available from: https://www.gulf-insider.com/bahrain-close-monitoring-of-mpox-threat/ (Accessed 02 October 2024).
    [Google Scholar]
  44. No cases of mpox reported in Oman: MOH. Available from: https://www.omanobserver.om/article/1157769/oman/health/no-cases-of-mpox-reported-in-oman-moh (Accessed 02 October 2024).
    [Google Scholar]
  45. Health ministry says no mpox cases have been detected in Egypt or neighboring states. Available from: https://www.sis.gov.eg/Story/194255/Health-ministry-says-no-mpox-cases-have-been-detected-in-Egypt-or-neighboring-states?lang=en-us (Accessed 02 October 2024).
    [Google Scholar]
  46. MoPH confirms Qatar is free of mpox cases. Available from: https://www.gulf-times.com/article/689560/community/moph-confirms-qatar-is-free-of-mpox-cases (Accessed 02 October 2024).
    [Google Scholar]
  47. Zaqout A , Daghfal J , Munir W , Abdelmajid A , Albayat SS , Abukhattab M , et al. Clinical Manifestations and outcome of Mpox infection in Qatar: an observational study during the 2022 outbreak. J Infect Public Health. 2023; 16:(11):1802–5.
    [Google Scholar]
  48. Jordanian health ministry records mpox case for a non-Jordanian resident, state news agency says. Available from: https://www.reuters.com/world/middle-east/jordanian-health-ministry-records-mpox-case-non-jordanian-resident-state-news-2024-09-02/ (Accessed 02 October 2024).
    [Google Scholar]
  49. Morocco confirms first mpox case in current outbreak. Available from: https://www.bbc.com/news/articles/c0rwr7rxrj5o (Accessed 02 October 2024).
    [Google Scholar]
  50. Damon IK , Roth CE , Chowdhary V . Discovery of monkeypox in Sudan. N Engl J Med. 2006; 355:(9):962–3.
    [Google Scholar]
  51. Izzoddeen A , Elbadri O , Nageeb Abdalla M , Magbol M , Osman M . Monkeypox pandemic in Sudan, surveillance epidemiologic report, 2022. BMC Public Health. 2024; 24:(1):2457.
    [Google Scholar]
  52. World Health Organization . Multi-country outbreak of mpox, external situation report #38. 2024Sep28. Available from: https://cdn.who.int/media/docs/default-source/documents/emergencies/20240928_mpox_external-sitrep_-38.pdf?sfvrsn=758b85b0_1&download=true (Accessed 02 October 2024).
    [Google Scholar]
  53. Amer F , Khalil HES , Elahmady M , ElBadawy NE , Zahran WA , Abdelnasser M , et al. Mpox: risks and approaches to prevention. J Infect Public Health. 2023; 16:(6):901–10.
    [Google Scholar]
  54. Shoaib HM . Monkeypox as a potential emerging pandemic: a discussion on future risks and preparedness in Saudi Arabia. Front Public Health. 2023; 11:: 1254545.
    [Google Scholar]
  55. Sah R , Srivastava S , Mehta R , Kumar S , Sah S , Mohanty A , et al. Global Mpox outbreak: are we prepared for emerging strains?New Microbes New Infect. 2024; 62:: 101466.
    [Google Scholar]
  56. WHO prequalifies the first vaccine against mpox. Available from: https://www.who.int/news/item/13-09-2024-who-prequalifies-the-first-vaccine-against-mpox (Accessed 02 October 2024).
    [Google Scholar]
  57. MVA-BN Vaccine. Available from: https://www.bavarian-nordic.com/pipeline/technology/mva-bn.aspx (Accessed 02 October 2024).
    [Google Scholar]
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  • Article Type: Review Article
Keyword(s): epidemiologymonkeypoxMpox and public health
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