Behavioral, Virologic, and Immunologic Factors Associated with the Acquisition and Severity of Mpox: A Tale of Africa and America

Authors

  • Michael Olugbamila Dada Department of Medical Laboratory Science, School of Public and Allied Health, Babcock University, Ilishan-Remo, 121109, Ogun State, Nigeria. https://orcid.org/0000-0002-0278-0579
  • Seyi Enitan Babcock University, Ilishan-Remo, Ogun State
  • Richard Yomi Akele Department of Biomedical Science, School of Applied Science, University of Brighton, Brighton ES BN2 4AT, United Kingdom. https://orcid.org/0000-0003-2006-0820
  • Okeoghene Marcel Edafetanure-Ibeh Department of Environmental and Occupational Health, Texas A&M School of Public Health, 212 Adriance Lab Rd, College Station, TX 77843, United States of America https://orcid.org/0000-0003-4467-3189
  • Adesuyi Ayodeji Omoare Department of Public Health Laboratory Services, Nigeria Centre for Disease Control and Prevention (NCDC). FCT Abuja, Nigeria https://orcid.org/0000-0003-4065-6509
  • Banenat Bajehson Dogonyaro Division of Virology, Parasitology and Bacteriology, National Veterinary Research Institute Vom, Plateau state, Nigeria. https://orcid.org/0000-0003-0933-7411
  • Aolat Olamide Adetosoye Department of Microbiology, Aberdeen University, Aberdeen, AB24 3FX, GB, United Kingdom https://orcid.org/0009-0009-7825-6472
  • Wilson Olumayowa Awelewa Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, United States of America https://orcid.org/0009-0004-1341-7953
  • Michael Muo-Ode Dickson Department of Biotechnology, School of Science and Technology, Nottingham Trent University, Mansfield, NG18 5BH, United Kingdom https://orcid.org/0009-0002-4828-3786
  • Faith Tobore Edafetanure-Ibeh Department of Data Sciences, Harrisburg University of Science and Technology, 326 Market Street, Harrisburg, PA 17101, United States of America https://orcid.org/0009-0009-4493-9953

DOI:

https://doi.org/10.35516/jmj.v59i3.3362

Keywords:

Mpox, Virologic factors, Immunologic response, Behavioral risk, Africa, America

Abstract

Background: Mpox (formerly monkeypox) has emerged as a critical public health issue worldwide, characterized by notable differences in acquisition and disease severity between Africa and the Americas. Understanding the interplay of behavioral, virologic, and immunologic factors is essential to addressing these disparities.

Aim: This review examines the behavioral, virologic, and immunologic determinants influencing Mpox acquisition and severity, with a focus on regional variations in Africa and the Americas.

Methodology: A narrative review was conducted using peer-reviewed articles, public health reports, and official guidelines published between 2019 and 2024. Key sources were identified via databases including PubMed, Scopus, and Google Scholar. Analysis centered on behavioral risk factors (e.g., sexual networks, wildlife exposure), virologic attributes (e.g., viral clades), and immunologic influences (e.g., vaccination status).

Results: The findings reveal distinct regional differences in Mpox transmission dynamics and outcomes. In Africa, zoonotic transmission is prominent, compounded by poor hygiene and under-resourced healthcare systems. In the Americas, outbreaks are driven predominantly by human-to-human transmission within sexual networks, particularly among men who have sex with men (MSM), and international travel. Virologically, the Central African clade demonstrates greater virulence than the West African clade, which has predominated recent global outbreaks. Immunologically, limited smallpox vaccination coverage in younger African populations has increased vulnerability, while partial cross-protection from smallpox vaccines in the Americas has mitigated disease severity to some extent.

Conclusion: Effective Mpox control necessitates region-specific public health strategies. Enhanced vaccination programs, improved healthcare infrastructure, and tailored interventions addressing behavioral and virologic drivers are critical. Global collaboration is imperative to mitigate Mpox's spread and burden while addressing socio-economic and epidemiological disparities.

References

Lu T, Wu Z, Jiang S, Lu L, Liu H. The current emergence of monkeypox: the recurrence of another smallpox? Biosaf Health. 2022; 4(6):369–75. Available from:

https://doi.org/10.1016/j.bsheal.2022.09.004

Sah R, Mohanty A, Hada V, Singh P, Govindaswamy A, Siddiq A, et al. The emergence of monkeypox: a global health threat. Cureus. 2022. Available from:

https://doi.org/10.7759/cureus.29304

Hakim MS, Widyaningsih SA. The recent re-emergence of human monkeypox: Would it become endemic Newsweek. Mpox cases in Africa. 2024. Available from:

https://www.newsweek.com/Mpox-map-cases-africa-sweden-spreading-outbreak-cdc-who-1941067.

World Health Organization (WHO). WHO Director-General declares Mpox outbreak a public health emergency of international concern. 2024. Available from:

https://www.who.int/news/item/14-08-2024-who-director-general-declares-Mpox-outbreak-a-public-health-emergency-of-international-concern

Karama RS, Akinola A, Kama J. Re-emergence of human monkeypox 2022: its ecology and public health significance-short review article. Int J Community Med Public Health. 2023; 10(4):1609–15. Available from:

https://doi.org/10.18203/2394-6040.ijcmph20230951

Reynolds MG, Doty JB, McCollum AM, Olson VA, Nakazawa Y. Monkeypox re-emergence in Africa: a call to expand the concept and practice of One Health. Expert Rev Anti Infect Ther. 2019; 17(2):129–39. Available from:

https://doi.org/10.1080/14787210.2019.1567330

Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLoS Negl Trop Dis. 2022; 16(2):e0010141. Available from: https://doi.org/10.1371/journal.pntd.0010141

Lu J, Xing H, Wang C, Tang M, Wu C, Ye F, et al. Mpox (formerly monkeypox): pathogenesis, prevention, and treatment. Signal Transduct Target Ther. 2023; 8(1). Available from: https://doi.org/10.1038/s41392-023-01675-2

Centre of Disease Control and Prevention (CDC). 2022-2023 Mpox Outbreak Global Map. https://archive.cdc.gov/www_cdc_gov/poxvirus/mpox/response/2022/world-map.html

Obermeier PE, Plinke CF, Brinkmann A, Lachmann R, Melchert J, Corman VM, et al. Reemergence of Clade IIB–associated mpox, Germany, July–December 2023. Emerg Infect Dis. 2024; 30(7). Available from: https://doi.org/10.3201/eid3007.240092

Ogunleye SC, Akinsulie OC, Aborode AT, Olorunshola MM, Gbore D, Oladoye M, et al. The re-emergence and transmission of monkeypox virus in Nigeria: the role of one health. Front Public Health. 2024; 11. Available from: https://doi.org/10.3389/fpubh.2023.1334238

UC Davis Health. What you need to know about the latest mpox outbreak. 2024

https://health.ucdavis.edu/news/headlines/what-you-need-to-know-about-the-latest-mpox-outbreak/2024/09

Shafaati, M., & Zandi, M. State-of-the-art on monkeypox virus: an emerging zoonotic disease. Infection, 2022; 50(6), 1425–1430. Available from: https://doi.org/10.1007/s15010-022-01935-3

Kozlov M. Growing mpox outbreak prompts WHO to declare global health emergency. Nature. 2024. Available from:

https://doi.org/10.1038/d41586-024-02607-y

Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, et al. Monkeypox virus infection in humans across 16 countries — April–June 2022. N Engl J Med. 2022; 387(8):679–91. Available from:

https://doi.org/10.1056/nejmoa2207323

Jeyaraman M, Selvaraj P, Halesh MB, Jeyaraman N, Nallakumarasamy A, Gupta M, et al. Monkeypox: an emerging global public health emergency. Life. 2022; 12(10):1590. Available from: https://doi.org/10.3390/life12101590

Fowotade A, Fasuyi T, Bakare R. Re-emergence of monkeypox in Nigeria: a cause for concern and public enlightenment. Afr J Clin Exp Microbiol. 2018; 19(4):307. Available from:

https://doi.org/10.4314/ajcem.v19i4.9

Precious ND, Agboola P, Oluwatimilehin O, Olakunle OK, Olaniyi P, Adiatu AI, et al. Re-emergence of monkeypox virus outbreak in Nigeria: epidemic preparedness and response (Review-Commentary). Ann Med Surg. 2023; 85(8):3990–6. Available from:

https://doi.org/10.1097/ms9.0000000000001069

Duarte PM, Adesola RO, Priyadarsini S, Singh R, Shaheen MN, Ogundijo OA, Gulumbe BH, Lounis M, Samir M, Govindan K, Adebiyi OS. Unveiling the Global Surge of Mpox (Monkeypox): A comprehensive review of current evidence. The Microbe. 2024 Aug 17:100141.

https://doi.org/10.1016/j.microb.2024.10014

Tuttle A, Hughes CM, Dvorak M, et al. Notes from the Field: Clade II Mpox Surveillance Update — United States, October 2023–April 2024. MMWR Morb Mortal Wkly Rep 2024;73:474–476. DOI: http://dx.doi.org/10.15585/mmwr.mm7320a4

Africa Centres for Disease Control and Preventions (Africa CDC). Mpox outbreaks in Africa constitute a public health emergency of continental security. https://africacdc.org/news-item/mpox-outbreaks-in-africa-constitute-a-public-health-emergency-of-continental-security/ (Lasted visited on 15 Sep. 2024).

Chaudhari S, Treffeisen L, Virk J, Parikh T, Ravikumar NPG, Goti AM, et al. The 2022 monkeypox epidemic and what has led to the current state of the disease in the US: a systematic review. Cureus. 2023. Available from: https://doi.org/10.7759/cureus.33515

Abdullah N, Ali S, Cançado FaCQ, De Oliveira CaF. The emergence of monkeypox virus, new challenges to the healthcare settings in Pakistan. J Med Virol. 2022; 95(1). Available from: https://doi.org/10.1002/jmv.27899

World Health Organization (WHO). WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern. 2022.

https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern

Centers for Disease Control and Prevention (CDC). 2022-2023 U.S. Map & Case Count. https://archive.cdc.gov/www_cdc_gov/poxvirus/mpox/response/2022/us-map.html

Centers for Disease Control and Prevention (CDC). Ongoing Clade II Mpox Global Outbreak: Mpox in the United States. 2024. https://www.cdc.gov/mpox/outbreaks/2022/index-1.html?CDC_AAref_Val=https://www.cdc.gov/poxvirus/mpox/outbreak/2022-ongoing-global.html (Last updated Sep. 13, 2024).

Centers for Disease Control and Prevention (CDC). U.S. Mpox Wastewater Data. 2024, https://www.cdc.gov/nwss/wastewater-surveillance/mpox-data.html (Updated September 13, 2024).

Meo SA, Al-Masri AA, Klonoff DC, Alshahrani AN, Al-Khlaiwi T. Comparison of biological, pharmacological characteristics, indications, contraindications, and adverse effects of JYNNEOS and ACAM2000 monkeypox vaccines. Vaccines (Basel). 2022 Nov 21; 10(11):1971. Available from:

https://doi.org/10.3390/vaccines10111971.

Payne AB, Ray LC, Kugeler KJ, Fothergill A, White EB, Canning M, et al. Incidence of monkeypox among unvaccinated persons compared with persons receiving ≥1 JYNNEOS vaccine dose - 32 U.S. jurisdictions. MMWR Morb Mortal Wkly Rep. 2022; 71(40):1278-82. Available from: doi: 10.15585/mmwr.mm7140e3

Sberna G, Rozera G, Minosse C, Bordi L, Mazzotta V, D’Abramo A, et al. Role of direct sexual contact in human transmission of monkeypox virus, Italy. Emerg Infect Dis. 2024; 30(9). Available from:

https://doi.org/10.3201/eid3009.240075

Krishna S, Kurrey C, Yadav M, Mahilkar S, Sonkar SC, Vishvakarma NK, et al. Insights into the emergence and evolution of monkeypox virus: historical perspective, epidemiology, genetic diversity, transmission, and preventative measures. Infect Med. 2024; 3(2):100105. Available from: https://doi.org/10.1016/j.imj.2024.100105

Peiró-Mestres A, Fuertes I, Camprubí-Ferrer D, Marcos MÁ, Vilella A, Navarro M, Rodriguez-Elena L, Riera J, Català A, Martínez MJ, Blanco JL; Hospital Clinic de Barcelona Monkeypox Study Group. Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain, May to June 2022. Euro Surveill. 2022 Jul;27(28):2200503. doi: 10.2807/1560-7917.ES.2022.27.28.2200503.

Lapa D, Carletti F, Mazzotta V, Matusali G, Pinnetti C, Meschi S, Gagliardini R, Colavita F, Mondi A, Minosse C, Scorzolini L, Cicalini S, Maffongelli G, Specchiarello E, Camici M, Bettini A, Baldini F, Francalancia M, Mizzoni K, Garbuglia AR, Nicastri E, Girardi E, Antinori A, Vaia F, Maggi F; INMI Monkeypox Study Group. Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding. Lancet Infect Dis. 2022 Sep;22(9):1267-1269. doi: 10.1016/S1473-3099(22)00513-8.

Allan-Blitz LT, Klausner JD. Current Evidence Demonstrates That Monkeypox Is a Sexually Transmitted Infection. Sex Transm Dis. 2023 Feb 1;50(2):63-65. doi:

1097/OLQ.0000000000001705

Begum JPS, Ngangom L, Semwal P, Painuli S, Sharma R, Gupta A. Emergence of monkeypox: a worldwide public health crisis. Hum Cell. 2023; 36(3):877–93. Available from: https://doi.org/10.1007/s13577-023-00870-1

Kumar S, Guruparan D, Karuppanan K. Recent advances in monkeypox (Mpox): characterization, diagnosis, and therapeutics - A multidimensional review. Advance. 2023 Jul 04. Available from: https://doi.org/10.22541/au.168846306.66701439/v1.

Ayorinde TA, Olufadewa II, Adesina MA, Oladele RI, Oladoye MJ, Adene T, et al. The reemergence of the human monkeypox: strengthening Africa’s epidemic preparedness and response system. Ann Med Surg. 2023; 85(1):24–7. Available from: https://doi.org/10.1097/ms9.0000000000000039

Dabie K, Adulley F, Jonathan E, Ababio BA, Peprah-Yamoah E, Osman M, et al. Recent status and knowledge on the Re-emergence of Monkeypox Disease. Sci Afr. 2023; 21:e01849. Available from:

https://doi.org/10.1016/j.sciaf.2023.e01849

Durski KN, McCollum AM, Nakazawa Y, Petersen BW, Reynolds MG, Briand S, et al. Emergence of monkeypox — West and Central Africa, 1970–2017. MMWR Morb Mortal Wkly Rep. 2018; 67(10):306–310. Available from:

https://doi.org/10.15585/mmwr.mm6710a5

Huang Y, Mu L, Wang W. Monkeypox: epidemiology, pathogenesis, treatment and prevention. Signal Transduct Target Ther. 2022; 7(1). Available from:

https://doi.org/10.1038/s41392-022-01215-4

Kaler J, Hussain A, Flores G, Kheiri S, Desrosiers D. Monkeypox: A comprehensive review of transmission, pathogenesis, and manifestation. Cureus. 2022. Available from: https://doi.org/10.7759/cureus.26531Ejaz H

Junaid K, Younas S, Abdalla AE, Bukhari SNA, Abosalif KO, et al. Emergence and dissemination of monkeypox, an intimidating global public health problem. J Infect Public Health. 2022; 15(10):1156–65. Available from:

https://doi.org/10.1016/j.jiph.2022.09.008

Cahill S. Lessons Learned from the US Public health response to the 2022 mpox Outbreak. LGBT health. 2023 Oct 1;10(7):489-95.

https://doi.org/10.1089/lgbt.2022.0274

Zheng Q, Al-Tawfiq JA, Memish ZA, Bao C, Pan Q. Disparities in transmission dynamics of the 2022 mpox outbreaks between Europe and Americas. New Microbes New Infect. 2023 Mar 12;52:101111. doi: 10.1016/j.nmni.2023.101111

Shafaati, M., & Zandi, M. Human monkeypox (hMPXV) re‐emergence: Host immunity status and current 2 landscape. Journal of Medical Virology, 2022; 95(1). Available from: https://doi.org/10.1002/jmv.28251

Gao L, Shi Q, Dong X, Wang M, Liu Z, Li Z. Mpox, Caused by the MPXV of the Clade IIb lineage, goes global. Tropical Medicine and Infectious Disease. 2023 Jan 20; 8(2):76. https://doi.org/10.3390/tropicalmed8020076

Liu BM, Rakhmanina NY, Yang Z, Bukrinsky MI. Mpox (Monkeypox) Virus and Its Co-infection with HIV, sexually transmitted infections, or bacterial superinfections: Double whammy or a new prime culprit?. Viruses. 2024 May 15;16(5):784. https://doi.org/10.3390/v16050784

Zhao B, Liu Q, Du Q, Kang J, Tang R, Tu Y, Liu D. Characteristics and Differences in Mpox Patients with and without HIV Infection: A Retrospective Cross-Sectional Study in Chengdu, China. International Journal of General Medicine. 2024 Dec 31:1381-1393.

https://doi.org/10.2147/IJGM.S456198

Taha AM, Elrosasy A, Mahmoud AM, Saed SA, Moawad WA, Hamouda E, Nguyen D, Tran VP, Pham HT, Sah S, Barboza JJ. The effect of HIV and mpox co‐infection on clinical outcomes: Systematic review and meta‐analysis. HIV medicine. 2024 Mar 5.

https://doi.org/10.1111/hiv.13622

Zucker J, Hazra A, Titanji BK. Mpox and HIV—Collision of Two Diseases. Current HIV/AIDS Reports. 2023 Dec;20(6):440-450.

https://doi.org/10.1007/s11904-023-00682-w

Jarrar B, Abu-Shqueir M, Jarrar Y, Jarrar Q. Knowledge and Awareness toward Viral Diseases among University Students in Jordan: Spring 2020. Jordan Medical Journal. 2022 Oct 16;56(4). https://doi.org/10.35516/jmj.v56i4.469

Downloads

Published

2025-07-06

How to Cite

Dada, M. ., Enitan, S., Akele, R. ., Edafetanure-Ibeh, O. ., Omoare, A. ., Dogonyaro, B. ., Adetosoye, A. ., Awelewa, W. ., Dickson, M. ., & Edafetanure-Ibeh, F. . (2025). Behavioral, Virologic, and Immunologic Factors Associated with the Acquisition and Severity of Mpox: A Tale of Africa and America. Jordan Medical Journal, 59(3). https://doi.org/10.35516/jmj.v59i3.3362

Issue

Section

Articles