Atypical and Unique Transmission of Monkeypox Virus during the 2022 Outbreak: An Overview of the Current State of Knowledge

An ongoing monkeypox outbreak in non-endemic countries has resulted in the declaration of a public health emergency of international concern by the World Health Organization (WHO). Though monkeypox has long been endemic in regions of sub-Saharan Africa, relatively little is known about its ecology, epidemiology, and transmission. Here, we consider the relevant research on both monkeypox and smallpox, a close relative, to make inferences about the current outbreak. Undetected circulation combined with atypical transmission and case presentation, including mild and asymptomatic disease, have facilitated the spread of monkeypox in non-endemic regions. A broader availability of diagnostics, enhanced surveillance, and targeted education, combined with a better understanding of the routes of transmission, are critical to identify at-risk populations and design science-based countermeasures to control the current outbreak.

Automated summary

This article discusses the current monkeypox outbreak in non-endemic countries based on relevant research on monkeypox and smallpox. Undetected circulation, atypical transmission routes, and mild/asymptomatic cases have facilitated the spread of monkeypox in non-endemic regions. Therefore, improved diagnostics, enhanced surveillance, targeted education, and a better understanding of transmission routes are critical to controlling the current outbreak.