{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T20:45:20Z","timestamp":1789073120062,"version":"build-2803163510"},"reference-count":124,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T00:00:00Z","timestamp":1699228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Monkeypox, a rare but significant zoonotic and orthopoxviral disease, has garnered increasing attention due to its potential for human-to-human transmission and its recent resurgence in multiple countries throughout Europe, North America, and Oceania. The disease has emerged as a novel threat to the global health systems that are still striving to recover from the major shocks of the COVID-19 pandemic. The unusual manifestation of the illness highlights a substantial knowledge deficit and necessitates the immediate development of a public health action strategy, considering the epidemiological differences observed in the ongoing outbreak and the appearance of cases in non-endemic nations. This literature review aims to synthesize existing knowledge on monkeypox, encompassing its historical context, etiology, epidemiology, surveillance, prevention, transmission, clinical presentation, diagnosis, treatments, and recent outbreak. Particular attention is given to both advances and gaps in our understanding of monkeypox, and we point toward future directions for research and intervention efforts as pertains to vaccine development and distribution. Lastly, we will also review the recent outbreak through a sociopolitical lens as relates to decision-making strategies, especially given the lessons learned from COVID-19.<\/jats:p>","DOI":"10.3390\/microorganisms11112713","type":"journal-article","created":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T08:15:56Z","timestamp":1699258556000},"page":"2713","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["A Review of the Past, Present, and Future of the Monkeypox Virus: Challenges, Opportunities, and Lessons from COVID-19 for Global Health Security"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9304-9916","authenticated-orcid":false,"given":"Rahim","family":"Hirani","sequence":"first","affiliation":[{"name":"School of Medicine, New York Medical College, Valhalla, NY 10595, USA"},{"name":"Graduate School of Biomedical Sciences, New York Medical College, Valhalla, NY 10595, USA"},{"name":"Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleb","family":"Noruzi","sequence":"additional","affiliation":[{"name":"School of Medicine, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aroubah","family":"Iqbal","sequence":"additional","affiliation":[{"name":"School of Medicine, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0761-3718","authenticated-orcid":false,"given":"Anum S.","family":"Hussaini","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafay A.","family":"Khan","sequence":"additional","affiliation":[{"name":"School of Medicine, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandr","family":"Harutyunyan","sequence":"additional","affiliation":[{"name":"School of Medicine, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mill","family":"Etienne","sequence":"additional","affiliation":[{"name":"School of Medicine, New York Medical College, Valhalla, NY 10595, USA"},{"name":"Department of Neurology, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj K.","family":"Tiwari","sequence":"additional","affiliation":[{"name":"Graduate School of Biomedical Sciences, New York Medical College, Valhalla, NY 10595, USA"},{"name":"Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1038\/s41577-022-00775-4","article-title":"Monkeypox: Disease epidemiology, host immunity and clinical interventions","volume":"22","author":"Lum","year":"2022","journal-title":"Nat. Rev. Immunol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e30406","DOI":"10.1097\/MD.0000000000030406","article-title":"Human monkeypox virus: An updated review","volume":"101","author":"Adnan","year":"2022","journal-title":"Medicine"},{"key":"ref_3","unstructured":"(2023, October 02). Multi-Country Monkeypox Outbreak in Non-Endemic Countries. Available online: https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2022-DON385."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Alakunle, E., Moens, U., Nchinda, G., and Okeke, M.I. (2020). Monkeypox Virus in Nigeria: Infection Biology, Epidemiology, and Evolution. Viruses, 12.","DOI":"10.3390\/v12111257"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.antiviral.2018.11.004","article-title":"Vaccinating against monkeypox in the Democratic Republic of the Congo","volume":"162","author":"Petersen","year":"2019","journal-title":"Antiviral Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.idc.2019.03.001","article-title":"Human Monkeypox: Epidemiologic and Clinical Characteristics, Diagnosis, and Prevention","volume":"33","author":"Petersen","year":"2019","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1093\/oxfordjournals.bmb.a011720","article-title":"Re-emergence of monkeypox in Africa: A review of the past six years","volume":"54","author":"Heymann","year":"1998","journal-title":"Br. Med. Bull."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bunge, E.M., Hoet, B., Chen, L., Lienert, F., Weidenthaler, H., Baer, L.R., and Steffen, R. (2022). The changing epidemiology of human monkeypox\u2014A potential threat? A systematic review. PLoS Negl. Trop. Dis., 16.","DOI":"10.1371\/journal.pntd.0010141"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1093\/ije\/17.3.643","article-title":"The Transmission Potential of Monkeypox Virus in Human Populations","volume":"17","author":"Fine","year":"1988","journal-title":"Int. J. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kmiec, D., and Kirchhoff, F. (2022). Monkeypox: A New Threat?. Int. J. Mol. Sci., 23.","DOI":"10.20944\/preprints202207.0075.v1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/j.1600-065X.2008.00691.x","article-title":"Monkeypox virus and insights into its immunomodulatory proteins","volume":"225","author":"Weaver","year":"2008","journal-title":"Immunol. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1086\/498115","article-title":"Clinical Characteristics of Human Monkeypox, and Risk Factors for Severe Disease","volume":"41","author":"Huhn","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","unstructured":"Nigeria Centre for Disease Control and Prevention (2023, September 27). Available online: https:\/\/ncdc.gov.ng\/diseases\/sitreps\/?cat=8&name=An%20Update%20of%20Monkeypox%20Outbreak%20in%20Nigeria."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S1473-3099(22)00359-0","article-title":"Tracking the 2022 monkeypox outbreak with epidemiological data in real-time","volume":"22","author":"Kraemer","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_15","first-page":"55","article-title":"Monkeypox outbreak in the age of COVID-19: A new global health emergency","volume":"9","author":"Hirani","year":"2022","journal-title":"Mil. Med. Res."},{"key":"ref_16","unstructured":"Kimball, S. (2023, September 27). CNBC. WHO Declares Rapidly Spreading Monkeypox Outbreak a Global Health Emergency. Available online: https:\/\/www.cnbc.com\/2022\/07\/23\/who-declares-spreading-monkeypox-outbreak-a-global-health-emergency.html."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2206633","DOI":"10.1002\/smll.202206633","article-title":"Addressing the Silent Spread of Monkeypox Disease with Advanced Analytical Tools","volume":"19","author":"Bhalla","year":"2023","journal-title":"Small"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.virol.2005.05.030","article-title":"Virulence differences between monkeypox virus isolates from West Africa and the Congo basin","volume":"340","author":"Chen","year":"2005","journal-title":"Virology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1056\/NEJMoa032299","article-title":"The Detection of Monkeypox in Humans in the Western Hemisphere","volume":"350","author":"Reed","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1038\/s41591-022-01907-y","article-title":"Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of monkeypox virus","volume":"28","author":"Isidro","year":"2022","journal-title":"Nat. Med."},{"key":"ref_21","first-page":"e26531","article-title":"Monkeypox: A Comprehensive Review of Transmission, Pathogenesis, and Manifestation","volume":"14","author":"Kaler","year":"2022","journal-title":"Cureus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"688","DOI":"10.3390\/v4050688","article-title":"Poxvirus Cell Entry: How Many Proteins Does it Take?","volume":"4","author":"Moss","year":"2012","journal-title":"Viruses"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Rampogu, S., Kim, Y., Kim, S.W., and Lee, K.W. (2023). An overview on monkeypox virus: Pathogenesis, transmission, host interaction and therapeutics. Front. Cell Infect. Microbiol., 13, Available online: https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2023.1076251.","DOI":"10.3389\/fcimb.2023.1076251"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Moss, B. (2013). Poxvirus DNA Replication. Cold Spring Harb. Perspect. Biol., 5.","DOI":"10.1101\/cshperspect.a010199"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Malik, Y.S., Singh, R.K., and Dhama, K. (2020). Animal-Origin Viral Zoonoses, Springer. Livestock Diseases and Management.","DOI":"10.1007\/978-981-15-2651-0"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1086\/381976","article-title":"Looking Back at Smallpox","volume":"38","author":"Bray","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.tim.2008.07.009","article-title":"Vaccinia virus morphogenesis and dissemination","volume":"16","author":"Roberts","year":"2008","journal-title":"Trends Microbiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1080\/22221751.2022.2095309","article-title":"Monkeypox virus emerges from the shadow of its more infamous cousin: Family biology matters","volume":"11","author":"Xiang","year":"2022","journal-title":"Emerg. Microbes Infect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1093\/infdis\/156.2.293","article-title":"Human Monkeypox: Clinical Features of 282 Patients","volume":"156","author":"Szczeniowski","year":"1987","journal-title":"J. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1086\/498155","article-title":"Reemergence of Monkeypox: Prevalence, Diagnostics, and Countermeasures","volume":"41","author":"Weinstein","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S0140-6736(22)02075-X","article-title":"Monkeypox","volume":"401","author":"Ogoina","year":"2023","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1093\/cid\/cit703","article-title":"Human Monkeypox","volume":"58","author":"McCollum","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1056\/NEJMicm2206893","article-title":"Monkeypox Genital Lesions","volume":"387","author":"Peruzzu","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2200421","DOI":"10.2807\/1560-7917.ES.2022.27.22.2200421","article-title":"Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022","volume":"27","author":"Antinori","year":"2022","journal-title":"Eurosurveillance"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1093\/infdis\/jix260","article-title":"Maternal and Fetal Outcomes Among Pregnant Women With Human Monkeypox Infection in the Democratic Republic of Congo","volume":"216","author":"Mbala","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.ajog.2022.08.017","article-title":"Monkeypox in pregnancy: Virology, clinical presentation, and obstetric management","volume":"227","author":"Dashraath","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Satapathy, P., Mohanty, P., Manna, S., Shamim, M.A., Rao, P.P., Aggarwal, A.K., Khubchandani, J., Mohanty, A., Nowrouzi-Kia, B., and Chattu, V.K. (2022). Potentially Asymptomatic Infection of Monkeypox Virus: A Systematic Review and Meta-Analysis. Vaccines, 10.","DOI":"10.3390\/vaccines10122083"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e209","DOI":"10.1016\/S2666-5247(22)00379-2","article-title":"People with asymptomatic or unrecognised infection potentially contribute to monkeypox virus transmission","volume":"4","author":"Accordini","year":"2023","journal-title":"Lancet Microbe"},{"key":"ref_39","unstructured":"(2023). A Brief Review of the Monkeypox Outbreak: Transmission, Presentation, and Developments in Treatment and Vaccines. J. Immunol. Sci., 7, 1\u201314. Available online: https:\/\/www.immunologyresearchjournal.com\/articles\/a-brief-review-of-the-monkeypox-outbreak-transmission-presentation-and-developments-in-treatment-and-vaccines.html."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"(2023, September 27). Outbreak of Human Monkeypox, Democratic Republic of Congo, 1996 to 1997\u2014Volume 7, Number 3\u2014June 2001\u2014Emerging Infectious Diseases Journal\u2014CDC, Available online: https:\/\/wwwnc.cdc.gov\/eid\/article\/7\/3\/01-7311_article.","DOI":"10.3201\/eid0703.017311"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1001\/jama.2022.10259","article-title":"What Is Monkeypox?","volume":"328","author":"Walter","year":"2022","journal-title":"JAMA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"106995","DOI":"10.1016\/j.ijsu.2022.106995","article-title":"Can monkeypox virus be transmitted through the air?\u2014Correspondence","volume":"108","author":"Wang","year":"2022","journal-title":"Int. J. Surg. Lond. Engl."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Milton, D.K. (2012). What was the primary mode of smallpox transmission? Implications for biodefense. Front. Cell Infect. Microbiol., 2.","DOI":"10.3389\/fcimb.2012.00150"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1056\/NEJMoa2207323","article-title":"Monkeypox Virus Infection in Humans across 16 Countries\u2014April\u2013June 2022","volume":"387","author":"Thornhill","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1038\/mi.2016.97","article-title":"The rectal mucosa and condomless receptive anal intercourse in HIV-negative MSM: Implications for HIV transmission and prevention","volume":"10","author":"Kelley","year":"2017","journal-title":"Mucosal Immunol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"314","DOI":"10.3389\/fimmu.2017.00314","article-title":"Host Immune Responses in HIV-1 Infection: The Emerging Pathogenic Role of Siglecs and Their Clinical Correlates","volume":"8","author":"Mikulak","year":"2017","journal-title":"Front. Immunol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"592","DOI":"10.3201\/eid1404.071044","article-title":"Retrospective Analysis of Monkeypox Infection","volume":"14","author":"Dubois","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s12985-023-02085-0","article-title":"Cross-reactive immune responses to monkeypox virus induced by MVA vaccination in mice","volume":"20","author":"Gao","year":"2023","journal-title":"Virol. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e073153","DOI":"10.1136\/bmj-2022-073153","article-title":"Transmission dynamics of monkeypox in the United Kingdom: Contact tracing study","volume":"379","author":"Ward","year":"2022","journal-title":"BMJ"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Davis, I., Payne, J.M., Olguin, V.L., Sanders, M.P., Clements, T., Stefan, C.P., Williams, J.A., Hooper, J.W., Huggins, J.W., and Mucker, E.M. (2023). Development of a specific MPXV antigen detection immunodiagnostic assay. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1243523"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"34419","DOI":"10.1021\/acsami.3c04285","article-title":"Rapid Detection of the Monkeypox Virus Genome and Antigen Proteins Based on Surface-Enhanced Raman Spectroscopy","volume":"15","author":"Zhang","year":"2023","journal-title":"ACS Appl. Mater. Interfaces"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Di Gennaro, F., Veronese, N., Marotta, C., Shin, J.I., Koyanagi, A., Silenzi, A., Antunes, M., Saracino, A., Bavaro, D.F., and Soysal, P. (2022). Human Monkeypox: A Comprehensive Narrative Review and Analysis of the Public Health Implications. Microorganisms, 10.","DOI":"10.3390\/microorganisms10081633"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jhin.2022.12.005","article-title":"Monkeypox Outbreak 2022: Disparities and Prevention","volume":"133","author":"Hirani","year":"2022","journal-title":"J. Hosp. Infect."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1056\/NEJMra2208860","article-title":"Monkeypox","volume":"387","author":"Gessain","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1016\/j.mayocp.2022.07.011","article-title":"Monkeypox 2022: Gearing Up for Another Potential Public Health Crisis","volume":"97","author":"Ranganath","year":"2022","journal-title":"Mayo Clin. Proc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1016\/S1473-3099(22)00431-5","article-title":"Does it matter who is spreading monkeypox?","volume":"22","author":"Schneider","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1016\/S1473-3099(22)00514-X","article-title":"Monkeypox: How will we know if the treatments work?","volume":"22","author":"Rojek","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Dumonteil, E., Herrera, C., and Sabino-Santos, G. (2023, October 09). Monkeypox Virus Evolution before 2022 Outbreak\u2014Volume 29, Number 2\u2014February 2023\u2014Emerging Infectious Diseases Journal\u2014CDC, Available online: https:\/\/wwwnc.cdc.gov\/eid\/article\/29\/2\/22-0962_article.","DOI":"10.3201\/eid2902.220962"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1038\/sj.icb.7100033","article-title":"Immunopathogenesis of poxvirus infections: Forecasting the impending storm","volume":"85","author":"Stanford","year":"2007","journal-title":"Immunol. Cell Biol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.cell.2016.09.049","article-title":"Cross-Neutralizing and Protective Human Antibody Specificities to Poxvirus Infections","volume":"167","author":"Gilchuk","year":"2016","journal-title":"Cell"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"D73","DOI":"10.1016\/j.vaccine.2009.07.103","article-title":"Smallpox Vaccines for Biodefense","volume":"27","author":"Kennedy","year":"2009","journal-title":"Vaccine"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"87","DOI":"10.3121\/cmr.1.2.87","article-title":"Smallpox Vaccine: The Good, the Bad, and the Ugly","volume":"1","author":"Belongia","year":"2003","journal-title":"Clin. Med. Res."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Sudarmaji, N., Kifli, N., Hermansyah, A., Yeoh, S.F., Goh, B.H., and Ming, L.C. (2022). Prevention and Treatment of Monkeypox: A Systematic Review of Preclinical Studies. Viruses, 14.","DOI":"10.3390\/v14112496"},{"key":"ref_64","unstructured":"(2023, October 29). History of Smallpox Vaccination. Available online: https:\/\/www.who.int\/news-room\/spotlight\/history-of-vaccination\/history-of-smallpox-vaccination."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1128\/CVI.00035-14","article-title":"Human Antibody Responses to the Polyclonal Dryvax Vaccine for Smallpox Prevention Can Be Distinguished from Responses to the Monoclonal Replacement Vaccine ACAM2000","volume":"21","author":"Pugh","year":"2014","journal-title":"Clin. Vaccine Immunol. CVI"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Fern\u00e1ndez, D.E., Fern\u00e1ndez-Quezada, D., Casillas-Mu\u00f1oz, F.A.G., Carrillo-Ballesteros, F.J., Ortega-Prieto, A.M., Jimenez-Guarde\u00f1o, J.M., and Regla-Nava, J.A. (2023). Human Monkeypox: A Comprehensive Overview of Epidemiology, Pathogenesis, Diagnosis, Treatment, and Prevention Strategies. Pathogens, 12.","DOI":"10.3390\/pathogens12070947"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Arag\u00f3n, T.J., Ulrich, S., Fernyak, S., and Rutherford, G.W. (2003). Risks of serious complications and death from smallpox vaccination: A systematic review of the United States experience, 1963\u20131968. BMC Public Health, 3.","DOI":"10.1186\/1471-2458-3-26"},{"key":"ref_68","unstructured":"(2023, October 29). Surveillance Guidelines for Smallpox Vaccine (Vaccinia) Adverse Reactions, Available online: https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/rr5501a1.htm."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1093\/infdis\/122.4.303","article-title":"Complications of Smallpox Vaccination, 1968: Results of Ten Statewide Surveys","volume":"122","author":"Ruben","year":"1970","journal-title":"J. Infect. Dis."},{"key":"ref_70","unstructured":"(2023, October 29). Women with Smallpox Vaccine Exposure during Pregnancy Reported to the National Smallpox Vaccine in Pregnancy Registry\u2014United States, Available online: https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm5217a3.htm."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"257","DOI":"10.15585\/mmwr.mm6510a2","article-title":"Use of Vaccinia Virus Smallpox Vaccine in Laboratory and Health Care Personnel at Risk for Occupational Exposure to Orthopoxviruses\u2014Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015","volume":"65","author":"Petersen","year":"2016","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"734","DOI":"10.15585\/mmwr.mm7122e1","article-title":"Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices\u2014United States. 2022","volume":"71","author":"Rao","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Greenberg, R.N., Hurley, Y., Dinh, D.V., Mraz, S., Vera, J.G., von Bredow, D., von Krempelhuber, A., Roesch, S., Virgin, G., and Arndtz-Wiedemann, N. (2015). A Multicenter, Open-Label, Controlled Phase II Study to Evaluate Safety and Immunogenicity of MVA Smallpox Vaccine (IMVAMUNE) in 18\u201340 Year Old Subjects with Diagnosed Atopic Dermatitis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0138348"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Overton, E.T., Lawrence, S.J., Wagner, E., Nopora, K., R\u00f6sch, S., Young, P., Schmidt, D., Kreusel, C., Carli, S.D., and Meyer, T.P. (2018). Immunogenicity and safety of three consecutive production lots of the non replicating smallpox vaccine MVA: A randomised, double blind, placebo controlled phase III trial. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0195897"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Zitzmann-Roth, E.M., von Sonnenburg, F., de la Motte, S., Arndtz-Wiedemann, N., von Krempelhuber, A., Uebler, N., Vollmar, J., Virgin, G., and Chaplin, P. (2015). Cardiac Safety of Modified Vaccinia Ankara for Vaccination against Smallpox in a Young, Healthy Study Population. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0122653"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1056\/NEJMoa1817307","article-title":"Phase 3 Efficacy Trial of Modified Vaccinia Ankara as a Vaccine against Smallpox","volume":"381","author":"Pittman","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1093\/infdis\/jiac455","article-title":"One- and Two-Dose Vaccinations With Modified Vaccinia Ankara-Bavarian Nordic Induce Durable B-Cell Memory Responses Comparable to Replicating Smallpox Vaccines","volume":"227","author":"Ilchmann","year":"2022","journal-title":"J. Infect. Dis."},{"key":"ref_78","unstructured":"CDC. Centers for Disease Control and Prevention (2023, October 29). CDC\u2019s Mpox Pediatric Considerations, Available online: https:\/\/www.cdc.gov\/poxvirus\/mpox\/clinicians\/pediatric.html."},{"key":"ref_79","unstructured":"CDC. Centers for Disease Control and Prevention (2023, October 28). Mpox Vaccine Recommendations, Available online: https:\/\/www.cdc.gov\/poxvirus\/mpox\/vaccines\/vaccine-recommendations.html."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"2600","DOI":"10.1016\/j.vaccine.2020.01.058","article-title":"A randomized phase II trial to compare safety and immunogenicity of the MVA-BN smallpox vaccine at various doses in adults with a history of AIDS","volume":"38","author":"Overton","year":"2020","journal-title":"Vaccine"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.15585\/mmwr.mm7149a5","article-title":"Reduced Risk for Mpox After Receipt of 1 or 2 Doses of JYNNEOS Vaccine Compared with Risk Among Unvaccinated Persons\u201443 U.S. Jurisdictions, 31 July\u20131 October 2022","volume":"71","author":"Payne","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"342","DOI":"10.15585\/mmwr.mm7213a4","article-title":"JYNNEOS Vaccination Coverage Among Persons at Risk for Mpox\u2014United States, 22 May 2022\u201331 January 2023","volume":"72","author":"Owens","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_83","unstructured":"(2023, September 28). JYNNEOS Vaccine Distribution by Jurisdiction | SNS | HHS\/ASPR, Available online: https:\/\/aspr.hhs.gov:443\/SNS\/Pages\/JYNNEOS-Distribution.aspx."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.15585\/mmwr.mm7143e2","article-title":"Receipt of First and Second Doses of JYNNEOS Vaccine for Prevention of Monkeypox\u2014United States, 22 May\u201310 October 2022","volume":"71","author":"Kriss","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.15585\/mmwr.mm7132e3","article-title":"Epidemiologic and Clinical Characteristics of Monkeypox Cases\u2014United States, 17 May\u201322 July 2022","volume":"71","author":"Philpott","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"2705","DOI":"10.1099\/0022-1317-68-10-2705","article-title":"Genetic Analysis of Vaccinia Virus Lister Strain and Its Attenuated Mutant LC16m8: Production of Intermediate Variants by Homologous Recombination","volume":"68","author":"Suzuki","year":"1987","journal-title":"J. Gen. Virol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"11873","DOI":"10.1128\/JVI.79.18.11873-11891.2005","article-title":"An Attenuated LC16m8 Smallpox Vaccine: Analysis of Full-Genome Sequence and Induction of Immune Protection","volume":"79","author":"Morikawa","year":"2005","journal-title":"J. Virol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"5179","DOI":"10.1128\/JVI.02642-05","article-title":"LC16m8, a Highly Attenuated Vaccinia Virus Vaccine Lacking Expression of the Membrane Protein B5R, Protects Monkeys from Monkeypox","volume":"80","author":"Saijo","year":"2006","journal-title":"J. Virol."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"(2023, September 28). A Single Vaccination of Nonhuman Primates with Highly Attenuated Smallpox Vaccine, LC16m8, Provides Long-Term Protection against Monkeypox. Available online: https:\/\/www.jstage.jst.go.jp\/article\/yoken\/70\/4\/70_JJID.2016.417\/_article.","DOI":"10.7883\/yoken.JJID.2016.417"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1001\/jama.2009.289","article-title":"Clinical and Immunological Response to Attenuated Tissue-Cultured Smallpox Vaccine LC16m8","volume":"301","author":"Saito","year":"2009","journal-title":"JAMA"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1093\/infdis\/jir527","article-title":"Safety and Immunogenicity of LC16m8, an Attenuated Smallpox Vaccine in Vaccinia-Naive Adults","volume":"204","author":"Kennedy","year":"2011","journal-title":"J. Infect. Dis."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1056\/NEJMoa2035389","article-title":"Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine","volume":"384","author":"Baden","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1038\/d41587-021-00023-5","article-title":"First COVID-19 DNA vaccine approved, others in hot pursuit","volume":"39","author":"Sheridan","year":"2021","journal-title":"Nat. Biotechnol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"225","DOI":"10.3390\/vaccines1030225","article-title":"Vector Design for Improved DNA Vaccine Efficacy, Safety and Production","volume":"1","author":"Williams","year":"2013","journal-title":"Vaccines"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/nrd.2017.243","article-title":"mRNA vaccines\u2014A new era in vaccinology","volume":"17","author":"Pardi","year":"2018","journal-title":"Nat. Rev. Drug Discov."},{"key":"ref_97","first-page":"1","article-title":"Monkeypox virus quadrivalent mRNA vaccine induces immune response and protects against vaccinia virus","volume":"8","author":"Sang","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1038\/s41422-023-00792-5","article-title":"Polyvalent mRNA vaccination elicited potent immune response to monkeypox virus surface antigens","volume":"33","author":"Fang","year":"2023","journal-title":"Cell Res."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1007\/s11427-023-2378-x","article-title":"Multi-valent mRNA vaccines against monkeypox enveloped or mature viron surface antigens demonstrate robust immune response and neutralizing activity","volume":"66","author":"Zhang","year":"2023","journal-title":"Sci. China Life Sci."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"5925","DOI":"10.1038\/s41467-023-41628-5","article-title":"mRNA vaccines encoding fusion proteins of monkeypox virus antigens protect mice from vaccinia virus challenge","volume":"14","author":"Hou","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1093\/infdis\/jiq017","article-title":"Multivalent Smallpox DNA Vaccine Delivered by Intradermal Electroporation Drives Protective Immunity in Nonhuman Primates Against Lethal Monkeypox Challenge","volume":"203","author":"Hirao","year":"2011","journal-title":"J. Infect. Dis."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"4433","DOI":"10.1128\/JVI.78.9.4433-4443.2004","article-title":"Smallpox DNA Vaccine Protects Nonhuman Primates against Lethal Monkeypox","volume":"78","author":"Hooper","year":"2004","journal-title":"J. Virol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"103978","DOI":"10.1016\/j.amsu.2022.103978","article-title":"Monkeypox virus: A future scourge to the Pakistani Healthcare system","volume":"79","author":"Mansoor","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1002\/hpm.3466","article-title":"Polio amidst COVID-19 in Pakistan: Ongoing efforts, challenges, and recommendations","volume":"37","author":"Sahito","year":"2022","journal-title":"Int. J. Health Plann. Manag."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"100704","DOI":"10.1016\/j.jemep.2021.100704","article-title":"Dengue, measles, and COVID-19: A threefold challenge to public health security in Pakistan","volume":"19","author":"Yousaf","year":"2021","journal-title":"Ethics Med. Public. Health"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"6465","DOI":"10.1002\/jmv.27241","article-title":"Arboviral diseases and COVID-19 coincidence: Challenges for Pakistan\u2019s derelict healthcare system","volume":"93","author":"Butt","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1038\/s41579-022-00776-z","article-title":"Monkeypox virus: A neglected zoonotic pathogen spreads globally","volume":"20","author":"Alakunle","year":"2022","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Saied, A.A., Dhawan, M., Metwally, A.A., Fahrni, M.L., Choudhary, P., and Choudhary, O.P. (2022). Disease History, Pathogenesis, Diagnostics, and Therapeutics for Human Monkeypox Disease: A Comprehensive Review. Vaccines, 10.","DOI":"10.3390\/vaccines10122091"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.3201\/eid2704.203569","article-title":"Reemergence of Human Monkeypox and Declining Population Immunity in the Context of Urbanization, Nigeria, 2017\u20132020","volume":"27","author":"Nguyen","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1007\/s13312-022-2578-2","article-title":"Monkeypox Disease Outbreak (2022): Epidemiology, Challenges, and the Way Forward","volume":"59","author":"Lahariya","year":"2022","journal-title":"Indian. Pediatr."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1038\/s41579-020-00459-7","article-title":"Characteristics of SARS-CoV-2 and COVID-19","volume":"19","author":"Hu","year":"2021","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_112","unstructured":"(2023, September 28). WHO Coronavirus (COVID-19) Dashboard. Available online: https:\/\/covid19.who.int."},{"key":"ref_113","unstructured":"Commissioner of the FDA (2023, September 28). FDA Approves First COVID-19 Vaccine, Available online: https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-approves-first-covid-19-vaccine."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"311.e5","DOI":"10.1016\/j.avsg.2018.12.097","article-title":"Hybrid Repair of an Innominate Artery Mycotic Aneurysm with an \u201cOn-The-Table\u201d Customized Endograft","volume":"59","author":"Dominguez","year":"2019","journal-title":"Ann. Vasc. Surg."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"2969","DOI":"10.1002\/jmv.27697","article-title":"Current evidence on efficacy of COVID-19 booster dose vaccination against the Omicron variant: A systematic review","volume":"94","author":"Chenchula","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"107365","DOI":"10.1016\/j.ypmed.2022.107365","article-title":"The COVID-19 pandemic and depression among medical students: Barriers and solutions","volume":"171","author":"Khuram","year":"2023","journal-title":"Prev. Med."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"e5881","DOI":"10.1002\/gps.5881","article-title":"Epidemiological effects of the COVID-19 pandemic on modifiable risk factors for dementia","volume":"38","author":"Hirani","year":"2023","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"232","DOI":"10.3201\/eid2002.130118","article-title":"Genomic Variability of Monkeypox Virus among Humans, Democratic Republic of the Congo","volume":"20","author":"Kugelman","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"578","DOI":"10.3389\/fvets.2020.00578","article-title":"COVID-19 in Human, Animal, and Environment: A Review","volume":"7","author":"Swelum","year":"2020","journal-title":"Front. Vet. Sci."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1038\/d41586-021-02519-1","article-title":"Did the coronavirus jump from animals to people twice?","volume":"597","author":"Mallapaty","year":"2021","journal-title":"Nature"},{"key":"ref_121","unstructured":"(2023, October 29). Mpox in Animals and Pets | Mpox | Poxvirus | CDC, Available online: https:\/\/www.cdc.gov\/poxvirus\/mpox\/veterinarian\/mpox-in-animals.html."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1093\/ajhp\/zxab209","article-title":"Lessons from the mismanagement of the COVID-19 pandemic: A blueprint to reform CDC","volume":"78","author":"Guharoy","year":"2021","journal-title":"Am. J. Health Syst. Pharm."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1212\/CPJ.0000000000001042","article-title":"Disaster Neurology Update","volume":"11","author":"Miller","year":"2021","journal-title":"Neurol. Clin. Pract."},{"key":"ref_124","unstructured":"CDC. Centers for Disease Control and Prevention (2023, October 29). What to Do if You Have Mpox, Available online: https:\/\/www.cdc.gov\/poxvirus\/mpox\/if-sick\/what-to-do.html."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/11\/2713\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:18:07Z","timestamp":1760131087000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/11\/2713"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,6]]},"references-count":124,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["microorganisms11112713"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms11112713","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,6]]}}}