{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:58:56Z","timestamp":1790297936865,"version":"4.1.0"},"reference-count":54,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T00:00:00Z","timestamp":1660694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Monkeypox is a rare disease but is increasing in incidence in different countries since the first case was diagnosed in the UK by the United Kingdom (UK) Health Security Agency on 6 May 2022. As of 9 August, almost 32,000 cases have been identified in 89 countries. In endemic areas, the monkeypox virus (MPXV) is commonly transmitted through zoonosis, while in non-endemic regions, it is spread through human-to-human transmission. Symptoms can include flu-like symptoms, rash, or sores on the hands, feet, genitalia, or anus. In addition, people who did not take the smallpox vaccine were more likely to be infected than others. The exact pathogenesis and mechanisms are still unclear; however, most identified cases are reported in men who have sex with other men (MSM). According to the CDC, transmission can happen with any sexual or non-sexual contact with the infected person. However, a recent pooled meta-analysis reported that sexual contact is involved in more than 91% of cases. Moreover, it is the first time that semen analysis for many patients has shown positive monkeypox virus DNA. Therefore, in this review, we will describe transmission methods for MPXV while focusing mainly on potential sexual transmission and associated sexually transmitted infections. We will also highlight the preventive measures that can limit the spread of the diseases in this regard.<\/jats:p>","DOI":"10.3390\/pathogens11080924","type":"journal-article","created":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T22:53:30Z","timestamp":1660776810000},"page":"924","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":113,"title":["Monkeypox and Its Possible Sexual Transmission: Where Are We Now with Its Evidence?"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2695-8714","authenticated-orcid":false,"given":"Ranjit","family":"Sah","sequence":"first","affiliation":[{"name":"Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu 44600, Nepal"},{"name":"Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3787-5970","authenticated-orcid":false,"given":"Abdelaziz","family":"Abdelaal","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA 02115, USA"},{"name":"School of Medicine, Boston University, Boston, MA 02118, USA"},{"name":"Tanta Research Team, Tanta 31527, Egypt"},{"name":"MBBCh, Faculty of Medicine, Tanta University, Tanta 31527, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2180-0029","authenticated-orcid":false,"given":"Abdullah","family":"Reda","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University, Cairo 11651, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basant E.","family":"Katamesh","sequence":"additional","affiliation":[{"name":"Tanta Research Team, Tanta 31527, Egypt"},{"name":"MBBCh, Faculty of Medicine, Tanta University, Tanta 31527, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emery","family":"Manirambona","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, University of Rwanda, Kigali 3286, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanaa","family":"Abdelmonem","sequence":"additional","affiliation":[{"name":"MBBCh, Faculty of Medicine Fayoum University, Fayoum 63514, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachana","family":"Mehta","sequence":"additional","affiliation":[{"name":"National Public Health Laboratory, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6774-9847","authenticated-orcid":false,"given":"Ali A.","family":"Rabaan","sequence":"additional","affiliation":[{"name":"Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia"},{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"},{"name":"Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4552-4513","authenticated-orcid":false,"given":"Saad","family":"Alhumaid","sequence":"additional","affiliation":[{"name":"Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4501-5316","authenticated-orcid":false,"given":"Wadha A.","family":"Alfouzan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait"},{"name":"Microbiology Unit, Department of Laboratories, Farwania Hospital, Farwania 85000, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4557-2814","authenticated-orcid":false,"given":"Amer I.","family":"Alomar","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faryal","family":"Khamis","sequence":"additional","affiliation":[{"name":"Infection Diseases Unit, Department of Internal Medicine, Royal Hospital, Muscat 1331, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadwa S.","family":"Alofi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, King Fahad Hospital, Madinah 42351, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha H.","family":"Aljohani","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, King Fahad Hospital, Madinah 42351, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal H.","family":"Alfaraj","sequence":"additional","affiliation":[{"name":"Pediatric Department, Abqaiq General Hospital, First Eastern Health Cluster, Abqaiq 33261, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2523-835X","authenticated-orcid":false,"given":"Mubarak","family":"Alfaresi","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Sheikh Khalifa General Hospital, Umm Al Quwain P.O. Box 499, United Arab Emirates"},{"name":"Department of Pathology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jumana M.","family":"Al-Jishi","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Qatif Central Hospital, Qatif 35342, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jameela","family":"Alsalman","sequence":"additional","affiliation":[{"name":"Infection Disease Unit, Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 435, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahlam","family":"Alynbiawi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh 12231, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8733-1472","authenticated-orcid":false,"given":"Mohammed S.","family":"Almogbel","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Sciences, College of Applied Medical Sciences, University of Hail, Hail 4030, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9773-2192","authenticated-orcid":false,"given":"Alfonso J.","family":"Rodriguez-Morales","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira 660003, Risaralda, Colombia"},{"name":"Institucion Universitaria Vision de las Americas, Pereira 12998, Risaralda, Colombia"},{"name":"Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima 15024, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bragazzi, N.L., Kong, J.D., Mahroum, N., Tsigalou, C., Khamisy-Farah, R., Converti, M., and Wu, J. (2022). Epidemiological trends and clinical features of the ongoing monkeypox epidemic: A preliminary pooled data analysis and literature review. J. Med. Virol.","DOI":"10.1002\/jmv.27931"},{"key":"ref_2","first-page":"103975","article-title":"Monkeypox in 2022: A new threat in developing","volume":"78","author":"Ahmed","year":"2022","journal-title":"Ann. Med. Surg. 2012"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/S1473-3099(22)00228-6","article-title":"Clinical features and management of human monkeypox: A retrospective observational study in the UK","volume":"22","author":"Adler","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Lansiaux, E., Jain, N., Laivacuma, S., and Reinis, A. (2022, August 01). The Virology of Human Monkeypox Virus (hMPXV): A Brief Overview. Available online: https:\/\/www.researchgate.net\/publication\/361245313_The_Virology_of_Human_Monkeypox_Virus_hMPXV_A_Brief_Overview.","DOI":"10.1016\/j.virusres.2022.198932"},{"key":"ref_5","first-page":"593","article-title":"A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo","volume":"46","author":"Ladnyj","year":"1972","journal-title":"Bull. World Health Organ."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1111\/tmi.13785","article-title":"Monkeypox 2022 outbreak: An update","volume":"27","author":"Velavan","year":"2022","journal-title":"Trop. Med. Int. Health TM IH"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bragazzi, N.L., Khamisy-Farah, R., Tsigalou, C., Mahroum, N., and Converti, M. (2022). Attaching a stigma to the LGBTQI+ community should be avoided during the monkeypox epidemic. J. Med. Virol.","DOI":"10.1002\/jmv.27913"},{"key":"ref_8","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_9","unstructured":"World Health Organization (2022, August 10). Multi-Country Monkeypox Outbreak: Situation Update. Available online: \/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2022-DON396."},{"key":"ref_10","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_11","first-page":"580","article-title":"Use of the term \u2018gay bowel syndrome\u2019","volume":"49","author":"Marcus","year":"1994","journal-title":"Am. Fam. Physician"},{"key":"ref_12","first-page":"2200424","article-title":"Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022","volume":"27","author":"Duque","year":"2022","journal-title":"Eurosurveillance"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"764","DOI":"10.15585\/mmwr.mm7123e1","article-title":"Monkeypox outbreak\u2014nine states, May 2022","volume":"71","author":"Minhaj","year":"2022","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_14","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_15","doi-asserted-by":"crossref","unstructured":"Davido, B., D\u2019Anglejan, E., Jourdan, J., Robinault, A., and Davido, G. (2022). Monkeypox 2022 outbreak: Cases with exclusive genital lesions. J. Travel Med., taac077.","DOI":"10.1093\/jtm\/taac077"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e554","DOI":"10.1016\/S2666-5247(22)00153-7","article-title":"Global human monkeypox outbreak: Atypical presentation demanding urgent public health action","volume":"3","author":"Otu","year":"2022","journal-title":"Lancet Microbe"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1080\/14787210.2020.1819791","article-title":"An overview of tecovirimat for smallpox treatment and expanded anti-orthopoxvirus applications","volume":"19","author":"Russo","year":"2021","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_18","unstructured":"World Health Organization (2022, August 12). Monkeypox: Key Facts. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/monkeypox."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/S1473-3099(22)00354-1","article-title":"Monkeypox outbreaks outside endemic regions: Scientific and social priorities","volume":"22","author":"Zumla","year":"2022","journal-title":"Lancet. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Girometti, N., Byrne, R., Bracchi, M., Heskin, J., McOwan, A., Tittle, V., Gedela, K., Scott, C., Patel, S., and Gohil, J. (2022). Epidemiological Characteristics and Clinical Features of Confirmed Human Monkeypox Virus Cases in Individuals Attending a Sexual Health Centre in London, United Kingdom.: An observational analysis. Lancet Infect. Dis.","DOI":"10.2139\/ssrn.4125251"},{"key":"ref_21","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_22","doi-asserted-by":"crossref","unstructured":"Thornhill, J.P., Barkati, S., Walmsley, S., Rockstroh, J., Antinori, A., Harrison, L.B., Palich, R., Nori, A., Reeves, I., and Habibi, M.S. (2022). Monkeypox virus infection in humans across 16 countries\u2014April\u2013June 2022. N. Engl. J. Med.","DOI":"10.1056\/NEJMoa2207323"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"o1542","DOI":"10.1136\/bmj.o1542","article-title":"Monkeypox: Gay and Bisexual Men with High Exposure Risk Will Be Offered Vaccine in England","volume":"377","author":"Mahase","year":"2022","journal-title":"BMJ"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e210","DOI":"10.1093\/cid\/ciaa143","article-title":"Clinical course and outcome of human monkeypox in Nigeria","volume":"71","author":"Ogoina","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Rodriguez-Morales, A.J., and Lopardo, G. (2022). Monkeypox: Another Sexually Transmitted Infection?. Pathogens, 11.","DOI":"10.3390\/pathogens11070713"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"10889","DOI":"10.1073\/pnas.0804985105","article-title":"Rapid protection in a monkeypox model by a single injection of a replication-deficient vaccinia virus","volume":"105","author":"Earl","year":"2008","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1016\/j.vaccine.2013.04.050","article-title":"Safety and immunogenicity of IMVAMUNE\u00ae smallpox vaccine using different strategies for a post event scenario","volume":"31","author":"Frey","year":"2013","journal-title":"Vaccine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1093\/infdis\/jis753","article-title":"Safety, immunogenicity, and surrogate markers of clinical efficacy for modified vaccinia Ankara as a smallpox vaccine in HIV-infected subjects","volume":"207","author":"Greenberg","year":"2013","journal-title":"J. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"7683","DOI":"10.1128\/JVI.02174-10","article-title":"Establishment of the black-tailed prairie dog (Cynomys ludovicianus) as a novel animal model for comparing smallpox vaccines administered preexposure in both high- and low-dose monkeypox virus challenges","volume":"85","author":"Keckler","year":"2011","journal-title":"J. Virol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"7845","DOI":"10.1128\/JVI.79.12.7845-7851.2005","article-title":"Modified vaccinia virus Ankara protects macaques against respiratory challenge with monkeypox virus","volume":"79","author":"Stittelaar","year":"2005","journal-title":"J. Virol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.1016\/j.vaccine.2005.11.022","article-title":"Safety and immunogenicity of IMVAMUNE, a promising candidate as a third generation smallpox vaccine","volume":"24","author":"Vollmar","year":"2006","journal-title":"Vaccine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.vaccine.2009.11.030","article-title":"A randomized, double-blind, dose-finding Phase II study to evaluate immunogenicity and safety of the third generation smallpox vaccine candidate IMVAMUNE","volume":"28","author":"Vollmar","year":"2010","journal-title":"Vaccine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1093\/infdis\/jit105","article-title":"Safety and immunogenicity of modified vaccinia Ankara in hematopoietic stem cell transplant recipients: A randomized, controlled trial","volume":"207","author":"Walsh","year":"2013","journal-title":"J. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1111\/jdv.13797","article-title":"Long-term safety of replication-defective smallpox vaccine (MVA-BN) in atopic eczema and allergic rhinitis","volume":"30","author":"Darsow","year":"2016","journal-title":"J. Eur. Acad. Dermatol. Venereol. JEADV"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Greenberg, R.N., Hurley, M.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_36","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_37","doi-asserted-by":"crossref","unstructured":"Greenberg, R.N., Hay, C.M., Stapleton, J.T., Marbury, T.C., Wagner, E., Kreitmeir, E., R\u00f6esch, S., von Krempelhuber, A., Young, P., and Nichols, R. (2016). A Randomized, Double-Blind, Placebo-Controlled Phase II Trial Investigating the Safety and Immunogenicity of Modified Vaccinia Ankara Smallpox Vaccine (MVA-BN\u00ae) in 56\u201380-Year-Old Subjects. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0157335"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1016\/j.vaccine.2017.02.032","article-title":"Safety and immunogenicity of a modified vaccinia Ankara vaccine using three immunization schedules and two modes of delivery: A randomized clinical non-inferiority trial","volume":"35","author":"Jackson","year":"2017","journal-title":"Vaccine"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Overton, E.T., Lawrence, S.J., Wagner, E., Nopora, K., R\u00f6sch, S., Young, P., Schmidt, D., Kreusel, C., De Carli, S., 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_40","doi-asserted-by":"crossref","first-page":"ofv040","DOI":"10.1093\/ofid\/ofv040","article-title":"Safety and Immunogenicity of Modified Vaccinia Ankara-Bavarian Nordic Smallpox Vaccine in Vaccinia-Naive and Experienced Human Immunodeficiency Virus-Infected Individuals: An Open-Label, Controlled Clinical Phase II Trial","volume":"2","author":"Overton","year":"2015","journal-title":"Open Forum Infect. Dis."},{"key":"ref_41","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_42","unstructured":"Centers for Disease Control and Prevention (2022, August 10). Vaccination Administration Considerations for Specific Populations, Available online: \/\/www.cdc.gov\/poxvirus\/monkeypox\/interim-considerations\/special-populations.html."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Sah, R., Abdelaal, A., Asija, A., Basnyat, S., Sedhai, Y.R., Ghimire, S., Sah, S., Bonilla-Aldana, K., and Rodriguez-Morales, A.J. (2022). Monkeypox Virus Containment: The Application of Ring Vaccination and Possible Challenges. J. Travel Med., taac085.","DOI":"10.1093\/jtm\/taac085"},{"key":"ref_44","unstructured":"Nguyen, L.B.L., Ghosn, J., Durier, C., Tachot, C., Tartour, E., Touati, A., Simon, T., Autran, B., Perez, I.O., and Telford, E. (2022). A prospective national cohort evaluating ring MVA vaccination as post-exposure prophylaxis for monkeypox. Nat. Med."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Chowell, G., Tariq, A., and Kiskowski, M. (2019). Vaccination strategies to control Ebola epidemics in the context of variable household inaccessibility levels. PLoS Negl. Trop. Dis., 13.","DOI":"10.1101\/665646"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Ebola \u00e7a Suffit Ring Vaccination Trial Consortium (2015). The ring vaccination trial: A novel cluster randomised controlled trial design to evaluate vaccine efficacy and effectiveness during outbreaks, with special reference to Ebola. BMJ Br. Med. J., 351, h3740.","DOI":"10.1136\/bmj.h3740"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"17407745211073594","DOI":"10.1177\/17407745211073594","article-title":"The ring vaccination trial design for the estimation of vaccine efficacy and effectiveness during infectious disease outbreaks","volume":"19","author":"Dean","year":"2022","journal-title":"Clin. Trials"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.vaccine.2019.10.034","article-title":"Stopping live vaccines after disease eradication may increase mortality","volume":"38","author":"Aaby","year":"2020","journal-title":"Vaccine"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S379","DOI":"10.1093\/infdis\/jiaa588","article-title":"Smallpox","volume":"224","author":"Breman","year":"2021","journal-title":"J. Infect. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1089\/bsp.2006.4.64","article-title":"The smallpox vaccine: A multidimensional model of choice","volume":"4","author":"Kaltman","year":"2006","journal-title":"Biosecur. Bioterror. Biodef. Strategy Pract. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"20120148","DOI":"10.1098\/rstb.2012.0148","article-title":"Vaccine refusal and the endgame: Walking the last mile first","volume":"368","author":"Omer","year":"2013","journal-title":"Philos. Trans. R. Soc. Lond. Ser. B Biol. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.jped.2018.01.008","article-title":"Vaccine refusal-what we need to know","volume":"94","author":"Succi","year":"2018","journal-title":"J. De Pediatr."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Stangl, A.L., Earnshaw, V.A., Logie, C.H., van Brakel, W., Simbayi, L.C., Barr\u00e9, I., and Dovidio, J.F. (2019). The Health Stigma and Discrimination Framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med., 17.","DOI":"10.1186\/s12916-019-1271-3"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/BF03391698","article-title":"Social media engagement and public health communication: Implications for public health organizations being truly \u201csocial\u201d","volume":"35","author":"Heldman","year":"2013","journal-title":"Public Health Rev."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/8\/924\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:11:05Z","timestamp":1760141465000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/8\/924"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,17]]},"references-count":54,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["pathogens11080924"],"URL":"https:\/\/doi.org\/10.3390\/pathogens11080924","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,17]]}}}