{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:17:36Z","timestamp":1764595056007,"version":"3.46.0"},"reference-count":97,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Monkeypox virus (MPXV) re-emerged in 2022 with a global outbreak that affected more than 100,000 individuals worldwide. People living with HIV (PLWH) accounted for a substantial proportion of cases, raising concerns about disease presentation, management, and outcomes in this population. Evidence indicates that PLWH with advanced or uncontrolled HIV infection experienced more severe mpox, with higher hospitalization rates, more complications, and longer disease courses. In contrast, individuals with well-controlled HIV generally had outcomes similar to those without HIV. Access to timely diagnosis, consistent antiretroviral therapy, and availability of tecovirimat were key factors influencing prognosis. Reports also suggest bidirectional interactions between mpox and HIV pathogenesis. Immune activation and APOBEC3-related viral evolution have been proposed; however, these mechanisms remain incompletely characterized and warrant further investigation. Moreover, disparities in healthcare access and stigma compound the vulnerability of PLWH, emphasizing the need for integrated approaches.<\/jats:p>","DOI":"10.3390\/v17121558","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:03:02Z","timestamp":1764594182000},"page":"1558","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mpox in People Living with HIV: Clinical Challenges, Preventive Strategies and Public Health Implications"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8713-6370","authenticated-orcid":false,"given":"Rita","family":"Cordeiro","sequence":"first","affiliation":[{"name":"Emergency Response and Biopreparedness Unit, Infectious Diseases Department, National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisbon, Portugal"},{"name":"Institute of Environmental Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7798-7064","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Caria","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service, Local Health Unity Arr\u00e1bida, 2910-549 Set\u00fabal, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3955-0117","authenticated-orcid":false,"given":"Daniel","family":"Sobral","sequence":"additional","affiliation":[{"name":"Genomics and Bioinformatics Unit, National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4531-2123","authenticated-orcid":false,"given":"Diana","family":"P\u00f3voas","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service, Curry Cabral Hospital, Local Health Unity S\u00e3o Jos\u00e9, 1069-166 Lisbon, Portugal"},{"name":"Gulbenkian Institute for Molecular Medicine, 2780-156 Oeiras, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"772","DOI":"10.3390\/idr14050079","article-title":"Monkeypox: From a Neglected Tropical Disease to a Public Health Threat","volume":"14","author":"Antunes","year":"2022","journal-title":"Infect. Dis. Rep."},{"key":"ref_2","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_3","unstructured":"World Health Organization (2025, July 29). Global Mpox Trends. Available online: https:\/\/worldhealthorg.shinyapps.io\/mpx_global\/."},{"key":"ref_4","unstructured":"European Centre for Disease Prevention and Control (2025, July 29). Weekly Communicable Disease Threats Report, Week 29, 12\u201318 July 2025. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/communicable-disease-threats-report-12-18-july-2025-week-29."},{"key":"ref_5","unstructured":"European Centre for Disease Prevention and Control (2025, July 29). Epidemiological Update, 5 April 2024: Outbreak of Mpox Caused by Monkeypox Virus Clade I in the Democratic Republic of the Congo. Available online: https:\/\/www.ecdc.europa.eu\/en\/news-events\/outbreak-mpox-caused-monkeypox-virus-clade-i-democratic-republic-congo."},{"key":"ref_6","unstructured":"European Centre for Disease Prevention and Control (2025, July 29). Epidemiological Update, 14 January 2025: Mpox Due to Monkeypox Virus Clade I. Available online: https:\/\/www.ecdc.europa.eu\/en\/news-events\/epidemiological-update-14-january-2025-mpox-due-monkeypox-virus-clade-i."},{"key":"ref_7","unstructured":"Africa Centres for Disease Control and Prevention (2025, July 29). Africa CDC Weekly Event-Based Surveillance Report, March 2024. Available online: https:\/\/africacdc.org\/download\/africa-cdc-weekly-event-based-surveillance-report-march-2024."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/S0140-6736(23)00273-8","article-title":"Mpox in People with Advanced HIV Infection: A Global Case Series","volume":"401","author":"Alemany","year":"2023","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.15585\/mmwr.mm7136a1","article-title":"HIV and Sexually Transmitted Infections Among Persons with Monkeypox\u2014Eight U.S. Jurisdictions, May 17\u2013July 22, 2022","volume":"71","author":"Curran","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.15585\/mmwr.mm7132e3","article-title":"Epidemiologic and Clinical Characteristics of Monkeypox Cases\u2014United States, May 17\u2013July 22, 2022","volume":"71","author":"Philpott","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_11","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_12","unstructured":"European Centre for Disease Prevention and Control (2025, July 30). Factsheet for Health Professionals on Mpox. 16 August 2024. Available online: https:\/\/www.ecdc.europa.eu\/en\/all-topics-z\/monkeypox\/factsheet-health-professionals."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Srivastava, S., Sharma, K., Sridhar, S.B., Talath, S., Shareef, J., Mehta, R., Satapathy, P., and Sah, R. (2024). Clade Ib: A new emerging threat in the Mpox outbreak. Front. Pharmacol., 15.","DOI":"10.3389\/fphar.2024.1504154"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/S0140-6736(24)02353-5","article-title":"Concurrent outbreaks of mpox in Africa-an update","volume":"405","author":"Beiras","year":"2025","journal-title":"Lancet"},{"key":"ref_15","unstructured":"U.S. Centers for Disease Control and Prevention (2025, July 29). Clinical Considerations for Mpox in Immunocompromised People, Available online: https:\/\/www.cdc.gov\/mpox\/hcp\/clinical-care\/immunocompromised-people.html."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S1473-3099(03)00856-9","article-title":"Human Monkeypox: An Emerging Zoonosis","volume":"4","author":"Eckburg","year":"2004","journal-title":"Lancet Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Brown, K., and Leggat, P.A. (2016). Human Monkeypox: Current State of Knowledge and Implications for the Future. Trop. Med. Infect. Dis., 1.","DOI":"10.3390\/tropicalmed1010008"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1001\/jama.2022.9499","article-title":"What to Know About Monkeypox","volume":"327","author":"Harris","year":"2022","journal-title":"JAMA"},{"key":"ref_19","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 Neglected Trop. Dis., 16.","DOI":"10.1371\/journal.pntd.0010141"},{"key":"ref_20","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_21","unstructured":"World Health Organization (2025). Clinical Management and Infection Prevention Control for Mpox: Living Guideline, May 2025, World Health Organization."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e572","DOI":"10.1016\/S2214-109X(23)00607-1","article-title":"Paediatric, Maternal, and Congenital Mpox: A Systematic Review and Meta-Analysis","volume":"12","author":"Coles","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S0140-6736(25)00047-9","article-title":"Epidemiological and Clinical Features of Mpox during the Clade Ib Outbreak in South Kivu, Democratic Republic of the Congo: A Prospective Cohort Study","volume":"405","author":"Brosius","year":"2025","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e016937","DOI":"10.1136\/bmjgh-2024-016937","article-title":"Risk Factors Associated with Human Mpox Infection: A Systematic Review and Meta-Analysis","volume":"10","author":"Ugwu","year":"2025","journal-title":"BMJ Glob. Health"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Liu, Q., Fu, L., Wang, B., Sun, Y., Wu, X., Peng, X., Li, Y., Lin, Y.-F., Fitzpatrick, T., and Vermund, S.H. (2023). Clinical Characteristics of Human Mpox (Monkeypox) in 2022: A Systematic Review and Meta-Analysis. Pathogens, 12.","DOI":"10.3390\/pathogens12010146"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"102494","DOI":"10.1016\/j.jiph.2024.102494","article-title":"Epidemiological and Clinical Characteristics of Monkeypox among People with and without HIV in Peru: A National Observational Study","volume":"17","year":"2024","journal-title":"J. Infect. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/QAI.0000000000003407","article-title":"Clinical Features and Outcomes of Mpox in People with and without HIV: A National Comparative Study","volume":"96","year":"2024","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/1346-8138.17605","article-title":"Atypical Mucocutaneous Manifestations of Mpox: A Systematic Review","volume":"52","author":"Finello","year":"2025","journal-title":"J. Dermatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s11904-023-00661-1","article-title":"Mpox and HIV: A Narrative Review","volume":"20","author":"Saldana","year":"2023","journal-title":"Curr. HIV\/AIDS Rep."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Shabil, M., Gaidhane, S., Roopashree, R., Kaur, M., Srivastava, M., Barwal, A., Prasad, G.V.S., Rajput, P., Syed, R., and Dev, A. (2025). Association of HIV Infection and Hospitalization among Mpox Cases: A Systematic Review and Meta-Analysis. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10512-6"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1186\/s12985-024-02392-0","article-title":"The Impact of Immunosuppression on the Mortality and Hospitalization of Monkeypox: A Systematic Review and Meta-Analysis of the 2022 Outbreak","volume":"21","author":"Azzam","year":"2024","journal-title":"Virol. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1111\/hiv.13622","article-title":"The Effect of HIV and Mpox Co-Infection on Clinical Outcomes: Systematic Review and Meta-Analysis","volume":"25","author":"Taha","year":"2024","journal-title":"HIV Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1016\/S1473-3099(23)00482-6","article-title":"Mpox as AIDS-Defining Event with a Severe and Protracted Course: Clinical, Immunological, and Virological Implications","volume":"24","author":"Pinnetti","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_34","unstructured":"World Health Organization (2025, July 29). Integration of HIV and Syphilis Testing Services as Part of Mpox Response: Standard Operating Procedures. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240107229."},{"key":"ref_35","unstructured":"World Health Organization (2024). Diagnostic Testing and Testing Strategies for Mpox: Interim Guidance, 12 November 2024, World Health Organization."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"106759","DOI":"10.1016\/j.isci.2023.106759","article-title":"Clinical and Laboratory Diagnosis of Monkeypox (Mpox): Current Status and Future Directions","volume":"26","author":"Kohl","year":"2023","journal-title":"iScience"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"7240","DOI":"10.1038\/s41467-024-51539-8","article-title":"Rapid Intra-Host Diversification and Evolution of SARS-CoV-2 in Advanced HIV Infection","volume":"15","author":"Ko","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"105042","DOI":"10.1016\/j.cmicom.2024.105042","article-title":"Multiple-Clone Infections of Mpox: Insights from a Single Primary Lesion","volume":"1","author":"Kaku","year":"2024","journal-title":"CMI Commun."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"649","DOI":"10.3201\/eid2903.221388","article-title":"Intrahost Monkeypox Virus Genome Variation in Patient with Early Infection, Finland, 2022","volume":"29","author":"Vauhkonen","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1126\/science.adg8116","article-title":"APOBEC3 Deaminase Editing in Mpox Virus as Evidence for Sustained Human Transmission since at Least 2016","volume":"382","author":"Neher","year":"2023","journal-title":"Science"},{"key":"ref_41","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_42","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.3201\/eid3011.240729","article-title":"Emerging Monkeypox Virus Sublineage C.1 Causing Community Transmission, Vietnam, 2023","volume":"30","author":"Hoa","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e28791","DOI":"10.1002\/jmv.28791","article-title":"Temporal Intra-Host Variability of Mpox Virus Genomes in Multiple Body Tissues","volume":"95","author":"Rueca","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3059","DOI":"10.1038\/s41467-024-46949-7","article-title":"Monkeypox Virus Genomic Accordion Strategies","volume":"15","author":"Varona","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e29029","DOI":"10.1002\/jmv.29029","article-title":"Intra- and Interhost Genomic Diversity of Monkeypox Virus","volume":"95","author":"Taouk","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1038\/s41591-025-03582-1","article-title":"Epidemiological and Genomic Evolution of the Ongoing Outbreak of Clade Ib Mpox Virus in the Eastern Democratic Republic of the Congo","volume":"31","author":"Masirika","year":"2025","journal-title":"Nat. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2459136","DOI":"10.1080\/22221751.2025.2459136","article-title":"Single-Cell Sequencing of Peripheral Blood Mononuclear Cells Reveals Immune Landscape of Monkeypox Patients with HIV","volume":"14","author":"Liu","year":"2025","journal-title":"Emerg. Microbes Infect."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"taad111","DOI":"10.1093\/jtm\/taad111","article-title":"Viral Load Dynamics and Shedding Kinetics of Mpox Infection: A Systematic Review and Meta-Analysis","volume":"30","author":"Kim","year":"2023","journal-title":"J. Travel Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.azn.2025.02.002","article-title":"Monkeypox Immunity: A Landscape of Host\u2013Virus Interactions, Vaccination Strategies, and Future Research Horizons","volume":"1","author":"Salauddin","year":"2025","journal-title":"Anim. Zoonoses"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e28851","DOI":"10.1002\/jmv.28851","article-title":"Profiling the Acute Phase Antibody Response against Mpox Virus in Patients Infected during the 2022 Outbreak","volume":"95","author":"Colavita","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/j.chom.2023.05.001","article-title":"Complement-Dependent Mpox-Virus-Neutralizing Antibodies in Infected and Vaccinated Individuals","volume":"31","author":"Hubert","year":"2023","journal-title":"Cell Host Microbe"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"100859","DOI":"10.1016\/S2666-5247(24)00074-0","article-title":"Immune Responses Associated with Mpox Viral Clearance in Men with and without HIV in Spain: A Multisite, Observational, Prospective Cohort Study","volume":"5","author":"Benet","year":"2024","journal-title":"Lancet Microbe"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2356153","DOI":"10.1080\/22221751.2024.2356153","article-title":"Levels of Antibodies against the Monkeypox Virus Compared by HIV Status and Historical Smallpox Vaccinations: A Serological Study","volume":"13","author":"Li","year":"2024","journal-title":"Emerg. Microbes Infect."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"232","DOI":"10.15585\/mmwr.mm7209a4","article-title":"Interim Clinical Treatment Considerations for Severe Manifestations of Mpox\u2014United States, February 2023","volume":"72","author":"Rao","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_55","unstructured":"National Institute of Allergy and Infectious Diseases (NIAID) (2025, August 02). Study of Tecovirimat for Human Monkeypox Virus (STOMP). ClinicalTrials.gov Identifier: NCT05534984. Updated 10 December 2024, Available online: https:\/\/clinicaltrials.gov\/study\/NCT05534984."},{"key":"ref_56","unstructured":"ANRS Emerging Infectious Diseases (MPX-RESPONSE) (2025, January 17). TECOVIRIMAT for Mpox\u2014Primary Clinical Outcome Results from the Randomized Part of the UNITY Clinical Trial. Proceedings of the IAS 2025, Kigali, Rwanda. Available online: https:\/\/clinicaltrials.gov\/study\/NCT05597735."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1056\/EVIDoa2400189","article-title":"Tecovirimat Use under Expanded Access to Treat Mpox in the United States, 2022\u20132023","volume":"3","author":"Yu","year":"2024","journal-title":"NEJM Evid."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1001\/jamainternmed.2023.7696","article-title":"Early Tecovirimat Treatment for Mpox Disease among People with HIV","volume":"184","author":"Aldred","year":"2024","journal-title":"JAMA Intern. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2426","DOI":"10.3201\/eid2912.231146","article-title":"Tecovirimat Resistance in Mpox Patients, United States, 2022\u20132023","volume":"29","author":"Smith","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e218","DOI":"10.1016\/S1473-3099(23)00044-0","article-title":"Use of Cidofovir in a Patient with Severe Mpox and Uncontrolled HIV Infection","volume":"23","author":"Stafford","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e28218","DOI":"10.1002\/jmv.28218","article-title":"Real-Life Use of Cidofovir for the Treatment of Severe Monkeypox Cases","volume":"95","author":"Raccagni","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"S489","DOI":"10.1093\/ofid\/ofad500.942","article-title":"897. Patients with Mpox, Minnesota, 2022","volume":"10","author":"Lehnertz","year":"2023","journal-title":"Open Forum Infect. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1093\/cid\/ciac971","article-title":"The Use of Vaccinia Immune Globulin in the Treatment of Severe Mpox Virus Infection in HIV\/AIDS","volume":"76","author":"Thet","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_64","unstructured":"Centers for Disease Control and Prevention (CDC) (2025, August 06). Use of Intravenous Vaccinia Immune Globulin (VIGIV) Under an Expanded Access Investigational New Drug (IND) Protocol for Monkeypox (Mpox) Treatment and Postexposure Prophylaxis, Available online: https:\/\/www.cdc.gov\/mpox\/media\/pdfs\/2024\/08\/VIGIV-Protocol.pdf."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e29354","DOI":"10.1002\/jmv.29354","article-title":"Trifluridine for treatment of mpox infection in drug combinations in ophthalmic cell models","volume":"96","author":"Cinatl","year":"2024","journal-title":"J. Med. Virol."},{"key":"ref_66","first-page":"101891","article-title":"Treatment of ocular-involving monkeypox virus with topical trifluridine and oral tecovirimat in the 2022 outbreak","volume":"32","author":"Perzia","year":"2023","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.3201\/eid3007.240388","article-title":"Relapsed monkeypox keratitis in advanced HIV infection in St. Louis, Missouri, USA","volume":"30","author":"Pi","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_68","unstructured":"U.S. Department of Health and Human Services (HHS) (2025, August 06). Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV: Mpox, Available online: https:\/\/clinicalinfo.hiv.gov\/sites\/default\/files\/guidelines\/archive\/adult-adolescent-oi-2024-10-08.pdf."},{"key":"ref_69","unstructured":"McLean, J.R., Zucker, J.E., Vail, R.M., Shah, S.S., Fine, S.M., McGowan, J.P., Merrick, S.T., Radix, A.E., Rodriguez, J., and Norton, B.L. (2025). Prevention and Treatment of Mpox. New York State Department of Health AIDS Institute Clinical Guidelines, Johns Hopkins University."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/1120009X.2023.2289270","article-title":"Mpox vaccination and treatment: A systematic review","volume":"36","author":"Eslami","year":"2024","journal-title":"J. Chemother."},{"key":"ref_71","unstructured":"European Medicines Agency (EMA) (2025, July 30). Imvanex. Available online: https:\/\/www.ema.europa.eu\/en\/medicines\/human\/EPAR\/imvanex."},{"key":"ref_72","unstructured":"European Medicines Agency (EMA) (2025, July 30). EMA Recommends Approval of Imvanex for the Prevention of Monkeypox Disease. Available online: https:\/\/www.ema.europa.eu\/en\/news\/ema-recommends-approval-imvanex-prevention-monkeypox-disease."},{"key":"ref_73","unstructured":"Bavarian Nordic A\/S (2025, August 03). Jynneos\u2014Product Information. Available online: https:\/\/bavariannordic.io\/uploads\/jynneos-pi.pdf."},{"key":"ref_74","unstructured":"Bavarian Nordic A\/S (2025, July 30). Health Canada Extends Approval of IMVAMUNE to Immunization Against Monkeypox and Orthopox Viruses. GlobeNewswire News Room. Available online: https:\/\/www.globenewswire.com\/news-release\/2020\/11\/12\/2125193\/0\/en\/Health-Canada-Extends-Approval-of-IMVAMUNE-to-Immunization-against-Monkeypox-and-Orthopox-Viruses.html."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"126053","DOI":"10.1016\/j.vaccine.2024.06.021","article-title":"Vaccine effectiveness of 3rd generation mpox vaccines against mpox and disease severity: A systematic review and meta-analysis","volume":"42","author":"Pischel","year":"2024","journal-title":"Vaccine"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1128\/JVI.02089-12","article-title":"Humoral Immunity to Smallpox Vaccines and Monkeypox Virus Challenge: Proteomic Assessment and Clinical Correlations","volume":"87","author":"Townsend","year":"2013","journal-title":"J. Virol."},{"key":"ref_77","first-page":"13","article-title":"Human monkeypox","volume":"27","author":"Jezek","year":"1983","journal-title":"J. Hyg. Epidemiol. Microbiol. Immunol."},{"key":"ref_78","first-page":"73","article-title":"Human monkeypox: Disease pattern, incidence and attack rates in a rural area of northern Zaire","volume":"40","author":"Jezek","year":"1988","journal-title":"Trop. Geogr. Med."},{"key":"ref_79","unstructured":"UK Health Security Agency (2025, July 30). Guidance Smallpox and Mpox: The Green Book, Available online: https:\/\/assets.publishing.service.gov.uk\/media\/68483ced944a600f13bcb899\/Green-Book-chapter-29_Smallpox-and-mpox_6June2025.pdf."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1128\/CVI.00148-07","article-title":"Monkeypox-Induced Immunity and Failure of Childhood Smallpox Vaccination To Provide Complete Protection","volume":"14","author":"Karem","year":"2007","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_81","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_82","unstructured":"European Medicines Agency (EMA) (2025, July 30). EMA\u2019s Emergency Task Force Advises on Intradermal Use of Imvanex\/Jynneos Against Monkeypox. Available online: https:\/\/www.ema.europa.eu\/en\/news\/emas-emergency-task-force-advises-intradermal-use-imvanex-jynneos-against-monkeypox."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"553","DOI":"10.15585\/mmwr.mm7220a3","article-title":"Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study, United States, August 19, 2022\u2013March 31, 2023","volume":"72","author":"Dalton","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_84","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_85","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/S1473-3099(25)00018-0","article-title":"Safety and effectiveness of MVA-BN vaccination against mpox in at-risk individuals in Germany (SEMVAc and TEMVAc): A combined prospective and retrospective cohort study","volume":"25","author":"Hillus","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"126409","DOI":"10.1016\/j.vaccine.2024.126409","article-title":"MVA-BN vaccine effectiveness: A systematic review of real-world evidence in outbreak settings","volume":"42","author":"Mason","year":"2024","journal-title":"Vaccine"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"S229","DOI":"10.1093\/infdis\/jiad492","article-title":"Development and Pilot of an Mpox Severity Scoring System","volume":"229","author":"Zucker","year":"2024","journal-title":"J. Infect. Dis."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"460","DOI":"10.15585\/mmwr.mm7320a3","article-title":"Monkeypox Virus Infections After 2 Preexposure Doses of JYNNEOS Vaccine, United States, May 2022\u2013May 2024","volume":"73","author":"Guagliardo","year":"2024","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.virol.2007.02.041","article-title":"Recombinant modified vaccinia virus Ankara provides durable protection against disease caused by an immunodeficiency virus as well as long-term immunity to an orthopoxvirus in a non-human primate","volume":"366","author":"Earl","year":"2007","journal-title":"Virology"},{"key":"ref_90","first-page":"2400575","article-title":"Orthopoxvirus-specific antibodies wane to undetectable levels 1 year after MVA-BN vaccination of at-risk individuals, the Netherlands, 2022\u20132023","volume":"29","author":"Shamier","year":"2024","journal-title":"Eurosurveillance"},{"key":"ref_91","unstructured":"Haute Autorit\u00e9 de Sant\u00e9 (2025, July 30). Avis n\u00b0 2024.0058\/AC\/SESPEV du 29 Ao\u00fbt 2024 du Coll\u00e8ge de la Haute Autorit\u00e9 de Sant\u00e9 Relatif \u00e0 la Strat\u00e9gie de Vaccination Contre le Mpox. Available online: https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2024-08\/avis_2024.0058.ac.sespev_du_29_aout_2024_du_college_de_la_has_relatif_a_la_strategie_de_vaccination__2024-08-30_16-13-45_323.pdf."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Liu, J., Liu, S., Yu, S., Du, X., Hao, J., Hui, R., Buh, A., Chen, W., and Chen, J. (2024). Willingness to receive mpox vaccine among men who have sex with men: A systematic review and meta-analysis. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-19260-9"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1038\/s43856-024-00564-1","article-title":"Global prevalence and correlates of mpox vaccine acceptance and uptake: A systematic review and meta-analysis","volume":"4","author":"Sulaiman","year":"2024","journal-title":"Commun. Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"o1869","DOI":"10.1136\/bmj.o1869","article-title":"What poo tells us: Wastewater surveillance comes of age amid covid, monkeypox, and polio","volume":"378","author":"Nelson","year":"2022","journal-title":"BMJ"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1056\/NEJMc2213882","article-title":"Use of Wastewater for Mpox Outbreak Surveillance in California","volume":"388","author":"Wolfe","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1021\/acs.estlett.2c00693","article-title":"First Detection of Monkeypox Virus Genome in Sewersheds in France: The Potential of Wastewater-Based Epidemiology for Monitoring Emerging Disease","volume":"9","author":"Wurtzer","year":"2022","journal-title":"Environ. Sci. Technol. Lett."},{"key":"ref_97","unstructured":"Garcia Iglesias, J., Williams, J., Nagington, M., May, T., Buijsen, S., McHugh, C., Horwood, J., Pickersgill, M., Chataway, J., and Aml\u00f4t, R. (2023). Responding to Mpox: Communities, Communication, and Infrastructures, University College London. Available online: https:\/\/theippo.co.uk\/wp-content\/uploads\/2023\/03\/Responding-to-Mpox.pdf."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/12\/1558\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:07:08Z","timestamp":1764594428000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/12\/1558"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":97,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["v17121558"],"URL":"https:\/\/doi.org\/10.3390\/v17121558","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,28]]}}}