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Mpox, formerly known as monkeypox, has re-emerged as a significant global health concern, particularly during the widespread outbreak of 2022. As an orthopoxvirus related to the eradicated smallpox virus, mpox has been primarily managed with smallpox vaccines and treatments, including the antiviral agent Tecovirimat. This systematic review aims to evaluate the effectiveness and safety of Tecovirimat in treating mpox, focusing on its use during the 2022 outbreak, especially among high-risk populations, including men who have sex with men and people living with HIV.

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Plaque reduction neutralization test for smallpox vaccines: Laboratory optimization and validation method for immunogenicity assessment.

J Immunol Methods

December 2024

Division of Infectious Disease Vaccine Research, Center for Vaccine Research, National Institute of Infectious Diseases, National Institute of Health, CheongJu, Chungbuk, Republic of Korea. Electronic address:

The eradication of smallpox, a historic triumph in global public health, was accomplished without a complete conception of the mechanisms underlying vaccine-induced protection. Contemporary concerns regarding potential bioterrorism threats and the possibility of smallpox reemergence have spurred research efforts toward developing third-generation vaccines capable of effectively neutralizing the variola virus. Clinical trials for a third-generation smallpox vaccine (KVAC103) are underway to obtain licensure.

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Since 2022, mpox (formerly known as monkeypox) has emerged as a sexually-associated infection that disproportionately impacts gay, bisexual, and other men who have sex with men (GBMSM). Fortunately, the JYNNEOS vaccine, which was initially developed for smallpox, has demonstrated significant efficacy against mpox and was distributed across the United States. In January 2024, the Centers for Disease Control and Prevention (CDC) reported that Rhode Island ranked first among the 50 states for rates of full vaccination coverage (two doses) against mpox among people at increased risk including GBMSM, and second among the 50 states for rates of partial vaccination (single dose).

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Although not as lethal as variola virus (VARV), the cause of smallpox, monkeypox virus (MPXV) represents a threat to public health, with important infection rates and mortality in several African countries and signs of spreading worldwide. MPXV may establish new reservoirs in non-endemic countries and can be considered a possible biological weapon. Human-to-human MPXV transmission is increasing with a growing susceptibility, coincident with the declining herd immunity against smallpox.

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Mpox, caused by the monkeypox virus (MPXV), is categorized into two primary clades: Clade I and Clade II, with notable outbreaks linked to Clade IIb. Historically endemic in Africa, recent years have seen significant global spread. The World Health Organization (WHO) declared mpox a Public Health Emergency of International Concern in August 2024, highlighting the emergence of Clade Ib outside Africa and the broadening demographic impact of the outbreak.

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