Suggested model of monkeypox (mpox) virus (MPXV) transmission. From Episode I as a beginning, the MPXV has been in a wild forest in Central Africa and infects wild animals. The zoonotic transmission routes can occur by hunting wild animals, cooking, and consuming infected meat or bushmeat. During evolutional pressure, the MPXV of the Democratic Republic of the Congo (DRC) clade (A.1) may change its genetic sequence slightly to the Republic of the Congo (ROC) clade (A.2) and clade B.1. From animal to animal, animal to human, and personal transmission may occur endemically within the African boundary. Episode II, as a limited infection, occurred in the USA in 2003. Some infected animals exported from African endemic areas transmitted the infection to humans by direct contact with blood and bodily fluids. Episode III can be defined as the mixing and pre-boiling stage. The mpox in the African countries crossed the border. New genetic sequences (clade B.1) from a Nigerian person or tourists to Nigeria were found in 2017 and 2018 around the world. Four sequences (ON676701.1 from Texas in 2021, ON674051.1 from Florida in 2022, ON675438.01 from Virginia, and ON676708 from MD revealed high similarity with the earlier Nigeria strains, suggesting that the cases of mpox were already presented in the USA before the global outbreak in 2022. Episode IV, as a boiling or eruptive stage, one super-spreader of mpox may attend densely closed gay societies or mass events in earlier 2022 and densely transmit the infection into societies. Finally, secondary person-to-person transmission occurred during sexual contacts around the world. The World Health Organization realized the seriousness of personal transmission and has declared a global health emergency against the infection. In the near future, the mpox may be endemic worldwide and progress into the re-mixing and boiling stage if we are not concerned about the infection.

Urogenit Tract Infect 2023;18:35-44 https://doi.org/10.14777/uti.2023.18.2.35

© 2023 Urogenit Tract Infect