Critical appraisal of Monkeypox (Mpox) in Africa using scoping and systematic review methods

Abstract

Africa remains a battlefield for the emergence and re-emergence of deadly aetiologies including the Lassa fever virus from 1969, Monkey pox (mpox) virus from 1970, and Ebola virus from 1976 till date, among others. With the recent index case of mpox following rapid spread from Africa to different continents, a critical appraisal of the disease to x-ray its dynamics in Africa is warranted. This study integrated a mix of scoping and systematic reviews to converse the epidemiology and biosecurity/environmental issues from one health perspective. Our scoping review used major scientific databases based on their relevance and reliability, while the PROSPERO-registered systematic review followed the PRISMA guidelines. Phylogeny analysis was performed to compare recent outbreaks of mpox with the existing genotypic information. The genetic analysis focused on the H3L gene that codes for envelope proteins involved in viral attachment. Transmission of mpox virus was reported mainly in four routes. Animals implicated include monkeys, squirrels, and pigs. Risk factors include age, gender, occupation, climate, travel, political instability, and vaccination status. Different circulating strains were reported with eight-point mutations found to occur in Africa. Observed clustering within the predominant West African (WA) clade and the recent outbreak strains corroborate the reports of WA clade in other non-African and non-endemic countries. Viral adaptation in the WA clade enhanced person-to-person transmissibility, spreading to over 100 countries. Hence, there is need to address mpox host-associated physiological and biochemical changes, the development of mpox virus-specific diagnostic kits and vaccines, and studies on the disease's socio-ecological, economic and psychological consequences.