Critical Appraisal of Mpox (Monkeypox) in Africa using Scoping and Systematic Reviews: Epidemiology, Biochemistry, Phylogeny, Pathogenesis, Clinical Features, Diagnosis, Treatment, Biosecurity and One-Health

Abstract Although the WHO declared Mpox (monkeypox) as the 7th aetiology of public health emergency of international concern (PHEIC) in 2022, Africa remains a battlefield for the emergence and re-emergence of deadly aetiologies including the Lassa fever virus from 1969, 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 for research gap identification and policy implementation 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, reliability, and robust indexed contents, while the PROSPERO registered systematic review followed the PRISMA guidelines. Phylogenetic analysis was piloted to equate recent outbreaks of mpox with the existing genotypic information. The genetic analysis conducted focused on the H3L gene that codes for envelope proteins involved in viral attachment. Transmission of mpox virus was reported mainly in four (4) routes. Animals implicated include monkeys, squirrels, and pigs. Reported risk factors include age, sex, occupation, climate, travels, political instability, and vaccination status. Reported circulating strains on the continent include Congo-8, Liberia-1, Sierra Leone, MPV-ZAI, Central African, West African (WA), and the Congo basin mpox virus. Eight (8) point mutations were observed to occur in Africa with resultant amino acid changes. Observed clustering within the predominant West African 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 that culminated in its spread to over 100 countries. Hence, there is need to address the mpox host-associated physiological and biochemical changes, development of mpox virus-specific diagnostic kits and vaccine, studies on the socio-ecological, economic and psychological consequences of the disease. We recommend policy implementation focused on African-led drug discovery campaigns towards mpox virus, national and/or international frameworks for controlling the disease as part of the holistic and strategic campaigns for controlling mpox virus in Africa.