In recent years, mpox has re-emerged in several regions, spreading beyond previously known geographic patterns and challenging public health systems. What key epidemiological, environmental, and social factors have contributed to the resurgence and global spread of mpox? Additionally, how should health systems strengthen surveillance, community awareness, vaccination strategies, and rapid response mechanisms to prevent future outbreaks—particularly in areas with limited public health infrastructure?
Sample Answer
The resurgence and global spread of mpox (formerly known as monkeypox) are driven by a complex interplay of epidemiological, environmental, and social factors. Health systems must adopt comprehensive, multi-faceted strategies focused on surveillance, awareness, vaccination, and rapid response to effectively mitigate future outbreaks.
🛑 Contributing Factors to Mpox Resurgence
1. Epidemiological Factors
Shift in Transmission Dynamics: The 2022 global outbreak was primarily driven by human-to-human transmission through close physical contact, including sexual activity, marking a significant departure from the historical pattern dominated by zoonotic spillover (animal-to-human transmission) . The high concentration of cases within specific social networks accelerated spread in non-endemic countries.
Waning Immunity: Mass vaccination against smallpox, which provides cross-protection against mpox, ceased globally after 1980. This created a large, growing population born after that time that is immunologically naive to orthopoxviruses, increasing susceptibility and reducing herd immunity.
Asymptomatic or Atypical Presentation: Cases presenting with atypical lesions (e.g., in the genital or perianal area) or minimal systemic symptoms can lead to missed diagnosis and continued, silent transmission.
2. Environmental Factors
Zoonotic Spillover Persistence: Mpox remains an endemic zoonosis in parts of Central and West Africa, particularly among rodents and non-human primates. Factors like deforestation, habitat encroachment, and increased human contact with reservoir animals continue to facilitate spillover events, acting as potential triggers for new human outbreaks.
Climate Change and Ecology: Changes in climate and ecological systems can alter the distribution and density of animal hosts and vectors, potentially increasing the frequency and geographic range of human exposure.
3. Social and Behavioral Factors
Increased Global Travel and Mobility: Rapid international travel provides the mechanism for a localized outbreak to become a global pandemic in days, as demonstrated by the initial dispersal of the 2022 strain.
Stigma and Delayed Care: The initial high prevalence of mpox in specific communities led to stigma and discrimination, which discouraged affected individuals from seeking prompt testing, diagnosis, and care. Delayed presentation allowed for further community transmission before isolation measures could be implemented.
Lack of Public Health Priority: Before 2022, mpox was often considered a rare, geographically isolated disease. This resulted in low levels of funding for research, vaccine stockpiling, and diagnostic capacity outside endemic regions.