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Virology and Viral Diseases · Journal article
Zoonotic Diseases · August 14, 2026
Raises a question worth testing. It does not answer one.
This systematic review documents mpox epidemiology and genomic evolution in West Africa from 1970 to 2025, identifying a historical 'Era of Silence' (1970–2016) followed by a 2017 re-emergence with shift to urban, secondary transmission and novel clinical presentations. Genomic evidence suggests clade IIb experienced accelerated APOBEC3-mediated hypermutation consistent with cryptic human-to-human circulation as early as 2014, but the hypothesis lacks direct experimental validation and no definitive reservoir has been identified.
Systematic review. West African mpox epidemiology and virology literature from 1970 to 2025, encompassing human cases, wildlife reservoirs (rodents and small mammals), and genomic sequences of MPXV clades.. West Africa, with focus on Nigeria and regional spread from 1970 to 2025..
Four decades of cryptic enzootic circulation of MPXV in West African wildlife (1970–2016) preceded 2017 re-emergence in Nigeria. Disease profile shifted from sporadic rural paediatric infections to sustained urban secondary transmission among young adult males, often associated with sexual networks and men who have sex with men. Clade II diverged from clade I approximately 3500 years ago and is defined by deletion of virulence factors including complement-binding protein.
Total human population size, case counts, mortality, and regional distribution within West Africa not specified in abstract.
Clinicians should recognize the epidemiological shift in mpox presentation from rare paediatric zoonosis to urban secondary transmission with genital and perianal lesions in adult males. The hypothesis of cryptic human-to-human circulation since 2014 suggests earlier endemic spread than previously recognized, relevant to contact tracing and surveillance design.
A systematic review synthesizing historical epidemiology and genomic evolution without new primary data or experimental evidence; raises mechanistic questions about cryptic circulation and APOBEC3-mediated hypermutation rather than testing hypotheses.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should recognize the epidemiological shift in mpox presentation from rare paediatric zoonosis to urban secondary transmission with genital and perianal lesions in adult males. The hypothesis of cryptic human-to-human circulation since 2014 suggests earlier endemic spread than previously recognized, relevant to contact tracing and surveillance design.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Historically, mpox was thought to be a geographically constrained ‘disease of poverty,’ leading to decades of neglect by global health actors. Waning population immunity from the cessation of smallpox vaccination and prolonged scientific neglect created conditions that enabled the monkeypox virus (MPXV) to adapt cryptically. This ultimately contributed to the emergence of unprecedented global public health crises. This review aims to systematically trace the history, epidemiology, genomic evolution, and reservoir ecology of mpox in West Africa from 1970 to 2025. Following PRISMA guidelines, 110 articles met the inclusion criteria and were synthesized to map the virus’s trajectory. For nearly four decades, an “Era of Silence” (1970–2016) masked the silent enzootic circulation of MPXV within West African wildlife, primarily rodents and small mammals. This epidemiological quiescence ended with the 2017 re-emergence in Nigeria, which signaled a fundamental paradigm shift. The disease profile transitioned from sporadic, rural paediatric infections to sustained, urban and secondary transmission among young adult males. This shift was often associated with sexual networks, especially among men who have sex with men, and was characterized by novel clinical presentations, including genital and perianal lesions. Genomic analyses revealed that clade II diverged from clade I approximately 3500 years ago and is uniquely defined by the deletion of virulence factors, such as the complement-binding protein. Importantly, the clade IIb lineage, which triggered the 2022 global outbreak, exhibits accelerated microevolution consistent with APOBEC3-mediated hypermutation. This host-driven mutational signature provides genomic evidence supporting the hypothesis that clade IIb circulated cryptically within human-to-human transmission chains in West Africa as early as 2014. Ecologically, while no definitive reservoir has yet been identified, evidence suggests diverse rodents and an expanding host range. The transformation of mpox from a rare zoonosis to a global threat underscores the severe consequences of delayed intervention, demanding robust, integrated “One Health” surveillance.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.