The recent monkeypox (MPVX) outbreak has been characterized by an unprecedented increase in cases, unlike any other outbreaks in the past. The disease pattern and transmissibility are also different from previous outbreaks. This systematic review aimed to evaluate whether the current outbreak has significant contrasting features from the previous ones, necessitating changes in prevention and control guidelines. A thorough literature search related to MPVX infection was performed on the online databases PubMed, Google Scholar, and ScienceDirect using appropriate keywords "MPVX", "men who have sex with men (MSM)", "transmission", and "smallpox vaccination", for choosing relevant articles from the inception of MPVX in 1970 to August 31, 2022. We identified 5110 cases of MPVX, documented in 63 articles on MPVX. We discovered that the median age of MPVX infection has slowly increased since its inception, and currently, it is more common in adults. Compared to previous outbreaks, a significantly greater male preponderance is witnessed in the current outbreak. Only 238 (4.65%) out of the 5110 evaluated patients were vaccinated with the smallpox vaccine in our review. There were 107 mortalities, most of which were children below the age of 10 years. Out of the 1534 cases identified in 2022, 1134 (73.92%) patients admitted that they had been involved in sexual relations within the last 21 days (MSM/gay/bisexual). We found that in contrast to previous outbreaks, human-to-human transmission is more common in this outbreak, with most cases having no link with endemic countries. There are evolving traits and undetected transmission modes of MPVX infection that require new disease mitigation strategies.

Monkeypox is a rare, zoonotic viral illness that was initially endemic mainly to Africa. The virus later spread to non-African countries and, in 2022, it exploded on a global scale, with an unprecedented number of cases. The rapid, multi-country transmission, primarily in men who have sex with men (MSM), and evolving clinical manifestations and demographic traits of the current outbreak have raised serious concerns among the international health community. An in-depth inquiry into the past and present outbreaks are required, especially when contrasting features are witnessed across countries and outbreaks. This narrative review aims to summarize the evolution in the epidemiology, clinical features, mode of transmission, and management protocol of human monkeypox infection (H-MPVX) over the decades. For a detailed characterization of the novelties associated with the current outbreak that would facilitate the accurate dissemination of information and policy-making, we performed a thorough literature search for MPVX infection on PubMed, Google Scholar, and Science Direct, using appropriate keywords to choose relevant articles.