Abstract
Monkeypox virus (mpox) has spread globally. Emerging studies have now provided evidence regarding mpox transmission, that can inform rational evidence-based polices and reduce misinformation on this topic. We aimed to review the evidence on transmission of the virus. Real-world studies have isolated viable virus from high touch surfaces for as long as 15 days. Strong evidence suggests that current circulating monkeypox has evolved from previous outbreaks outside of Africa, but it is yet unknown whether these mutations may lead to an inherently increased infectivity of the virus. Strong evidence also suggests that the main route of current mkeypox transmission is sexual; through either close contact or directly, with detection of culturable virus in saliva, nasopharynx and sperm for prolonged periods and the presence of rashes mainly in genital areas. The milder clinical presentations and potential presence of presymptomatic transmission in the current circulating variant compared to previous clades, as well as the dominance of spread amongst men who have sex with men (MSMs) suggests that mpox has a developed distinct clinical phenotype that has increased its transmissibility. Increased public awareness of mpox transmission modalities may lead to earliar detection of the spillover of new cases into other groups.
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