Monkeypox in Europe: Epidemiology, Risk Factors and Implications for Public Health Actions : A Scoping Review Study

BackgroundMonkeypox (mpox) is a zoonotic disease originating from the Congo Basin (Clade I) and West Africa (Clade II). In 2022, mpox spread to non-endemic European countries, predominantly through human transmission associated with sexual contact. The outbreak in Europe was primarily with the Clade IIb lineage, which is less virulent. The World Health Organization (WHO) declared this outbreak a Public Health Emergency of International Concern (PHEIC) in 2022, which ended in May 2023 after a decline in cases. However, in July 2024, a resurgence of the more virulent Clade I occurred in the Democratic Republic of Congo (DRC), leading WHO to declare mpox a PHEIC again, due to the risk of global spread. Understanding epidemiology and risk factors of mpox is vital for effective public health measures. Methodology and principal findingsA search conducted from 2014 to 2024 across PubMed, Scopus and Embase identified 38 studies on mpox in Europe, which were included for qualitative analysis. The key themes identified were epidemiology and risk factors/ behaviors. High-risk behaviors include sexual contact among men who have sex with men (MSM) with multiple partners, living with HIV, and frequent travel to endemic regions. Conclusions and significanceWith no definitive cure for mpox, public health measures such as surveillance, monitoring, and contact tracing are essential. Additionally, encouraging case-control studies is crucial for exploring other potential risk behaviors and design behavioral interventions, vaccination campaigns and awareness programs aimed at reducing high-risk behaviors among these populations. Although the number of cases in Europe did not surge in August 2024, proactive measures are necessary to prevent further spread.