Changing trends in global burden of mpox infection from 1970 to 2025: A systematic review and observational study

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Abstract
Mpox resurged globally in 2022 after five decades of African confinement. Pooling 70 studies (1970–2025) and WHO surveillance, we show hospitalisation and case-fatality fell from 33% and 3.3% pre-2022 to 10% and 0.7% during the clade-IIb pandemic. Clade-Ia remained high deadlier (≈80% admission, 9% death). Since 2024, Central Africa has again driven cases and deaths. High-income regions recorded milder, larger outbreaks; Africa continues to bear excess mortality. Targeted clade-Ia surveillance, vaccination and health-system support in Central Africa are urgently needed to curb mpox’s persistent global burden.