A review of vaccines and antivirals against human poxviruses with special emphasis on mpox virus.

A significant proportion of the global population with waning immunity to smallpox is susceptible to poxviruses. Zoonotic orthopoxviruses are re-emerging and emerging worldwide, including the mpox virus, vaccinia virus, and cowpox virus. Knowledge gaps exist regarding reservoir hosts for many poxviruses, modes of transmission, zoonotic potential, and vaccine effectiveness. The precise natural reservoir of many emerging zoonotic infections such as vaccinia virus, cowpox virus, and mpox virus is unknown which is a significant barrier to the development of appropriate public health preventive measures, including vaccines and antivirals. Accurate diagnosis of the pox virus causing lesions in animals is essential for proper veterinary preventive measures including vaccinating noninfected neighboring herds. Adopting strict personal hygiene among farm workers, butchers, and veterinarians will prevent the spread from animals to humans. The availability of specific anti-pox virus medications is limited, and many candidate drugs are undergoing clinical trials. Management of any health emergency requires regional collaboration and efficient public health leadership. Antivirals or vaccines to manage many pox viruses are inaccessible in endemic countries, home to many rare zoonotic pox viruses.