Origin of monkeypox outbreaks in non-endemic countries

In a recent review posted on OSF* Preprint server The author explained the reasons for the mysterious origin of the recent outbreak of monkeypox in non-endemic countries outside Africa.

Study: Origin of the mysterious monkeypox outbreak in multiple countries in non-endemic countries. Image Credit: FOTOGRIN / Shutterstock


Cases of monkeypox are increasing in many non-endemic countries around the world despite the lack of travel links and gatherings associated with Africa. Despite its worldwide prevalence, the reasons why monkeypox originated outside the African continent is unclear. If the more deadly Ebola virus turns out similarly, serious consequences for human health can be expected, and therefore, the origin of the mysterious outbreaks of monkeypox must be understood.

In this review, researchers report on the causes of monkeypox outbreaks in many non-endemic countries around the world.

Pathological manifestations of monkeypox infection do not require transmission of monkeypox virus to other organisms

The recent outbreaks of monkeypox cannot be explained based on the logical conclusions of the data obtained through empirical analysis but by clarifying the reality and making only reasonable conclusions to obtain results that must agree with the experiments.

The effects of pathogens that allow immune pathways to protect organisms from infection by those pathogens do not depend on the exclusive nature of a particular pathogen but on the immunological nature in which the pathogenic effects are shared with the sterile pathogenic effects.

Immune mechanisms that reduce pathogen load among animals may not necessarily reduce disease severity or render the disease asymptomatic. This is supported by the lower loads of SARS-CoV-2 that have been reported in fewer severe SARS-CoV-2 infections than in mild SARS-CoV-2 infections. The results suggest that disease severity depends on the hyperinflammatory state rather than the direct effects of pathogen toxicity.

Therefore, outbreaks of infections that were considered asymptomatic do not necessarily require transmission of pathogens but rather, the disappearance of many that allow immune mechanisms as asymptomatic without eliminating the causes of disease.

The manifestations of monkeypox in one case may not be the same as in others and may appear in the absence of monkeypox virus

Different diseases may appear for different reasons but have identical immunopathological effects with different manifestations in the absence of the pathogen (monkeypox virus). Different causes with effects of the same immunological nature appear concurrently in cases of monkeypox and are already present in individuals in non-endemic countries. Therefore, monkeypox outbreaks have appeared in areas outside the African continent, although there are no travel links and clusters connected to Africa.

Researchers have made relentless efforts to characterize the genetic basis of the large-scale global spread of monkeypox in central parts of Africa compared to western regions of Africa. It was assumed that the pathogens responsible for the outbreak in Central Africa had higher transmissibility and potency than those responsible for the outbreak in West Africa.

However, a common observation among all groups of monkeypox cases is exposure to factors that facilitate the disappearance of conditions that allow immune mechanisms to render monkeypox asymptomatic without eliminating the etiological factors of the same immune nature. Therefore, the origin of monkeypox in non-endemic areas does not depend on the transmissibility or virulence of monkeypox virus, but rather on the disappearance (and re-emergence) of conditions that respond to the manifestations of monkeypox.

Moreover, the manifestations of infection associated with a particular pathogen are as diverse as the disappearance of conditions that allow the immune system and various drivers of the same immunity to lead to asymptomatic concomitant infections. The severity of manifestations is comparable to that of infections that share the same immunity, regardless of the susceptibility to infection and the virulence of the pathogenic organism.

Pathogen-associated manifestations may cause catastrophic effects in individuals even in the absence of the causative agent if the agents create conditions that allow the infection with the same immunity to be considered asymptomatic. Such an infection can spread widely within a short period.


Based on the findings, further research should explore the immunological nature of the more deadly Ebola virus infection and identify different diseases that share immunity with Ebola infection, respectively.

Such an approach would be more useful in preventing potentially catastrophic effects of Ebola infection than investigating the genetic basis of Ebola virus infection or transmissibility and subversion of Ebola virus. In addition, factors that allow immune mechanisms to be considered asymptomatic Ebola virus infection must be identified.

*Important note

OSF publishes preliminary scientific reports that have not been peer-reviewed and therefore should not be considered conclusive, guide clinical practice/health-related behaviour, or be treated as established information.


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