Mpox Outbreaks Beyond Historically Endemic Regions: A Clinical Review of Vaccination Strategies and Public Health Challenges

BACKGROUND: Mpox, caused by the monkeypox virus, emerged as a global public health concern following the 2022 outbreaks in non-endemic regions. Although classical presentations include a febrile prodrome and mucocutaneous lesions, atypical symptoms and stigma have complicated clinical recognition and containment. Smallpox-derived vaccines, such as ACAM2000 and modified vaccinia Ankara, have been deployed for prophylaxis; however, access, policy implementation, and public acceptance remain inconsistent across regions. SUMMARY: Global mpox vaccination strategies demonstrate pronounced disparities in coverage, infrastructure, and public trust. High-income countries, including the United States and European nations, prioritized men who have sex with men, transgender individuals, and people living with HIV through targeted outreach in sexual health clinics and community-based programs. In contrast, many South-East Asian and African nations lacked coordinated vaccination campaigns due to limited resources, weak surveillance systems, and low awareness. Misinformation and sociocultural stigma further suppressed vaccine uptake, particularly in parts of the Eastern Mediterranean region. In settings such as Taiwan and the Netherlands, inclusive public health messaging and equitable access policies contributed to higher vaccination coverage. Healthcare worker knowledge significantly influenced vaccine delivery, though educational gaps persist. KEY MESSAGES: Despite demonstrated efficacy, vaccination coverage remains globally inequitable, with disparities shaped by structural and social determinants, including race, socioeconomic status, and geography. Dermatologists play a pivotal role in early detection, patient counseling, and vaccine advocacy. Strengthening coordinated, evidence-based vaccination strategies is essential to improving outbreak preparedness and advancing global health equity.