Mpox virus clade evolution and epidemiology in Africa: a systematic review of genetic variability and clinical impact

Abstract Background: The Mpox virus (MPXV), formerly known as monkeypox virus, is re-emerging in endemic and non-endemic regions, driven in part by divergent genetic lineages: Clade 1 and Clade 2. Objective : This systematic review synthesizes current evidence on the genomic variability of MPXV in Africa and its relationship to clinical severity, transmission dynamics, and outbreak patterns. Methods : Following PRISMA guidelines, we searched Semantic Scholar, PubMed, Google Scholar, and other relevant databases to identify studies comparing Clade 1 and Clade 2. Data extraction included mutation profiling, outbreak size, and transmission dynamics. Results : Eleven studies met inclusion criteria. Clade 1, predominant in Central and East Africa, exhibits key deletions in virulence genes (D14L, complement control protein) and high mortality rates (up to 10%). Clade 2, prevalent in West Africa and globally, shows extensive APOBEC3-type mutations, frameshifts, and tandem repeats, with milder disease and enhanced human-to-human transmission. Conclusion : Genetic differences in virulence and immune evasion genes fundamentally influence outbreak characteristics across Mpox clades. Improved genomic surveillance is critical for public health preparedness.