Zoonotic orthopoxviruses after smallpox eradication: A shift from crisis response to a One Health approach

A systematic literature review was performed to assess the research trend on zoonotic orthopoxviruses (ZOPXV) as disease agents and as vectors for biomedical use in the period 2000-2023. The database search yielded to 669 titles of which 530 were excluded, not meeting the inclusion criteria. The analysis of the included 139 article showed that poxviruses are still widely studied as means to combat other diseases. Overall, 120 papers regarding ZOPXV role as pathogens were analyzed. It has been evidenced that, a limited number of research groups have been engaged in VACV and CPXV infections research in the last two decades. However, they largely contributed not to turn off the spotlight on these diseases. On the other hand, given the small size of the research network, the data remain restricted to a limited number of geographical contexts. The interest on MPXV, as a re-emerging pathogen, has grown in time starting with the first outbreak outside endemic areas in 2003 and culminating during and after the 2022 pandemic, as evidenced by a number of publications from different countries in the last 2 years. Inconsistencies between the geographic provenance of authors and study sites were particularly evident for MPXV research performed in Africa seldomly carried out by local authors alone. This constitutes a ground of reflection as ZOPXV diseases are endemic in Africa where research and surveillance need to be strengthened. Since the beginning of the millennium, authors have warned about the effects of waning immunity, after cessation of smallpox vaccination, and identified social and ecological factors boosting the emergence and spread of the diseases. Scientific evidence, to prioritize ZOPX diseases have been provided during the last two decades; nevertheless, these remain neglected by the global health agenda leading to persistent adoption of a reactive model in the event of an emergency.