Transmission patterns and future forecasting of mpox: a review of mathematical modelling approaches for prediction and public health preparedness

Mpox has shifted from a disease mainly associated with zoonotic spillover in Central and West Africa to a recurrent global public-health threat involving sexual-contact networks, household transmission, international mobility, ecological persistence and clade-specific uncertainty. Mathematical models have clarified important mechanisms in the 2022 clade IIb outbreak, including the role of heavy-tailed sexual-contact distributions, behavioural adaptation, vaccination and case isolation. However, the literature remains less mature in one respect that is essential for preparedness: the conversion of transmission insight into reliable, setting-specific forecasts. This narrative review synthesizes peer-reviewed modelling evidence on mpox transmission patterns and evaluates the extent to which existing compartmental, stochastic, network, agent-based, phylodynamic and time-series models support future outbreak prediction. The review identifies four recurring gaps: insufficient prospective validation, weak integration of spatial and cross-regional lags, limited clade-specific parameterization for clade I/Ib risk, and inadequate incorporation of immunity, reporting delay and surveillance uncertainty. We propose a forecasting-oriented framework that links epidemiological state variables, contact structure, population immunity, mobility, interventions and uncertainty quantification to decision-relevant outputs. The novelty of this review lies in repositioning mpox modelling from retrospective explanation toward predictive readiness. A forecasting-first approach can strengthen early warning, targeted vaccination, communication planning and health-system preparedness, particularly in settings where surveillance is delayed, incomplete or geographically fragmented.