Nanomedicine and One Health Approaches for Monkeypox: Emerging Preclinical Strategies for Prevention, Diagnosis, and Treatment.

The global resurgence of mpox, caused by monkeypox virus (MPXV), has highlighted the need for effective antiviral strategies, rapid diagnostics, vaccination, and integrated preparedness approaches. This review critically examines recent advances in MPXV biology, pathogenesis, transmission, clinical manifestations, prevention, diagnosis, treatment, and emerging nanomedicine-based strategies within a One Health framework. Particular emphasis is placed on nanoparticle-enabled vaccines, diagnostics, therapeutics, and wastewater surveillance, highlighting their potential to improve antigen delivery, diagnostic sensitivity, targeted drug delivery, and population-level monitoring. The review also compares conventional and nanoscale approaches and evaluates the current evidence supporting their efficacy and translational potential. Importantly, most nano-enabled MPXV interventions remain at the preclinical stage, and their reported performance cannot be directly compared because of differences in nanoparticle composition, target antigens, experimental models, assay conditions, and clinical validation strategies. Major challenges include long-term safety, pharmacokinetics, reproducibility, scalability, storage stability, regulatory approval, and the limited availability of well-designed clinical studies. Within the One Health framework, effective MPXV control also requires coordinated surveillance of human, animal, and environmental reservoirs, including standardized wastewater monitoring and cross-sectoral data sharing. Future research should therefore prioritize rigorous clinical validation, standardized evaluation protocols, diverse MPXV clade testing, long-term safety assessment, scalable manufacturing, and integrated human-animal-environmental surveillance.