Orthopoxvirus zoonosis: A potential threat across the Balkan countries.

Monkeypox disease (mpox) is an endemic zoonosis, previously restricted to Central and Western African countries. Since 2022, it is the most common orthopoxvirus (OPXV) zoonotic disease observed in non-endemic countries, including Europe and America, and 333 cases of mpox were already confirmed in the Balkan countries. To monitor and control the spread of mpox, a surveillance program was established in line with WHO guidelines. Although the risk of disease has diminished, sporadic cases still occur. The reemergence of mpox cases at the end of 2024 in Greece, where the first case was registered at the end of May 2022, and the first case recorded in Kosovo raised concerns about a potential outbreak of mpox in the Balkans. Here, we describe the clinical data of significant cases to provide a better understanding in terms of epidemiology, clinical symptoms and diagnostic methods for the detection of this disease. Our results reveal that mpox was diagnosed mainly among young and middle-aged men and people with high-risk behaviors, mostly as coinfections with the human immunodeficiency virus (HIV). This suggests that measures for effective tracing as well as vaccination of high-risk groups of the population are essential pillars to control mpox outbreaks.