Epidemiological shifts and zoonotic drivers of mpox in Nigeria: A One Health systematic review and meta-analysis, 2017–2025

Introduction: Since its re-emergence in 2017, mpox has become a significant public health priority in Nigeria. Despite numerous studies, epidemiological estimates remain fragmented. This review synthesises current evidence on the prevalence, mortality, and One Health drivers of mpox in Nigeria. Methods: Following PRISMA guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar for studies on mpox epidemiology in Nigeria published between 2017 and 2025. Random-effects meta-analysis was used to estimate pooled laboratory confirmation and case fatality rates (CFR). Results: Seventeen studies met the inclusion criteria. The pooled laboratory confirmation rate among suspected cases was 36.7% (95%CI: 22.2-54.1%), with significant heterogeneity (I2=93.7%). The pooled CFR among confirmed cases was 7.0% (95%CI: 5.4-9.2%). Critically, the CFR for HIV-positive individuals was 26.2% (CI: 4.2-73.9%), representing a nearly fourfold increase in mortality risk. Narrative synthesis of recent outbreaks (2022-2025) suggests evolving transmission dynamics, including the emergence of sexual transmission pathways and increased genital presentations, though quantitative comparisons were limited by heterogeneity in outcome reporting. While 1.8-21.5% of cases reported animal contact, no studies performed primary sampling of animal reservoirs. Environmental drivers, including flooding and deforestation, were consistently linked to seasonal peaks in the wet season (September-November). Conclusion: Mpox in Nigeria is characterised by evolving transmission dynamics and a high burden among immunocompromised populations. The lack of integrated human-animal-environmental sampling highlights a critical gap in the One Health response. Strengthening surveillance for asymptomatic infections and integrating HIV-mpox care are urgent priorities for national preparedness.