Title : Impact of climatic variations on the global distribution and prevalence of MPOX disease: Analysis of data from 52 countries using linear regression and time-series forecasting analyses

Background: Mpox (MPOX)has emerged as a growing global public health concern, with pronounced heterogeneity in transmission patterns and outcomes across and within regions. Notably, substantial disparities in MPOX prevalence have been observed between neighbouring countries with comparable health systems and sociodemographic profiles, suggesting that contextual factors beyond surveillance and healthcare access may influence disease dynamics. Climatic conditions represent a plausible but underexplored determinant of these observed differences. However, the extent to which climate variability contributes to MPOX prevalence and mortality at global and regional levels remains insufficiently characterised.

Methods: Weconducted a quantitative longitudinal ecological study with cross-sectional comparisons and time-series modelling to examine the association between climatic variables and MPOX epidemiology across 52 countries. Daily confirmed MPOX case data were analysed in relation to average mean surface air temperature (AMSAT), precipitation, and Köppen climate classifications. Linear regression models were used to assess global and regional associations between climate variables and MPOX prevalence and mortality. To capture temporal dynamics and seasonality, we employed Prophet and Seasonal Autoregressive Integrated Moving Average with Exogenous Variables (SARIMAX) models to forecast trends and evaluate potential future resurgence patterns.

Results: At the global level, no statistically significant associations were observed between temperature or precipitation and MPOX prevalence (p = 0.99 and p = 0.82, respectively), nor with mortality (p = 0.45 and p = 0.54). However, region-specific analyses revealed marked heterogeneity. Temperature was positively associated with MPOXprevalence in Europe (p = 0.049) and South America (p = 0.0036), while precipitation was significantly associated with MPOX prevalence in South America (p = 0.044). Countries within tropical and temperate climate zones demonstrated the highest MPOX burden. Time-series modelling using the Prophet framework showed fluctuating, seasonally influenced effects of temperature and precipitation on MPOX prevalence, with their overall impact attenuating over time. Higher temperatures were consistently associated with increased prevalence, while precipitation exhibited a nonlinear, two-phase relationship. SARIMAX modelling suggested a potential, relatively modest resurgence of MPOX around 2030; although higher temperatures were again associated with increased prevalence, this relationship did not reach statistical significance (p = 0.561). Precipitation levels between 500 mm and 1500 mm were associated with a slight, though non-significant, increase in MPOX prevalence (p = 0.113).

Conclusion: Although climatic variables do not exert a uniform global influence on MPOX prevalence or mortality, their effects vary substantially by region and climate zone and may partially explain disparities observed between geographically proximate countries. These findings underscore the importance of region-specific, climateinformed surveillance and preparedness strategies. Integrating climatic indicators into infectious disease monitoring frameworks may strengthen early warning systems andsupport targeted public health interventions aimed at mitigating future MPOX transmission and impact.

Dr. Iyanuloluwa Ojo is a Chevening Scholar, medical doctor, and MPH candidate at the University of Leeds with research interests in the epidemiology of non-communicable and hematologic diseases in low- and middle-income countries. His work includes systematic reviews, meta-analyses, and population-level studies on infectious diseases, vaccination uptake, and hematologic malignancies, with a strong focus on Sub-Saharan Africa. He served as the pioneer Ekiti State Coordinator for Slum and Rural Health Initiative, one of Africa’s largest health NGOs, and as the Administrative Director of the MINTING Study, Nigeria’s first national research collaboration among house physicians, where he led research capacity-building initiatives.