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BACKGROUND: Viral load dynamics and shedding kinetics are critical factors for studying infectious diseases. However, evidence on the viral dynamics of mpox remains limited and inconclusive. Thus, we aimed to provide a comprehensive understanding of viral load and viability of the re-emerged mpox virus since 2022.METHODS: For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, and Google Scholar for published articles which are related to mpox viral dynamics up to April, 2023.RESULTS: From 19 studies, 880 samples and 1477 specimens were collected. The pooled median Ct values appeared in the following order: skin lesion (Ct value 21.7 [IQR 17.8-25.5]), anorectal (22.3 [16.9-27.6]), saliva (25.9 [22.5-31.1]), oral (29.0 [24.5-32.8]), semen (29.6 [25.9-33.4]), urine (30.5 [24.6-36.4]), pharyngeal (31.9 [26.5-37.3]), urethra (33.0 [28.0-35.0]), and blood (33.2 [30.4-36.1]). People living with HIV have lower Ct value in the skin (skin HIV+, 19.2 [18.3-20.0] versus skin HIV-, 25.4 [21.2-29.0]). From the Ct values and test day since symptom onset, we identified temporal trends of viral load for each specimen type. Changes in the trend were observed at 4 days in saliva, 5 days in blood, 6 days in skin, 7 days in anorectal, urine, semen, pharyngeal, and 8 days in urethra. We determined optimal Ct cutoff values for anorectal (34.0), saliva (27.7), and urethra (33.0) specimens, where a Ct value above each cutoff suggests minimal viral viability. Using these cutoff values, we derived the duration of viable viral isolation in each specific specimen type (anorectal 19 days; saliva 14 days; and urethra 14 days).CONCLUSION: Skin lesion, anorectal, and saliva samples contained the highest viral load. The peak viral load manifests within 4-8 days after symptom onset, and viable virus detection was presumed to cease within 14-19 days from symptom onset in anorectal, saliva and urethra samples.