Its difficult to overstate just how influential Vampire: The Masquerade was in a post-Twilight era when vampires have so much shade thrown on them. Ironically, it's in part because of the tabletop roleplaying game that the undead became so over-saturated. BLADE, TRUE BLOOD, UNDERWORLD, and other works all drew from the lore of the game. There was a badly made Aaron Spelling TV series that I still have a fondness for and a couple of awesome video games. It was an influence on my STRAIGHT OUTTA FANGTON and I WAS A TEENAGE WEREDEER books and I can name many other urban fantasy authors who had some experience with the game.
The premise of the game is extremely simple: you are a vampire in the modern world. At some point in the last fifty years, your character was a normal human being transformed into one of the undead. You are part of an undead society that exists behind the scenes and must maintain a constant vigilance so humans cannot find out about your existence. This is the titular Masquerade. Nightly unlife is a constant struggle against the vampire nobility, vampire hunters, werewolves, and your dwindling humanity. If you give into the killing urge too often, you'll eventually degenerate into a mindless beast that has to be put down.
The 5th Edition of the game opens up with thirty pages of in-universe fiction that is designed to appeal to the now 30 and 40 year old fans of the game who played it in high school. The opening story is a letter from Mina Harker, a real person in the setting, who is addressing one of her descendants she's Embraced (turned into a vampire) out of loneliness. Other fiction talks about how the Camarilla (vampire society) has fallen and a Second Inquisition of ABC agencies globally has started a massive purge of the undead. Yes, the Masquerade is partially broken and now vampires have to fear drone strikes as well as thermal-vision equipped Special Forces.
The idea of the government knowing about the undead is probably the only way you could believably do the Masquerade in the 21st century. In an age of cellphone cameras, cloud servers, instant global communication, and satellite networks--it's slightly more believable the intelligence communities want to avoid a global panic from the revelation the supernatural is real. I also like how the gameline says humanity is kicking the collective asses of vampiredom. Setting juggernauts like the Tremere Inner Council and Camarilla's leadership are wiped out to remind people why the Masquerade is so important.
Previous editions were criticized for overly relying on their metaplot. So much so that the 20th anniversary edition of Vampire: The Masquerade (4th Edition by my count) actively removed all references to it. However, while the metaplot was overdone, I think it's one of the chief reasons to upgrade to a new edition. Seeing how old favorites and characters you had an attachment to growing up is something worthwhile. I've already heard they have plans for a 5th Edition of Chicago by Night and I'd enjoy discovering what the characters within have been up to for twenty years.
Gameplay-wise, the biggest change is the focus of the game is shifted. Previous editions were a power fantasy where the majority of focus was on your disciplines. Many characters were built like Connor Macleod with a trench coat, a katana hidden underneath it, and a bunch of awesome superpowers. Now, the game greatly broadens the focus on hunger and feeding. Many pages are spent discussing how a vampire feeds, what they feed on, and how they feel about who (or what) they eat. There's also a change to Humanity in order to make what a character cares about and how they stay sane more varied.
Fans of all thirteen clans may be disappointed to discover the book contains descriptions of only the original seven clans, Caitiff, and Thin Bloods. There's some light revisions to them like the fact the Gangrel's flaws are no longer as severe and the Malkavian's insanity is not related to any "real" mental illness (as they had previously been depicted as tricksters and doomsaying prophets--not really things you want to associate with the mentally ill). We also get updates to Disciplines (vampire powers), which are much more versatile. Perhaps the best rules revision is that its much harder to feed on animal blood or blood bags if you're a vampire of power. Vampires also become more powerful as they age in terms of Blood Potency.
Fans of the Sabbat, Followers of Set, Giovanni, Ravnos (they exist, or so I hear!), and Assamites will wonder why they didn't do all thirteen clans. Also, why there was no focus on the Paths of Enlightenment that serve as alternatives to Humanity. While I imagine part of this is a space issue, I think it's actually a thematic issue. The above clans are the most inhuman of Kindred and they're really beating the drum of V:TM as a game about coping with the horror of one's condition. Besides, they have to get you to buy the supplements somehow. That's good business and I'm not just saying that because I leave cliffhangers in my books for the exact same reason (bwhahahaha!).
The book has beautiful artwork spread throughout, using photos and touch-ups to give impressions of how the gameworld looks. Some of the artwork isn't great, like the Nosferatu look like poor college students and runaways than horrifying monsters in their Clan write-up, but most of it is incredible. The game is clearly intended for an older, more mature audience. This is a good thing as we finally get straight answers on everything from whether Kindred can have sex (High Humanity vampires can) to how to make a Herd of mortals.
The general tone of the book is dark and edgy in a deliberately overdone style that implies Kindred are selfish monstrous creatures at every turn. One of my favorite pieces of art is a Ventrue debutante with her slave sitting underneath her as she wears a slit dress while posing over the city. Beside her, she has a little speech about how being rich made her life a party but being undead has made the world her bitch. There's some questionable choices but the general sense is the game is trying to be politically aware in a time when punk is feeling out of fashion but never so relevant. Whereas the original books were Gothic Punk written for sixteen-year-olds, this feels more like it was written for people who watch HBO and FX.
There's some bad decisions in the book, I think. For one, there's a short story about how the Sabbat tried to claim credit for 9/11 despite having nothing to do with it. It's an attempt to refute the "vampires behind everything" of previous editions but I don't think anyone really needed a story about in the first place. I'm also not sure how Thin Bloods, a bunch of almost human vampires in the modern age, ended up making their own path of alchemy. The absence of a opening adventure like Gencon's Rusted Veins was a mistake, IMHO, as that was incredible. I also think making rules about how nice a vampire has to be to have sex is a bad decision.
Gameplay mechanics-wise, I think 5th Edition suffers a bit in design. The Predator types, basically how and what you feed on, are a major part of the new game. However, they aren't very well described and sometimes the mechanics doesn't make sense for what you're eating. For example, one kind of vampire only feeds from other vampires but it doesn't explain how you do that--especially with the Blood Bond being a thing. Some players will also object to the changes to favored clans like the Tremere who have gone from the Clan which everyone is Blood Bonded in to the Clan which can't do Blood Bonds period. The absence of Paths and Sabbat clans feels wrong, especially as they have a role as both antagonists as well as players. Given the Lasombra have supposedly joined the Camarilla, their presence is sorely missed.
Still, I think the game is fantastic. Vampire's 20th Anniversary Edition was great but it didn't feel sufficiently distinct from Revised. Every game is going to carry a heavy bias on "how you should play it." I think this manages to improve on Vampire: The Requiem, which also wanted to bring gamers into deeply personal horror stories but I feel failed in the fact it didn't provide a strong enough direction on how to do that. 5th Edition feels like it not only knows what it wants but is capable of showing gamers how to do it.