Availability, scope and quality of monkeypox clinical management guidelines globally: a systematic review

Abstract

BackgroundMonkeypox (MPX) is an important human Orthopoxvirus infection. There has been an increase in MPX cases and outbreaks in endemic and non-endemic regions in recent decades. We appraised the availability, scope, quality and inclusivity of clinical management guidelines for MPX globally.MethodsFor this systematic review, we searched six databases from inception until 14 October 2021, augmented by a grey literature search until 17 May 2022. MPX guidelines providing treatment and supportive care recommendations were included, with no exclusions for language. Two reviewers assessed the guidelines. Quality was assessed using the Appraisal of Guidelines for Research and Evaluation II tool.ResultsOf 2026 records screened, 14 guidelines were included. Overall, most guidelines were of low-quality with a median score of 2 out of 7 (range: 1–7), lacked detail and covered a narrow range of topics. Most guidelines focused on adults, five (36%) provided some advice for children, three (21%) for pregnant women and three (21%) for people living with HIV. Treatment guidance was mostly limited to advice on antivirals; seven guidelines advised cidofovir (four specified for severe MPX only); 29% (4/14) tecovirimat, and 7% (1/14) brincidofovir. Only one guideline provided recommendations on supportive care and treatment of complications. All guidelines recommended vaccination as post-exposure prophylaxis (PEP). Three guidelines advised on vaccinia immune globulin as PEP for severe cases in people with immunosuppression.ConclusionOur results highlight a lack of evidence-based clinical management guidelines for MPX globally. There is a clear and urgent need for research into treatment and prophylaxis including for different risk populations. The current outbreak provides an opportunity to accelerate this research through coordinated high-quality studies. New evidence should be incorporated into globally accessible guidelines, to benefit patient and epidemic outcomes. A ‘living guideline’ framework is recommended.PROSPERO registration numberCRD42020167361.

Monkeypox: epidemiology, pathogenesis, treatment and prevention

“…114,115 Meanwhile, monkeypox prevention and treatment guidelines have been issued in several countries around the world. 116 As of 13 September 2022, 57,995 monkeypox virus infections which were laboratory confirmed have been reported in >100 countries or regions across all six WHO regions 13 (Fig. 1 and Table 1).…”

Sequencing of Monkeypox virus from infected patients reveals viral genomes with APOBEC3-like editing, gene inactivation, and bacterial agents of skin superinfection

“…Although secondary bacterial infection of skin lesions are recognized as a common complication of monkeypox, the WHO recommends not to use antibiotics therapy or prophylaxis in patients with uncomplicated monkeypox because of the risk of emergence of multidrugresistant bacteria and of potential side-effects such as Clostridioides difficile diarrhoea (WHO, (CDC, 2022). In addition, on a total of 14 guidelines on monkeypox clinical management released worldwide until 2021, only two were considering, and recommending antibiotherapy for secondary complications (Webb et al, 2022).…”

“…Regarding US Centers for Disease Control and Prevention (CDC) guidelines, they recommend that antibiotic treatment should be considered in people who have secondary bacterial skin infections (CDC, 2022). In addition, on a total of 14 guidelines on monkeypox clinical management released worldwide until 2021, only two were considering, and recommending antibiotherapy for secondary complications (Webb et al, 2022). The first one was published by the Chinese Ministry of Health and the second one by the Nigeria Centre for Disease Control.…”

Prevention, Risk Exposure, and Knowledge of Monkeypox in Occupational Settings: A Scoping Review

“… Asia Asian countries have reported only a few cases during the current monkeypox outbreak so far [ 64 ]. Examples of monkeypox management guidelines are those issued in Taiwan and Singapore [ 65 ]. Guidelines regarding cases management and preventive measures have also been provided by the Saudi Arabia Public Authority [ 66 ].…”