Epidemiological trends and clinical features of the ongoing monkeypox epidemic: A preliminary pooled data analysis and literature review

Abstract

An emerging outbreak of monkeypox infection is quickly spreading worldwide, being currently reported in more than 30 countries, with slightly less than 1000 cases. In the present preliminary report, we collected and synthesized early data concerning epidemiological trends and clinical features of the ongoing outbreak and we compared them with those of previous outbreaks. Data were pooled from six clusters in Italy, Australia, the Czech Republic, Portugal, and the United Kingdom, totaling 124 cases (for 35 of which it was possible to retrieve detailed information). The ongoing epidemic differs from previous outbreaks in terms of age (54.29% of individuals in their thirties), sex/gender (most cases being males), risk factors, and transmission route, with sexual transmission being highly likely. Also, the clinical presentation is atypical and unusual, being characterized by anogenital lesions and rashes that relatively spare the face and extremities. The most prevalent sign/symptom reported was fever (in 54.29% of cases) followed by inguinal lymphadenopathy (45.71%) and exanthema (40.00%). Asthenia, fatigue, and headache were described in 22.86% and 25.71% of the subjects, respectively. Myalgia was present in 17.14% of the cases. Both genital and anal lesions (ulcers and vesicles) were reported in 31.43% of the cases. Finally, cervical lymphadenopathy was described in 11.43% of the sample, while the least commonly reported symptoms were diarrhea and axillary lymphadenopathy (5.71% of the case series for both symptoms). Some preliminary risk factors can be identified (being a young male, having sex with other men, engaging in risky behaviors and activities, including condomless sex, human immunodeficiency virus positivity (54.29% of the sample analyzed), and a story of previous sexually transmitted infections, including syphilis). On the other hand, being fully virally suppressed and undetectable may protect against a more severe infectious course. However, further research in the field is urgently needed.

When a Neglected Tropical Disease Goes Global: Knowledge, Attitudes and Practices of Italian Physicians towards Monkeypox, Preliminary Results

“…In other words, while a proper measurement of the potential role of conventional media on the modelling of knowledge, beliefs, and perceptions remains difficult to achieve, the proxy represented by the RSV seemly suggests that new media had no substantial influence on the data reporting. On the other hand, the data we present here were collected at the beginning of the MPX epidemic, when fewer than 1/10 of Italian cases officially notified by mid-June had been identified, but greater incertitude on the potential lethality of MPX infections still existed [ 87 ]. As a consequence, our estimates should be acknowledged as strictly bounded at the exact timeframe of the study (i.e., 24–31 May 2022), and we cannot rule out that a follow up study would lead to a different outcome.…”

“…Fifth, the General Knowledge test may also require further revision and adjustments, as the early epidemiological reports suggest that the ongoing pandemic may be associated with specific clinical features and a CFR that is far lower than previously reported, even from Western African (i.e., below 0.1%) [ 28 , 63 , 87 ]. For instance, skin lesions are often inconsistently pronounced in number, size, and density, being possibly confounded with chickenpox [ 16 , 89 ], and cervical lymphadenopathy, that was previously acknowledged as a nearly constant clinical sign, has been reported by less than 20% of early incident cases [ 16 , 89 , 90 ], and by 27% of cases notified to ECDC by 6 July 2022 [ 26 ].…”

Assessing transmission risks and control strategy for monkeypox as an emerging zoonosis in a metropolitan area

“…There is evidence of increased transmission efficiency among gbMSM 30 . Hence, we investigate the scenario that the transmission risk increases by 50%, making the within HRG R 0 ranged between 1.8 and 2.25.…”

Monkeypox and its Possible Sexual Transmission: Where are we now with its evidence?

“…In 1958, the Danish virologist Preben Christian Alexander von Magnus discovered the monkeypox virus (MPXV) in Copenhagen [1]. It was reported as a zoonotic disease transmitted from animals to humans by MPXV.…”