Monkeypox: considerations for the understanding and containment of the current outbreak in non-endemic countries

Quarleri, Jorge; Delpino, M Victoria; Galván, Verónica

doi:10.1007/s11357-022-00611-6

Cited by 92 publications

(134 citation statements)

References 53 publications

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“…A critical differentiating clinical finding is lymphadenopathy (62%), which is not present in other diseases such as smallpox or varicella [76]. However, even lymphadenopathy does not differ significantly in frequency between Africans and Europeans, and probably across the years of study, confirming their importance as a clinical finding in monkeypox [77,78].…”

Section: Discussionmentioning

confidence: 89%

Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Benítes-Zapata

Ulloque-Badaracco

Alarcón-Braga

et al. 2022

Ann Clin Microbiol Antimicrob

109

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Introduction A multicountry monkeypox disease (MPX) outbreak began in May 2022 in Europe, leading to the assessment as a potential Public Health Emergency of International Concern (PHEIC) on June 23, 2022. Some observational studies have partially characterised clinical features, hospitalisations, and deaths. However, no systematic reviews of this MPX outbreak have been published. Methods We performed a systematic review with meta-analysis, using five databases to assess clinical features, hospitalisations, complications and deaths of MPX confirmed or probable cases. Observational studies, case reports and case series, were included. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In addition, we carried out a subgroup analysis according to the continents and a sensitivity analysis excluding studies classified as having a high risk of bias. Results A total of 19 articles were included, using only 12 articles in the quantitative synthesis (meta-analysis). For 1958 patients, rash (93%, 95% CI 80–100%), fever (72%, 95% CI 30–99%), pruritus (65%, 95% CI 47–81%), and lymphadenopathy (62%, 47–76%), were the most prevalent manifestations. Among the patients, 35% (95% CI 14–59%) were hospitalised. Some 4% (95% CI 1–9%) of hospitalised patients had fatal outcomes (case fatality rate, CFR). Conclusion MPX is spreading rapidly, with a third of hospitalised patients, but less than 5% with fatal outcomes. As this zoonotic virus spreads globally, countries must urgently prepare human resources, infrastructure and facilities to treat patients according to the emerging guidelines and the most reliable clinical information.

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Section: Discussionmentioning

confidence: 89%

Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Benítes-Zapata

Ulloque-Badaracco

Alarcón-Braga

et al. 2022

Ann Clin Microbiol Antimicrob

109

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“…It has been noted that the DNA virus mutation rate is slow compared to RNA virus. It was noted that the variola virus's evolution rate is about 1 × 10 −5 substitutions per site per year [84,85]. If we calculate in terms of nucleotide changes, it should be related to approximately 1-2 nucleotide changes per year.…”

Section: Discussionmentioning

confidence: 99%

Evolution, epidemiology, geographical distribution, and mutational landscape of newly emerging monkeypox virus

et al. 2022

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Recent monkeypox (MPX) outbreaks are major ones in non-endemic countries. The present study analyzed molecular phylogenetics, divergence, epidemiology, the geographical distribution, entropy diversity of genome, mutational landscape, and evolution of the monkeypox virus (MPXV) genome and the current MPXV is entitled “hMPXV1.” We used different in-silico and statistical methods to study our objectives. The developed phylogram from molecular phylogenetics describes the origin and evolution of hMPXV1 of A, A.1, A.1.1, A.2, and B.1 lineages. The microevolution of B.1 lineage shows its evolution from May to August 2022. B.1 lineage is further adapting and showing more mutation and sub-lineages. The scatter plot of all lineages shows the clustering pattern of lineages and the divergence. We also developed two statistical models of confirmed cases and a diagram of the age-related pattern of infected cases to illustrate the epidemiology of the MPX outbreaks. The entropy diversity and mutational landscape of the hMPXV1 genome were analyzed in nucleotide and codon contexts. Our study has shown the in-depth evolution pattern of different lineages of the hMPXV1. We found B.1 lineage is associated with the current outbreaks. The mutational landscape informs about the slow mutation of the virus. Finally, the study might assists the new therapeutic development considering all the above points and would help the researcher to set up their future research directions.

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“…A critical differentiating clinical nding is lymphadenopathy (62%), which is not present in other diseases such as smallpox or varicella [73]. However, even lymphadenopathy does not differ signi cantly in frequency between Africans and Europeans, and probably across the years of study, con rming their importance as a clinical nding in monkeypox [74,75].…”

Section: Discussionmentioning

confidence: 99%

Clinical Features, Hospitalisation and Deaths associated with Monkeypox: A systematic review and meta-analysis

Benítes-Zapata

Ulloque-Badaracco

Alarcón-Braga

et al. 2022

Preprint

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Introduction: A multicountry monkeypox disease (MPX) outbreak began in May 2022 in Europe, leading to the assessment as a potential Public Health Emergency of International Concern (PHEIC) on June 23, 2022. Some observational studies have partially characterised clinical features, hospitalisations, and deaths. However, no systematic reviews of this MPX outbreak have been published.Methods: We performed a systematic review with meta-analysis, using five databases to assess clinical features, hospitalisations, complications and deaths of MPX confirmed or probable cases. Observational studies, case reports and case series, were included. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). In addition, we carried out a subgroup analysis according to the continents and a sensitivity analysis excluding studies classified as having a high risk of bias.Results: A total of 19 articles were included, using only 12 articles in the quantitative synthesis (meta-analysis). For 1958 patients, rash (93%, 95%CI 80-100%), fever (72%, 95%CI 30-99%), pruritus (65%, 95%CI 47-81%), and lymphadenopathy (62%, 47-76%), were the most prevalent manifestations. Among the patients, 35% (95%CI 14-59%) were hospitalised. Some 4% (95%CI 1-9%) of hospitalised patients had fatal outcomes (case fatality rate, CFR).Conclusion: MPX is spreading rapidly, with a third of hospitalised patients, but less than 5% with fatal outcomes. As this zoonotic virus spreads globally, countries must urgently prepare human resources, infrastructure and facilities to treat patients according to the emerging guidelines and the most reliable clinical information.

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Monkeypox: considerations for the understanding and containment of the current outbreak in non-endemic countries

Cited by 92 publications

References 53 publications

Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Evolution, epidemiology, geographical distribution, and mutational landscape of newly emerging monkeypox virus

Clinical Features, Hospitalisation and Deaths associated with Monkeypox: A systematic review and meta-analysis

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