Monkeypox epidemiology, clinical presentation, and transmission: a systematic review

Sharma, Ashima; Prasad, Hari; Kaeley, Nidhi; Bondalapati, Aparna; Edara, Lokesh; Kumar, Y. Ajay

doi:10.1186/s12245-023-00491-3

Cited by 19 publications

(8 citation statements)

References 40 publications

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“…We did not register any serious complications or deaths related to the infection. However, bronchopneumonia, sepsis, encephalitis, myocarditis, keratitis with visual loss, and rectal wall perforations have been described in previous reports [ 39 ]. Our hospitalization rate is close to the 8–13% seen in previous studies [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Epidemiological and Clinical Characteristics of Patients Admitted to a Secondary Hospital with Suspected MPOX Virus Infection: Is HIV Playing a Role?

Estévez,

Vara,

Gamo

et al. 2023

JCM

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MPOX (monkeypox) is a zoonotic viral disease, endemic in some Central and West African countries. However, in May 2022, cases began to be reported in non-endemic countries, demonstrating community transmission. Since the beginning of the outbreak, different epidemiological and clinical behaviors have been observed. We conducted an observational study at a secondary hospital in Madrid to characterize suspected and confirmed cases of MPOX epidemiologically and clinically. Besides the general descriptive analysis, we compared data between HIV-positive and HIV-negative subjects; 133 patients were evaluated with suspected MPOX, of which 100 were confirmed. Regarding positive cases, 71.0% were HIV positive, and 99.0% were men with a mean age of 33. In the previous year, 97.6% reported having sex with men, 53.6% used apps for sexual encounters, 22.9% practiced chemsex, and 16.7% went to saunas. Inguinal adenopathies were significantly higher in MPOX cases (54.0% vs. 12.1%, p < 0.001), as the involvement of genital and perianal area (57.0% vs. 27.3% and 17.0% vs. 1.0%, p = 0.006 and p = 0.082 respectively). Pustules were the most common skin lesion (45.0%). In HIV-positive cases, only 6.9% had a detectable viral load, and the mean CD4 count was 607.0/mm3. No significant differences were observed in the disease course, except for a greater tendency towards the appearance of perianal lesions. In conclusion, the MPOX 2022 outbreak in our area has been related to sexual intercourse among MSM, with no severe clinical cases nor apparent differences in HIV and non-HIV patients.

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Section: Discussionmentioning

confidence: 99%

“…In Europe, according to TESSy data updated to March 2023, 37.8% of patients with MPOX had HIV [ 42 ]. In other systematic reviews and meta-analyses, this percentage varies between 30.18% to 42.2% [ 31 , 39 , 43 ]. This percentage is almost twice as high in our hospital in Madrid, Spain, at 71.9%.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and Clinical Characteristics of Patients Admitted to a Secondary Hospital with Suspected MPOX Virus Infection: Is HIV Playing a Role?

Estévez,

Vara,

Gamo

et al. 2023

JCM

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“…In fact, the current data show that, regarding sex, age, and sexual orientation distribution, among cases with known data, a percentage of 96.9% of cases are related to male patients with a median age of 34 years. Furthermore, 79.9% of cases concern males between 18 and 44 years old, 84.8% of cases were diagnosed in men who have sex with men, and in 81.71% of cases, the transmission seems to be related to direct skin and mucosal contact during sexual activities [ 17 , 18 ].…”

Section: Diffusionmentioning

confidence: 99%

“…More than half of cases with known HIV status were HIV-positive, and 70.9% of all reported transmission events were due to a sexual encounter. In addition, several cases of syphilis coinfection have been reported recently [ 18 , 19 ].…”

Section: Diffusionmentioning

confidence: 99%

Monkeypox: A New Challenge for Global Health System?

Spirito

Guida

Caponio

et al. 2023

Life

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The COVID-19 pandemic, starting in 2020, has presented a major challenge in terms of early diagnosis and the subsequent containment and management of severe cases. The spread of viruses such as monkeypox in non-endemic countries is now creating new difficulties for healthcare professionals. Proper case definition and clinical examination are crucial for the early identification of suspected cases. For this reason, we performed a review of the literature in order to report the first signs, which are useful for healthcare providers for early case identification. Since 2022 to date, 86,930 laboratory-confirmed cases and 1051 probable cases have been reported worldwide, and of these, 116 were fatal cases and, for the first time, most of the cases were registered in countries that have not historically reported monkeypox and that lack direct or immediate epidemiological links to areas of West or Central Africa where the disease is endemic. Patients with Monkeypox experience prodromal symptoms, such as fever, fatigue, headache, muscle aches, and a rash after an incubation period of 5–21 days. The disease is usually self-limiting within 2–4 weeks but can lead to complications, such as pneumonia, encephalitis, kidney injury, and myocarditis in children, pregnant individuals, and those with weakened immune systems. The case–fatality ratio is between 1 and 10%. Today, prevention campaigns and the control of human monkeypox are the best weapons to prevent infection and stop transmission. Prevention strategies, such as avoiding contact with sick or dead animals, and the proper preparation of all foods containing animal meat or parts, should be adopted. Furthermore, close contact with infected people or contaminated materials should be avoided to prevent human-to-human transmission.

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“…The clinical presentation of mpox includes a distinctive, extensive rash, fever, headache, cough, asthenia, and lymphadenopathy. Additionally, complications such as coalescence of skin ulcers, bacterial skin infections, bronchopneumonia, and sepsis may occur [3]. MPXV is transmitted from animals to humans and between humans through contact with bodily fluids, lesions on the skin or mucosae, respiratory droplets, and contaminated objects [4].…”

Section: Introductionmentioning

confidence: 99%

MVA-BN Vaccine Effectiveness: A Systematic Review of Real-World Evidence in Outbreak Settings

Mason,

Betancur,

Riera-Montes

et al. 2024

Preprint

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Background: Mpox is a disease endemic to Central and West Africa. It caused outbreaks in non-endemic countries, mainly in 2022. The endemic Democratic Republic of Congo is currently experiencing its largest outbreak yet. The vaccine Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) is approved for active immunization against mpox and smallpox. Since the outbreak in 2022, real-world studies have assessed MVA-BN's vaccine effectiveness (VE) against mpox, and this systematic literature review aims to summarize the most current evidence. Methods: Medline (via PubMed), Embase, and LILACS were searched, as well as grey literature sources and publications' bibliographies to identify observational studies published between 1/Jan/2022 and 28/Feb/2024 that estimate the VE of MVA-BN against symptomatic mpox or provide risk measures that allow calculation of these VE estimates. Data were presented descriptively in tables and text; the methodological quality of included records was assessed using an informal qualitative approach. Results: The literature search identified a total of 16 records that fit the inclusion criteria. The studies took place in high-income countries and were heterogenous in design, setting, and definition of at-risk populations. MVA-BN VE estimates against symptomatic mpox infection ≥14 days post-vaccination were assessed. Where the study population was exclusively or primarily those receiving pre-exposure prophylactic vaccination, the adjusted VE estimates ranged from 35% to 86% (n=8 studies) for one dose and from 66% to 90% (n=5) for two doses. Where only post-exposure prophylactic vaccination was assessed, adjusted VE estimates were reported for one dose only at 78% and 89% (n=2). Additionally, MVA-BN reduced the risk of mpox-related hospitalization in one study and the severity of mpox clinical manifestations in two studies. Conclusions: Despite heterogeneity in study design, setting, and at-risk populations, the reported VE estimates against symptomatic mpox infection for one or two doses of MVA-BN support deployment of MVA-BN for mpox outbreak control.

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Monkeypox epidemiology, clinical presentation, and transmission: a systematic review

Cited by 19 publications

References 40 publications

Epidemiological and Clinical Characteristics of Patients Admitted to a Secondary Hospital with Suspected MPOX Virus Infection: Is HIV Playing a Role?

Epidemiological and Clinical Characteristics of Patients Admitted to a Secondary Hospital with Suspected MPOX Virus Infection: Is HIV Playing a Role?

Monkeypox: A New Challenge for Global Health System?

MVA-BN Vaccine Effectiveness: A Systematic Review of Real-World Evidence in Outbreak Settings

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