Mpox Person-to-Person Transmission—Where Have We Got So Far? A Systematic Review

Abstract

The recent multi-country outbreak of Mpox (Monkeypox disease) constituted a public health emergency. Although animal-to-human transmission is known to be the primary way of transmission, an increasing number of cases transmitted by person-to-person contact have been reported. During the recent Mpox outbreak sexual or intimate contact has been considered the most important way of transmission. However, other routes of transmission must not be ignored. The knowledge of how the Monkeypox Virus (MPXV) spreads is crucial to implement adequate measures to contain the spread of the disease. Therefore, this systematic review aimed to collect scientific data published concerning other implicated sources of infection beyond sexual interaction, such as the involvement of respiratory particles, contact with contaminated surfaces and skin-to-skin contact. The current study was performed using the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Publications analyzing contacts of Mpox index cases and their outcome after contact were included. A total of 7319 person-to-person contacts were surveyed and 273 of them became positive cases. Positive secondary transmission of MPXV was verified after contact with people cohabiting in the same household, with family members, with healthcare workers, or within healthcare facilities, and sexual contact or contact with contaminated surfaces. Using the same cup, sharing the same dishes, and sleeping in the same room or bed were also positively associated with transmission. Five studies showed no evidence of transmission despite contact with surfaces, skin-to-skin contact, or through airway particles within healthcare facilities where containment measures were taken. These records support the case for person-to-person transmission and suggest that other types of contact beyond sexual contact pose a significant risk of acquiring the infection. Further investigation is crucial to elucidate MPXV transmission dynamics, and to implement adequate measures to contain the spread of the infection.

An Investigation of the First Non-sexual Household-transmitted Mpox Cluster with Rapid Situation Analysis of Mpox Epidemic in Thailand

“…This observation confirmed the high plausibility of non-sexual transmission within a household beyond sexual transmission. 10 Our situational analysis did not reveal any evidence of this route of transmission within households before this investigation. So, this investigation was the first to document non-sexual transmission of mpox in Thailand, mirroring a similar occurrence in a hospital setting in the Republic of Congo.…”

Challenges and Counteracting Strategies Including Optimum Health Service Practices for Frontline Nurses During the Mpox Outbreak and Futuristic Vision

“…To spread MPXV, all it takes is direct contact with a patient's lesions, respiratory secretions, or infected things like clothing or bedding. There is currently a low level of threat among the general population ( Pinto et al, 2023 ). Despite the fact that the risks of healthcare-associated illnesses have not yet been identified for this outbreak, nurses who come into contact with infected patients should prevent infections by taking appropriate personal safety measures, including wearing adequate PPE ( Ren et al, 2022 ).…”

The 2022 monkeypox outbreak 1 year on: The 5 Ws

“…People at highest risk tended to be those living in endemic rural communities, 44,48 those in close contact with infected animals, 27,48 people who hunted, ate, or handled infected wild animals, 42,46 those who travelled to endemic regions, 50,51 people who had not received the smallpox vaccine (which provides cross-protection), 57,58 and healthcare workers involved in diagnosing, treating, and caring for Mpox patients. 59,60 By contrast, in the 2022 Mpox outbreak, individuals in the European and American continents were primarily affected. They had little or no connection with endemic regions or contact with infected animals.…”

“…Although everyone is potentially susceptible to infection with the Mpox virus, survey of confirmed or suspected cases over the last 50 years, indicated that certain groups were primary affected. People at highest risk tended to be those living in endemic rural communities, 44,48 those in close contact with infected animals, 27,48 people who hunted, ate, or handled infected wild animals, 42,46 those who travelled to endemic regions, 50,51 people who had not received the smallpox vaccine (which provides cross‐protection), 57,58 and healthcare workers involved in diagnosing, treating, and caring for Mpox patients 59,60 . By contrast, in the 2022 Mpox outbreak, individuals in the European and American continents were primarily affected.…”