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EClinicalMedicine Feb 2023Mpox (formerly known as monkeypox) is a global public health concern, given the recent outbreaks in non-endemic countries where little scientific evidence exists on the...
BACKGROUND
Mpox (formerly known as monkeypox) is a global public health concern, given the recent outbreaks in non-endemic countries where little scientific evidence exists on the disease epidemiology. Oral lesions among mpox cases have been poorly reported. Our aim was to estimate the overall prevalence of oral manifestations among patients with mpox globally.
METHODS
In this systematic review and meta-analysis, an extensive literature search in PubMed, Scopus, Web of Science, Embase, Cochrane, and preprint servers (medRxiv, arXiv, bioRxiv, BioRN, ChiRxiv, ChiRN, and SSRN) and assessment of all published articles, conducted across the world, until Nov 15 2022 as per the PROSPERO registration protocol (CRD42022371249), was undertaken. Primary studies (case series, cross-sectional, retrospective, prospective designs) that reported the oral/oropharyngeal symptoms among laboratory-confirmed mpox cases were included. The characteristics of the study, information on the number of cases, and symptomatic status were extracted from the included studies. The quality of the included studies was assessed for bias. Random-effects meta-regression with DerSimonian & Laird estimator, and subgroup analyses were conducted using STATA (v17.0). The degree of funnel plot asymmetry was assessed using Egger's test when at least 10 estimates were available. The heterogeneity between studies was assessed using the I statistic. The primary outcome was the pooled prevalence of oral manifestations in the examined population.
FINDINGS
19 studies were included with 4042 laboratory-confirmed patients with mpox for qualitative and quantitative synthesis. The pooled prevalence of oral manifestations in the investigated population was 36.75% (95% confidence interval [CI]: 23.77-50.65). Heterogeneity was found to be high in the current meta-analysis (I = 98.24%; p < 0.001). Subgroup analysis revealed a pooled prevalence of 39.96% (95% CI: 21.42-59.91) of sore throat, 24.80% (95% CI: 8.14-46.32) of mouth sore, 18.24% (95% CI: 0.34-52.54) of tonsillitis and 17.99% (95% CI: 15.66-20.43) of mouth rash from the included studies.
INTERPRETATION
Oral manifestations are common in patients with mpox, with variations in prevalence across the sites within the oral cavity, and geography of the studies. Healthcare workers should be wary of the oral signs and symptoms of mpox in endemic and high-risk areas.
FUNDING
None.
PubMed: 36628187
DOI: 10.1016/j.eclinm.2022.101817 -
New Microbes and New Infections Jan 2023The review aimed at examining patient factors that were associated with the worldwide geographic variation in number of monkeypox cases during the 2022 outbreak. (Review)
Review
BACKGROUND
The review aimed at examining patient factors that were associated with the worldwide geographic variation in number of monkeypox cases during the 2022 outbreak.
METHODS
A systematic search was conducted using Scopus, Google Scholar, and PubMed/MEDLINE, to identify studies published in the year 2022 until 30 September on the 2022 monkeypox outbreak. Studies that described demographics and patient characteristics of the affected populations were eligible. Only countries/regions with the highest and lowest globally reported numbers were included.
RESULTS
A total of 24 eligible studies reported data from the most affected countries in Europe [Spain and UK]; Americas [USA and Brazil]; and the least affected region [South East Asia]. There were no eligible studies reporting data from the Eastern Mediterranean which was allegedly the least affected region. Cases from Europe and the Americas were mostly men having sex with men [MSM], in fourth and fifth decades of life, with a substantial proportion of HIV and sexually transmitted diseases. Sporadic cases among women [sexual, household] and children [household] were identified. Sexual orientation and/or mode of transmission were not clearly stated in most studies from South East Asia.
CONCLUSIONS
The 2022 monkeypox outbreak was most obvious in the western part of the globe due mainly to sexual activities among MSM. Low numbers in the east may indicate the influence of the conservative social behaviors. Co-morbidities in the form of HIV and sexually transmitted diseases were identified. Detection of the disease among women and children highlights the importance of adopting appropriate preventive public health measures.
PubMed: 36618975
DOI: 10.1016/j.nmni.2022.101078 -
Frontiers in Immunology 2022In this paper we aimed to study the characteristics, laboratory data and outcomes of monkeypox virus (MPV) and COVID-19 co-infection. On 2 October 2022, we used the... (Review)
Review
In this paper we aimed to study the characteristics, laboratory data and outcomes of monkeypox virus (MPV) and COVID-19 co-infection. On 2 October 2022, we used the search term "("monkeypox virus" OR "MPV" OR "monkey pox" OR "monkeypox") AND ("COVID-19" OR "COVID 19" OR "novel coronavirus" OR "SARS-CoV-2")" in five databases to collect the relevant articles. We found three male patients, who had sex with men prior to the infection, had multiple comorbid conditions, were diagnosed with PCR, and were admitted to the hospital. The length of hospital stay was 4, 6, and 9 days. On admission, two cases had multiple vesicular lesions on various sites of the body associated with tonsillar inflammation, while the third case had genital ulcers and inguinal lymph node enlargement. All cases were managed in the hospital and recovered well. It might still be too early to establish solid evidence about the exact cause-effect association between SARS-CoV-2 and MPV co-infection and patient's outcomes because of the current low sample size. Accordingly, future relevant investigations, estimating the risk ratio of this association are needed to formulate definite evidence.
Topics: Humans; Male; Coinfection; COVID-19; Hospitalization; Length of Stay; SARS-CoV-2
PubMed: 36591217
DOI: 10.3389/fimmu.2022.1094346 -
Vaccines Dec 2022Background: Monkeypox is a global public health concern, given the recent outbreaks in non-endemic countries where little scientific evidence exists on the disease.... (Review)
Review
Background: Monkeypox is a global public health concern, given the recent outbreaks in non-endemic countries where little scientific evidence exists on the disease. Specifically, there is a lack of data on asymptomatic monkeypox virus infection. This study aims to evaluate the overall prevalence of asymptomatic monkeypox virus infection. Methods: In this systematic review and meta-analysis, we performed an extensive literature search in PubMed, Scopus, Web of Science, ProQuest, EMBASE, EBSCOHost, Cochrane, and preprint servers (medRxiv, arXiv, bioRxiv, BioRN, ChiRxiv, ChiRN, and SSRN) and assessed all published articles till September 2022. Primary studies reporting monkeypox infections among asymptomatic participants were included after quality assessment. The characteristics of the study and information on the number of cases and symptomatic status were extracted from the included studies. The heterogeneity between studies was assessed using the I2 statistic. Publication bias was analyzed using funnel plots and Egger regression tests. The primary outcome was the pooled prevalence of asymptomatic infections within the examined population. Results: A total of 16 studies were included for qualitative synthesis, while five studies, including 645 individuals, were included for quantitative synthesis. There was substantial heterogeneity between studies (I2 = 94.86%; p < 0.01), with a pooled percentage of asymptomatic infections in the studied population of 10.2% (95%CI, 2.5−17.9%). Conclusion: This meta-analysis suggests that many people infected with the monkeypox virus are asymptomatic and difficult to detect. Therefore, prompt detection of these cases of monkeypox virus and appropriate subsequent management is of utmost importance to global public health.
PubMed: 36560493
DOI: 10.3390/vaccines10122083 -
F1000Research 2022Monkeypox has been declared as a Public Health Emergency of International Concern (PHEIC) by the WHO Director General (WHO-DG). Most of the G20 nations have reported...
Monkeypox has been declared as a Public Health Emergency of International Concern (PHEIC) by the WHO Director General (WHO-DG). Most of the G20 nations have reported Monkeypox outbreak. Policies developed and implemented in G20 countries for the prevention and control of monkeypox preparedness and response have global consequences. This rapid review aimed to map the monkeypox prevention and control policies planned and implemented in G20 nations in line with temporary recommendations issued by the WHO-DG. We mapped monkeypox prevention and control policies in G20 nations based on the WHO-DG recommendations. Medline (through PubMed), Scopus, and ProQuest Health and Medical Complete were searched to understand G20 preventative, diagnostic, and therapeutic policies. We also performed an extensive gray literature search through the Ministry of Health websites and newspaper through Google. The documents/ studies that had an information on prevention, control and management guidelines/policies and published through journal, news articles and health ministry websites of G20 nations on monkeypox were included. We excluded the editorials, opinion, and perspective papers and studies published prior to May 6, 2022. We obtained 671 articles with 10 articles included in the review. Additionally, we identified 55 documents from the gray literature. We included national guidelines of the 18 countries on the control, prevention, and management of monkeypox. National guidelines were compared with the WHO guidelines in terms of implementing coordinated response, engaging and protecting communities, surveillance and public health measures and international travel, clinical management and infection, prevention and control (IPC) measures and medical countermeasures research. Depending on the availability of resources, some recommendations are followed by nations while others are not. Coordinated response among states is key to contain the transmission of monkeypox. To bring a coordinated response, G20 nations are following temporary recommendations that are context specific to their nation.
Topics: Humans; Mpox (monkeypox); Policy; Public Health; Disease Outbreaks
PubMed: 36545374
DOI: 10.12688/f1000research.125893.1 -
Comparative Immunology, Microbiology... Jan 2023Monkeypox was designated as an emerging illness in 2018 by the World Health Organization Research and Development Blueprint, necessitating expedited research,...
BACKGROUND
Monkeypox was designated as an emerging illness in 2018 by the World Health Organization Research and Development Blueprint, necessitating expedited research, development, and public health action. In this review, we aim to shed the light on the imported cases of monkeypox in attempt to prevent the further spread of the disease. Methodology An electronic search in the relevant database (Web of Science, PubMed Medline, PubMed Central, Google scholar, and Embase) was conducted to identify eligible articles. In addition to searching the grey literature, manual searching was carried out using the reference chain approach.
RESULTS
A total of 1886 articles were retrieved using the search strategy with 21 studies included in the systematic review. A total of 113 cases of imported monkeypox were confirmed worldwide. Nineteen patients mentioned a travel history from Nigeria, thirty-eight infected cases had travel destinations from Europe, fifty-four cases traveled from European countries such as; Spain, France, and the Netherlands, one case from Portugal, and another one from the United Kingdom (UK). All reported clades of the virus were West African clade. Nine studies showed the source of infection was sexual contact, especially with male partners. Six studies mentioned the cause of infection was contact with an individual with monkeypox symptoms. Two studies considered cases due to acquired nosocomial infection. Ingestion of barbecued bushmeat was the source of infection in three studies and rodent carcasses were the source of infection in the other two studies.
CONCLUSION
The development of functioning surveillance systems and point-of-entry screening is essential for worldwide health security. This necessitates ongoing training of front-line health professionals to ensure that imported monkeypox is properly diagnosed and managed. In addition, implementing effective health communication about monkeypox prevention and control is mandatory to help individuals to make informed decisions to protect their own and their communities' health.
Topics: Animals; Male; Europe; Mpox (monkeypox); Nigeria; Public Health; Rodentia; Travel
PubMed: 36521366
DOI: 10.1016/j.cimid.2022.101923 -
International Journal of Infectious... Feb 2023Human monkeypox virus (MPXV) infection is a recently declared public health emergency of international concern by the World Health Organization. Besides, there is scant...
OBJECTIVES
Human monkeypox virus (MPXV) infection is a recently declared public health emergency of international concern by the World Health Organization. Besides, there is scant literature available on the use of antivirals in MPXV infection. This systematic review compiles all evidence of various antivirals used on their efficacy and safety and summarizes their mechanisms of action.
METHODS
A review was done of all original studies mentioning individual patient data on the use of antivirals in patients with MPXV infection.
RESULTS
Of the total 487 non-duplicate studies, 18 studies with 71 individuals were included. Tecovirimat was used in 61 individuals, followed by cidofovir in seven and brincidofovir (BCV) in three individuals. Topical trifluridine was used in four ophthalmic cases in addition to tecovirimat. Of the total, 59 (83.1%) were reported to have complete resolution of symptoms; one was experiencing waxing and waning of symptoms, only one (1.8%) had died, and the others were having a resolution of symptoms. The death was thought unrelated to tecovirimat. Elevated hepatic panels were reported among all individuals treated with BCV (leading to treatment discontinuation) and five treated with tecovirimat.
CONCLUSION
Tecovirimat is the most used and has proven beneficial in several aggravating cases. No major safety concerns were detected upon its use. Topical trifluridine was used as an adjuvant treatment option along with tecovirimat. BCV and cidofovir were seldom used, with the latter often being used due to the unavailability of tecovirimat. BCV was associated with treatment discontinuation due to adverse events.
Topics: Humans; Antiviral Agents; Benzamides; Cidofovir; Disease Outbreaks; Isoindoles; Mpox (monkeypox); Monkeypox virus; Trifluridine
PubMed: 36470502
DOI: 10.1016/j.ijid.2022.11.040 -
Cureus Oct 2022The recent monkeypox (MPVX) outbreak has been characterized by an unprecedented increase in cases, unlike any other outbreaks in the past. The disease pattern and... (Review)
Review
The recent monkeypox (MPVX) outbreak has been characterized by an unprecedented increase in cases, unlike any other outbreaks in the past. The disease pattern and transmissibility are also different from previous outbreaks. This systematic review aimed to evaluate whether the current outbreak has significant contrasting features from the previous ones, necessitating changes in prevention and control guidelines. A thorough literature search related to MPVX infection was performed on the online databases PubMed, Google Scholar, and ScienceDirect using appropriate keywords "MPVX", "men who have sex with men (MSM)", "transmission", and "smallpox vaccination", for choosing relevant articles from the inception of MPVX in 1970 to August 31, 2022. We identified 5110 cases of MPVX, documented in 63 articles on MPVX. We discovered that the median age of MPVX infection has slowly increased since its inception, and currently, it is more common in adults. Compared to previous outbreaks, a significantly greater male preponderance is witnessed in the current outbreak. Only 238 (4.65%) out of the 5110 evaluated patients were vaccinated with the smallpox vaccine in our review. There were 107 mortalities, most of which were children below the age of 10 years. Out of the 1534 cases identified in 2022, 1134 (73.92%) patients admitted that they had been involved in sexual relations within the last 21 days (MSM/gay/bisexual). We found that in contrast to previous outbreaks, human-to-human transmission is more common in this outbreak, with most cases having no link with endemic countries. There are evolving traits and undetected transmission modes of MPVX infection that require new disease mitigation strategies.
PubMed: 36451652
DOI: 10.7759/cureus.30841 -
Viruses Nov 2022The outbreak of monkeypox, coupled with the onslaught of the COVID-19 pandemic is a critical communicable disease. This study aimed to systematically identify and review... (Review)
Review
The outbreak of monkeypox, coupled with the onslaught of the COVID-19 pandemic is a critical communicable disease. This study aimed to systematically identify and review research done on preclinical studies focusing on the potential monkeypox treatment and immunization. The presented juxtaposition of efficacy of potential treatments and vaccination that had been tested in preclinical trials could serve as a useful primer of monkeypox virus. The literature identified using key terms such as monkeypox virus or management or vaccine stringed using Boolean operators was systematically reviewed. Pubmed, SCOPUS, Cochrane, and preprint databases were used, and screening was performed in accordance with PRISMA guidelines. A total of 467 results from registered databases and 116 from grey literature databases were screened. Of these results, 72 studies from registered databases and three grey literature studies underwent full-text screening for eligibility. In this systematic review, a total of 27 articles were eligible according to the inclusion criteria and were used. Tecovirimat, known as TPOXX or ST-246, is an antiviral drug indicated for smallpox infection whereas brincidofovir inhibits the viral DNA polymerase after incorporation into viral DNA. The ability of tecovirimat in providing protection to poxvirus-challenged animals from death had been demonstrated in a number of animal studies. Non-inferior with regard to immunogenicity was reported for the live smallpox/monkeypox vaccine compared with a single dose of a licensed live smallpox vaccine. The trial involving the live vaccine showed a geometric mean titre of vaccinia-neutralizing antibodies post two weeks of the second dose of the live smallpox/monkeypox vaccine. Of note, up to the third generation of smallpox vaccines-particularly JYNNEOS and Lc16m8-have been developed as preventive measures for MPXV infection and these vaccines had been demonstrated to have improved safety compared to the earlier generations.
Topics: Animals; Humans; Mpox (monkeypox); Smallpox Vaccine; Smallpox; Pandemics; COVID-19; Monkeypox virus; Variola virus; Vaccinia virus; Vaccines, Attenuated; COVID-19 Drug Treatment
PubMed: 36423105
DOI: 10.3390/v14112496 -
Pathogens (Basel, Switzerland) Oct 2022Vaccination it is considered a vital strategy in order to mitigate monkeypox by protecting from severe disease and helping in reduction of hospitalisations. In this...
Vaccination it is considered a vital strategy in order to mitigate monkeypox by protecting from severe disease and helping in reduction of hospitalisations. In this sense, this study aims to estimate the global prevalence of vaccination acceptance against monkeypox. We conducted a systematic review with a comprehensive search strategy for the following databases: PubMed, Scopus and Web of Science. A random-effect model meta-analysis was carried out using observational studies assessing the intention of vaccines against monkeypox from multiple continents. The quality assessment was developed using the Newcastle-Ottawa Scale adapted for cross-sectional studies. In addition, a subgroup analysis by study location and population and a sensitivity analysis was developed.Eleven cross-sectional studies were included. A total of 8045 participants were included. The pooled prevalence of monkeypox vaccination acceptance in all participants was 56.0% (95%CI: 42.0-70.0%). In the subgroup analysis of monkeypox vaccine acceptance according to continents, the prevalence of vaccine acceptance was 50.0% (95%CI: 24.0-76.0%) in Asian countries and 70.0% (95%CI: 55.0-84.0%) in European countries. The prevalence of vaccine acceptance was 43.0% (95%CI: 35.0-50.0%) in the general population, 63.0% (95%CI: 42.0-70.0%) in healthcare workers, and 84.0% (95%CI: 83.0-86.0%) in the LGBTI community. Despite the high prevalence of monkeypox vaccination acceptance in the LGBTI community found in our study, vaccination acceptance from healthcare workers and the general population are lower. Governments could use these results for planning, developing or promoting vaccination strategies and public health policies focused on these populations.
PubMed: 36364999
DOI: 10.3390/pathogens11111248