Transmission dynamics, complications and mitigation strategies of the current mpox outbreak: A comprehensive review with bibliometric study

Proctitis and Other Gastrointestinal Manifestations in Mpox Disease: A Systematic Review and Meta-Analysis

Background

Mpox, caused by the monkeypox virus (MPXV), is primarily recognized for its dermatologic and systemic symptoms. However, emerging evidence suggests a significant prevalence of gastrointestinal (GI) manifestations, particularly proctitis, diarrhea, nausea, vomiting, and abdominal pain. Despite the growing clinical recognition of these symptoms, their epidemiology and impact remain poorly understood. This systematic review and meta-analysis aim to quantify the prevalence of GI manifestations in Mpox patients and assess their clinical significance.

Methods

A systematic review following PRISMA guidelines was conducted across PubMed, Embase, and Web of Science, including quantitative studies published up until October 2024 that reported GI manifestations in Mpox patients. Screening and data extraction were performed using Nested Knowledge software, and study quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was conducted using R version 4.4, with heterogeneity evaluated via the I 2 statistic. Sensitivity analyses and publication bias were assessed using Doi plots and the Luis Furuya-Kanamori (LFK) index.

Results

Out of 1229 records, 33 studies met the eligibility criteria, yielding a pooled prevalence of proctitis in Mpox patients at 24.75% (95% CI: 18.93%-31.04%) across 5878 participants, with high heterogeneity (I 2 = 94.8%). The prediction interval for proctitis ranged from 1.46% to 61.76%. The pooled prevalence of other GI manifestations was 30.45% (95% CI: 18.27%-44.14%) across 2237 participants, with significant heterogeneity (I 2 = 95.2%) and a prediction interval ranging from 0.00% to 85.28%. Sensitivity analyses confirmed the stability of these estimates, while publication bias was indicated by LFK index values exceeding 2.77.

Conclusions

This meta-analysis highlights the substantial burden of GI manifestations in Mpox, particularly proctitis, with considerable variability across studies. The findings underscore the need for standardized diagnostic criteria and increased clinical recognition of GI symptoms in Mpox management. Further research into the underlying pathophysiology and integrating GI symptom assessment into Mpox surveillance and treatment strategies could enhance diagnostic accuracy and patient care outcomes.

Virology, epidemiology, transmissions, diagnostic tests, prophylaxis and treatments of human Mpox: Saudi Arabia perspective

Mpox (Monkeypox) is a highly contagious viral disease that can be transmitted from animal-to-human or human-to-human through intimate contact, Mpox is caused by the monkeypox virus (MPXV), which is an enveloped double-stranded DNA that belongs to the genus Orthopoxvirus, Poxviridae family, and subfamily Chordopoxvirinae. Mpox cases were previously only reported in West and Central Africa, however in recent times non-endemic countries including Saudi Arabia (SA) also reported confirmed Mpox cases. The first laboratory-confirmed human Mpox case in SA was reported on 14 July 2022, since then a number of confirmed Mpox cases have been reported by WHO in SA. These confirmed Mpox cases in SA were observed among individuals with a history of visiting European Union countries. SA is not only at risk of importation of Mpox cases owing to travel to such countries, but also there are various other risk factors including geographic proximity to the African continent, trade in exotic animals, and massive inflow of tourists. Therefore, government health authorities of SA should continue to collaborate with various international health organizations including WHO to prevent, manage or monitor potential health risks at most of the entry points in SA including highways, seaports, and airports by ensuring adherence to hygiene protocols, vaccinations, and health screenings. There are a range of diagnostic tests are currently available that can be used in SA to confirm Mpox infections, including real-time PCR, loop-mediated isothermal amplification, serological testing, clustered regularly interspaced short palindromic repeat-CRISPR-associated protein (CRISPR-Cas)-based systems, whole-genome sequencing, electron microscopy, and virus isolation and culture. There is no approved treatment specifically for Mpox, however multiple approved antiviral agents for smallpox treatment were found to be useful in Mpox treatment and in the management of Mpox outbreaks, such as- trifluridine, brincidofovir, tecovirimat, and cidofovir. The aim of this review is to provide valuable insights regarding virology, pathogenesis, epidemiology, transmissions, clinical presentation, diagnostic tests, prophylactic measures and therapeutic options of Mpox from SA perspective. Moreover, a side-by-side discussion on the global trend and scenarios of Mpox has been provided for comparison and further improvement in measures against Mpox in SA.

Facilitating self-testing with a fast, accurate, and simplified shelf-stable colorimetric LAMP system for Mpox and SARS-CoV-2 detection

The rapid and accurate detection of viral infections is essential for effective disease management and prevention. Quantitative polymerase chain reaction (qPCR) remains the gold standard for viral detection due to its high sensitivity and specificity. However, its limitations-including the need for specialized equipment, trained personnel, and longer processing times-make it impractical for at-home or rapid testing. Although numerous point-of-care assays based on isothermal nucleic acid amplification have been developed, they often lack the simplicity and adaptability required for self-testing in non-laboratory settings such as at home. To address this, we developed and validated the SCOLAR (Shelf-stable Colorimetric LAMP system for Rapid self-testing of viruses) system, a simplified, portable, and accurate diagnostic tool designed for self-testing of Mpox and SARS-CoV-2 infections. The SCOLAR system employs novel lyophilized colorimetric loop-mediated isothermal amplification (LAMP) beads, a customized sample lysis buffer, and smartphone-assisted RGB color analysis for interpreting results. Validation was conducted using 24 mock Mpox skin swabs, 32 wastewater samples, and 104 clinical SARS-CoV-2 nasopharyngeal swabs, with comparisons to an in-house qPCR assay. The SCOLAR system demonstrated an analytical sensitivity of below 10 copies/μL for all targets within 15 min. Diagnostic performance for mock Mpox samples exhibited 93.8 % sensitivity and 100 % specificity, while wastewater samples achieved 100 % sensitivity and specificity. SARS-CoV-2 swabs had 96 % sensitivity and 100 % specificity. The system also proved effective for self-testing by untrained individuals. SCOLAR offers a reliable, easy-to-use platform for rapid self-testing, with potential for broader applications in public health strategies to enhance pandemic preparedness and response.

Monkeypox-related knowledge and vaccination willingness among HIV-diagnosed and -suspected males: a cross-sectional survey in Changsha

Objective

This study aimed to update baseline data on monkeypox (mpox)-related knowledge and vaccination willingness among human immunodeficiency virus (HIV) diagnosed and suspected males.

Methods

The cross-sectional survey was conducted in Changsha, a provincial capital in China, during 5 JULY to 5 SEPTEMBER 2023. Among the three study groups, the participants in the "previously diagnosed" group were recruited from a cohort of HIV-infected patients. The "newly diagnosed" and the "suspected" groups were recruited from the outpatients and grouped according to their confirmatory test results. The the exploratory factor analysis was firstly applied to capture the latent structure of participants' response to the questionnaire about monkeypox. The component and factor scores were compared between groups using the Kruskal-Wallis H tests. The chi-square test was then used to assess the difference of mpox vaccination willingness between MSM and non-MSM in each group. Finally, multivariate logistic regression analysis was performed to identify the determinants of vaccination willingness.

Results

A total of 481 males were included in the final analysis. The results revealed that there was a gap in knowledge about monkeypox between the three participant groups. The vaccination willingness rate of HIV-infected participants was above 90%, while the rate in the HIV-suspected group was 72.60%. Multivariate logistic regression analysis revealed that the previously diagnosed group (adjusted odds ratio [aOR] = 0.314, 95% confidence interval [CI]: 0.105-0.940) and the suspected group (aOR = 0.111, 95% CI: 0.034-0.363) had a lower level of vaccination willingness and they were referred to the newly diagnosed group. Participants in the age groups ranging 25-34 (aOR = 0.287, 95% CI: 0.086-0.959) and 35-44 (aOR = 0.136, 95% CI: 0.039-0.478) years showed a lower level of vaccination willingness, referred to the 15-24 year age group. A better knowledge about monkeypox was associated with a higher level of vaccination willingness (aOR = 1.701, 95% CI: 1.165-2.483). Additionally, a considerable percentage of heterosexual individuals in each group indicated their acceptance of monkeypox vaccines.

Conclusion

An overall high level of vaccination willingness was observed among HIV-infected and-suspected male individuals with disparities noted among those with different HIV infection status, knowledge levels of monkeypox, and age. Addressing the existing knowledge gap and engaging people with persistent risks-regardless of their sexual orientation-for a timely HIV diagnosis may facilitate vaccine-based mitigation measures against monkeypox.

Immunobiology of MPox Infection and Its Management: Experience From Developing Nations

PURPOSE

As humanity grapples with the COVID-19 pandemic caused by the novel SARS-CoV-2 virus, the rising threats of the MPox virus (MPXV) in 2022 and 2024 have shown signs of global transmission and the potential to spark another pandemic. Though MPXV has been present for over 5 decades, with cases traditionally confined to endemic regions in West and Central Africa, recent outbreaks have occurred in multiple non-endemic regions, declaring itself as a Public Health Emergency of International Concern. This study aims to examine the patterns of MPXV transmission, its zoonotic potential, associated complications, and viable strategies to control its spread.

METHODS

The study examines recent outbreak data, case reports, and literature on MPXV transmission, emphasising zoonotic pathways and healthcare-associated cases. A bibliometric analysis has also been performed to deepen the understanding and identify emerging research trends.

RESULTS

The findings suggest that while MPXV has traditionally been endemic in certain regions of Africa, recent outbreaks indicate an increased transmission risk in non-endemic countries, raising concerns about potential global spread. Data reveals that much of the transmission has occurred within healthcare settings. Additionally, global research on the outbreak remains limited and requires further exploration from various perspectives, emphasising the need for prompt intervention.

CONCLUSION

Containing MPXV's spread is essential to prevent another potential pandemic. Effective management and control strategies, including enhanced surveillance, public health interventions, and targeted education within at-risk communities, are critical to mitigate the spread and impact of MPXV globally. This study advocates for a proactive approach to MPXV control to avoid its escalation into a widespread health crisis.

Strengthening Africa's response to Mpox (monkeypox): insights from historical outbreaks and the present global spread

Mpox, formerly known as Monkeypox, is a viral zoonotic disease endemic to Central and West Africa that has posed significant public health challenges since its identification in 1970. Despite decades of experience in managing outbreaks, the 2022-2024 Mpox outbreaks exposed substantial gaps in global preparedness and response, leading the World Health Organization (WHO) to declare a Public Health Emergency of International Concern (PHEIC) in 2022. The resurgence of cases in Europe in 2022 and the more recent emergence of the virulent clade Ⅰb in the Democratic Republic of the Congo (DRC) in 2024 have highlighted a critical need for improved proactive and response strategies to curb the epidemic. This narrative review examines the historical and recent epidemiology of Mpox in Africa and explores the factors that have limited effective management. These include objective influences such as viral mutations, zoonotic transmission patterns, and environmental changes like deforestation, as well as subjective factors, including delayed responses, limited vaccine availability, cessation of smallpox vaccinations, and inequitable access to healthcare. In particular, the review emphasizes the ongoing disparities in global health equity, as wealthier nations have been able to secure vaccines and therapeutics quickly, while endemic regions in Africa continue to struggle with limited resources. The review also discusses how socio-economic and cultural factors, combined with weak public health infrastructure and inadequate surveillance systems, perpetuate cycles of outbreak in vulnerable populations. Furthermore, the emergence of clade Ⅰb in 2024, with its higher virulence and mortality rates among children, particularly in rural areas, underscores the urgency of addressing the evolving epidemiological landscape of Mpox. In response to these challenges, this review recommends strengthening healthcare infrastructure, enhancing surveillance systems, ensuring equitable access to vaccines and treatments, and integrating environmental management into public health strategies. Global collaboration remains essential to provide African countries with the resources and support needed to manage and prevent future outbreaks effectively. Without these measures, the world risks a prolonged public health crisis with far-reaching consequences for both Africa and the global community.

Mpox outbreak: Time series analysis with multifractal and deep learning network

This article presents an overview of an mpox epidemiological situation in the most affected regions-Africa, Americas, and Europe-tailoring fractal interpolation for pre-processing the mpox cases. This keen analysis has highlighted the irregular and fractal patterns in the trend of mpox transmission. During the current scenario of public health emergency of international concern due to an mpox outbreak, an additional significance of this article is the interpretation of mpox spread in light of multifractality. The self-similar measure, namely, the multifractal measure, is utilized to explore the heterogeneity in the mpox cases. Moreover, a bidirectional long-short term memory neural network has been employed to forecast the future mpox spread to alert the outbreak as it seems to be a silent symptom for global epidemic.