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Okoli GN, Van Caeseele P, Askin N, Abou-Setta AM. A global systematic evidence review with meta-analysis of the epidemiological characteristics of the 2022 Mpox outbreaks. Infection 2024; 52:901-921. [PMID: 38051425 DOI: 10.1007/s15010-023-02133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND In 2022, there were outbreaks of Mpox where the disease is not endemic. We summarized published full-text epidemiological data from the outbreaks. METHODS A global evidence review (protocol: osf.io/j3kb7) with systematic literature search up to February 09, 2023. We focused on experimental/observational studies of laboratory confirmed Mpox, excluding case reports and case series of < 5 cases. Epidemiological data were pooled using an inverse variance, random-effects model, and pooled estimates presented with associated 95% confidence intervals. RESULTS We included 66 studies. Mean incubation period was 7.8 days (6.6-9.0 days, 8 studies: 560 cases), reproductive number 1.8 (1.7-1.9, 6 studies), mean duration from symptom onset to diagnosis 5.8 days (4.8-6.8 days, 4 studies: 982 cases), mean symptom duration 17.5 days (14.7-20.2 days, 3 studies: 292 cases), mean serial interval 8.5 days (7.3-9.9 days, 1 study), hospitalisation 6% (4-9%, 26 studies: 5339 cases), and vaccine effectiveness 78% (65-91%, 3 studies: 953 cases). Highly relevant clinical manifestations were pleomorphic skin lesions 82% (68-94%, 26 studies: 4093 cases), anogenital lesions 64% (51-77%, 9 studies: 10,398 cases), fever 54% (50-57%, 52 studies: 25,992 cases), and lymphadenopathy 51% (46-57%, 42 studies: 17,803 cases), with cases mostly men who have sex with men (MSM). Possibly relevant manifestations were perianal lesions, fatigue, asthenia, myalgia, and headache. CONCLUSIONS The 2022 Mpox outbreaks presented with sex-related clinical manifestations and were mostly reported among MSM.
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Affiliation(s)
- George N Okoli
- George & Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada.
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Paul Van Caeseele
- Department of Medical Microbiology & Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Nicole Askin
- Neil John Maclean Library, University of Manitoba, Winnipeg, MB, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Taha AM, Elrosasy A, Mahmoud AM, Saed SAA, Moawad WAET, Hamouda E, Nguyen D, Tran VP, Pham HT, Sah S, Barboza JJ, Sah R. The effect of HIV and mpox co-infection on clinical outcomes: Systematic review and meta-analysis. HIV Med 2024. [PMID: 38443319 DOI: 10.1111/hiv.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Co-infection with HIV and mpox is a significant issue for public health because of the potential combined impact on clinical outcomes. However, the existing literature lacks a comprehensive synthesis of the available evidence. The purpose of this meta-analysis is to provide insight into the impact of HIV and mpox co-infection on clinical outcomes. METHODS We systematically searched major electronic databases (PubMed, Embase, Cochrane Central, and Web of Science) for pertinent studies published up to June 2023. Included were studies that described the clinical outcomes of people who had both mpox and HIV. We performed the analysis using OpenMeta and STATA 17 software. RESULTS With an overall number of participants of 35 207, 21 studies that met the inclusion criteria were considered. The greatest number of the studies (n = 10) were cohort designs, with three being cross-sectional and eight being case series studies. The meta-analysis found that people who had both HIV and mpox had a higher hospitalization rate than those who only had mpox (odds ratio [OR] 1.848; 95% confidence interval [CI] 0.918-3.719, p = 0.085, I2 = 60.19%, p = 0.020). Furthermore, co-infected patients had higher mortality rates than those who did not have HIV co-infection (OR 3.887; 95% CI 2.272-6.650, p < 0.001). Meta-regression analysis showed that CD4 levels can significantly predict the risk of hospitalization (p = 0.016) and death (p = 0.031). DISCUSSION HIV causes immunosuppression, making it difficult for the body to mount an effective immune response against pathogens such as mpox. Individuals who are co-infected are at a higher risk of severe disease and death, according to our findings. Although hospitalization rates did not differ significantly between the two groups, it is critical to prioritize interventions and improve management strategies tailored specifically for people living with HIV. CONCLUSION This meta-analysis provides substantial evidence that HIV and mpox co-infection has a negative impact on clinical outcomes. Co-infected individuals had higher hospitalization and significantly higher mortality rates. These findings highlight the significance of early diagnosis, prompt treatment initiation, and effective management strategies for people living with HIV and mpox.
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Affiliation(s)
| | - Amr Elrosasy
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | | | - Esraa Hamouda
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Dang Nguyen
- Massachusetts General Hospital, Corrigan Minehan Heart Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Hoang Tran Pham
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Sanjit Sah
- Research Scientist, Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, India
- SR Sanjeevani Hospital, Siraha, Nepal
| | | | - Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
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Cuetos-Suárez D, Gan RK, Cuetos-Suárez D, Arcos González P, Castro-Delgado R. A Review of Mpox Outbreak and Public Health Response in Spain. Risk Manag Healthc Policy 2024; 17:297-310. [PMID: 38328470 PMCID: PMC10849094 DOI: 10.2147/rmhp.s440035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/12/2023] [Indexed: 02/09/2024] Open
Abstract
Objective In May 2022, an unprecedented Mpox outbreak was reported in several non-endemic countries with unknown epidemiological links. Since May 2022, more than 20,000 cases have been reported in Europe. Spain has been the most affected country in Europe. We aim to describe the Mpox epidemiological profile in Spain, identify its outbreak risks, and describe public health interventions implemented by the Spanish authorities. Methods A literature review was conducted, using specific selection criteria to obtain relevant publications describing Mpox clinical presentation and risk factors and the public health response in Spain to the ongoing outbreak. Results 63.1% of the cases presented an anogenital rash, considered a specific and early symptom in this outbreak. Low case fatality rate is observed, mainly in risk groups, such as the immunocompromised population. Patients evolution was generally favorable, although 3-8% required hospitalization and two deaths occurred; 40% of patients were previously diagnosed with HIV infection. Most of the cases were seen among young population and concentrated in men who had sex with other men, mainly with multiple sexual partners, who did not practice safe sex such as using condoms, and those attending mass event parties. Conclusion To date, the Mpox outbreak is not considered a public health emergency of international concern. The epidemiological trend of the virus in Spain shows that public health response interventions (health education, contact tracing, vaccination, etc.) have adequately controlled the epidemic curve in high-risk populations and avoided spreading the virus to other groups within the community.
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Affiliation(s)
- Daniel Cuetos-Suárez
- Unit for Research in Emergency and Disaster, Public Health Area, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Rick Kye Gan
- Unit for Research in Emergency and Disaster, Public Health Area, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
| | - David Cuetos-Suárez
- Emergency Medicine Department, Spanish Central Defense Academy, Madrid, Spain
| | - Pedro Arcos González
- Unit for Research in Emergency and Disaster, Public Health Area, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
| | - Rafael Castro-Delgado
- Health Service Principality of Asturias (SAMU-Asturias), Health Research Institute of Asturias, ISPA (Prehospital Care and Disasters Research Group, GIAPREDE)Oviedo, Asturias, Spain
- Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
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Hatami H, Jamshidi P, Arbabi M, Safavi-Naini SAA, Farokh P, Izadi-Jorshari G, Mohammadzadeh B, Nasiri MJ, Zandi M, Nayebzade A, Sechi LA. Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:957. [PMID: 36979936 PMCID: PMC10045775 DOI: 10.3390/biomedicines11030957] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: In early May 2022, an increasing number of human monkeypox (mpox) cases were reported in non-endemic disparate regions of the world, which raised concerns. Here, we provide a systematic review and meta-analysis of mpox-confirmed patients presented in peer-reviewed publications over the 10 years before and during the 2022 outbreak from demographic, epidemiological, and clinical perspectives. (2) Methods: A systematic search was performed for relevant studies published in Pubmed/Medline, Embase, Scopus, and Google Scholar from 1 January 2012 up to 15 February 2023. Pooled frequencies with 95% confidence intervals (CIs) were assessed using the random or fixed effect model due to the estimated heterogeneity of the true effect sizes. (3) Results: Out of 10,163 articles, 67 met the inclusion criteria, and 31 cross-sectional studies were included for meta-analysis. Animal-to-human transmission was dominant in pre-2022 cases (61.64%), but almost all post-2022 reported cases had a history of human contact, especially sexual contact. The pooled frequency of MSM individuals was 93.5% (95% CI 91.0-95.4, I2: 86.60%) and was reported only in post-2022 included studies. The male gender was predominant in both pre- and post-2022 outbreaks, and the mean age of confirmed cases was 29.92 years (5.77-41, SD: 9.38). The most common clinical manifestations were rash, fever, lymphadenopathy, and malaise/fatigue. Proctalgia/proctitis (16.6%, 95% CI 10.3-25.6, I2: 97.76) and anal/perianal lesions (39.8%, 95% CI 30.4-49.9, I2: 98.10) were the unprecedented clinical manifestations during the 2022 outbreak, which were not described before. Genitalia involvement was more common in post-2022 mpox patients (55.6%, 95% CI 51.7-59.4, I2: 88.11). (4) Conclusions: There are speculations about the possibility of changes in the pathogenic properties of the virus. It seems that post-2022 mpox cases experience a milder disease with fewer rashes and lower mortality rates. Moreover, the vast majority of post-2022 cases are managed on an outpatient basis. Our study could serve as a basis for ongoing investigations to identify the different aspects of previous mpox outbreaks and compare them with the current ones.
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Affiliation(s)
- Hossein Hatami
- Department of Public Health, School of Public Health and Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Parnian Jamshidi
- Department of Public Health, School of Public Health and Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Mahta Arbabi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Seyed Amir Ahmad Safavi-Naini
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Parisa Farokh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Ghazal Izadi-Jorshari
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Benyamin Mohammadzadeh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Milad Zandi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran;
| | - Amirhossein Nayebzade
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Leonardo A. Sechi
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- SC Microbiologia e Virologia, Azienda Ospedaliera Universitaria, 07100 Sassari, Italy
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