Clinical characteristics and outcomes of patients with mpox during the 2022 mpox outbreak compared with those before the outbreak: A systematic review and meta-analysis

Cho W 1 , Park S 2 , Kim HJ 1 , Lee M 1 , Choi YS 3 , Yeo SG 4 Show all authors , Lee J 5 , Koyanagi A 6 , Jacob L 7 , Smith L 8 , Rahmati M 9 , Ahmad S 10 , Fond G 11 , Boyer L 11 , Rhee SY 1 , Lee SW 12 , Shin JI 13 , Woo HG 2 , Yon DK 1

Affiliations 

  • 1 Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
  • 2 Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
  • 3 Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
  • 4 Department of Otolaryngology - Head & Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
  • 5 Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
  • 6 Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
  • 7 Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris-Cité, Paris, France
  • 8 Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
  • 9 Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
  • 10 Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
  • 11 Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille University, Health Service Research and Quality of Life Center, Marseille, France
  • 12 Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
  • 13 Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
Rev Med Virol, 2024 Jan;34(1):e2508.
PMID: 38282393 DOI: 10.1002/rmv.2508

Abstract

On 23 July 2022, the World Health Organization declared the global mpox outbreak as a public health emergency of international significance. The mpox virus (MPXV) that caused the outbreak was classified as clade IIb, which belongs to the West African clade. However, the relationship between MPXV clades and symptoms, as well as the severity of mpox outcomes, is not fully understood. Thus, we aimed to investigate the global mpox prevalence and the differences in clinical manifestations and outcomes among patients with mpox between pre-outbreak (2003-2021) and the current mpox outbreak. In this systematic review and meta-analysis, PubMed/MEDLINE, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar were searched using the keyword "monkeypox" and "mpox" up to 13 October 2022. A random effects model was used to obtain the pooled prevalence and 95% confidence intervals. This study included 27 articles, and 5698 patients with mpox with 19 distinctive features from 19 countries across five continents were assessed. Patients with mpox during the 2022 mpox outbreak showed mild clinical manifestations and outcomes compared with those before the 2022 mpox outbreak: mild rash (relative ratio [RR]: 5.09, 95% confidence interval [CI]: 1.52-17.08), fever (0.68, 0.49-0.94), pruritus (0.25, 0.19-0.32), myalgia (0.50, 0.31-0.81), headache (0.56, 0.35-0.88), skin ulcer (0.32, 0.17-0.59), abdominal symptom (0.29, 0.20-0.42), pharyngitis (0.32, 0.18-0.58), nausea or vomiting (0.15, 0.02-0.93), conjunctivitis (0.11, 0.03-0.38), concomitant infection with HIV (1.70, 0.95-3 0.04), and death (0.02, 0.001-0.31). MPXV clade IIb exhibited higher infectivity but may cause mild disease symptoms and low mortality rate. It is important to consider MPXV infection in patients with mpox-related features and/or a history of sexual transmission to prevent the spread of the disease and recognise the current pandemic threat.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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