Comparative evaluation of the clinical presentation and epidemiology of the 2022 and previous Mpox outbreaks: a rapid review and meta-analysis

Clinical Predictors and Determinants of Mpox Complications in Hospitalized Patients: A Prospective Cohort Study from Burundi

(1) Objectives: Studies on mpox patterns, severity predictors, and public health impacts in Burundi remain limited. Therefore, we aimed to identify the clinical predictors and determinants of mpox complications among hospitalized patients in Bujumbura, Burundi, during an active outbreak. (2) Methods: We conducted a prospective cohort study of laboratory-confirmed mpox cases across three treatment centers (July-October 2024). Clinical characteristics and outcomes were assessed through a systematic review of medical and laboratory records supplemented by structured interviews with patients or caregivers. Risk factors for disease complications were evaluated using multivariate Firth penalized logistic regression. (3) Results: Complications developed in 3.1% of 850 patients (54.4% male; median age, 20.3 years). Conjunctivitis (odds ratio [OR]: 27.30; 95% confidence interval [CI], 7.67-122.23) and sore throat (OR: 12.63; 95% CI, 5.78-30.21) were significant predictors of severe disease progression. Conversely, generalized rash (OR, 0.10; 95% CI, 0.04-0.24) and lymphadenopathy (OR, 0.24; 95% CI, 0.08-0.62) were associated with a mild disease course. Sexual transmission was the predominant route of infection (58.6%). (4) Conclusions: Noncutaneous manifestations, particularly conjunctivitis and sore throat, are early indicators of mpox severity. These findings inform clinical risk stratification in resource-limited settings and highlight the need for further investigation of pathophysiological mechanisms.

Urogenital Manifestations in Mpox (Monkeypox) Infection: A Comprehensive Review of Epidemiology, Pathogenesis, and Therapeutic Approaches

Monkeypox (mpox), caused by mpox virus (MPXV) infection, reemerged in 2022 and still raises concerns globally. Abundant clinical data indicate that mpox is a sexually transmitted infection and that the urogenital system is the most frequently involved system in mpox, which deserves more attention. Penile lesions are the most common presentation, followed by urethritis. Acute urine retention and acute kidney injury are relatively rare but also highly crucial. Currently, the majority of the urogenital lesions are considered complications secondary to MPXV infection and the common immunosuppression in mpox patients. However, such viewpoints should be treated carefully due to the lack of understanding of the basic mpox pathology. Here, we briefly and comprehensively review the current evidence concerning urogenital lesions caused by mpox, including epidemiology, clinical features, pathogenesis, and therapeutic approaches to provide a preliminary reference for clinicians in future clinical practice.

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.

Epidemiological characteristics and risk factors of suspected and confirmed mpox cases during the 2022-2023 epidemic in the Capital Region, Korea

OBJECTIVES

This study investigated the general characteristics of laboratory-confirmed mpox patients in the Capital Region of Korea, as well as the risk factors for mpox infection, particularly focusing on the characteristics of polymerase chain reaction (PCR)-positive and PCR-negative cases.

METHODS

We investigated 160 adults, excluding 4 minors, from 164 suspected mpox patients reported in Seoul, Gyeonggi, Incheon, and Gangwon from June 21, 2022 to October 31, 2023. Data were collected via telephone and face-to-face interviews. A statistical analysis of the general characteristics of the infection was conducted using frequency analysis and logistic regression.

RESULTS

Of the 160 suspected cases of mpox, 59.3% (n=95) tested positive via mpox-PCR. Among the confirmed cases, 97.9% (n=93) were male. PCR-positive patients typically presented with genital and anal skin rashes or mucosal lesions, accompanied by pain. Additionally, 35.5% (n=33) of the male patients had human immunodeficiency virus (HIV) infections. Most confirmed cases (94.7%, 90/95) were believed to have contracted mpox through sexual contact during the maximal incubation period of 21 days prior to symptom onset, with a significant number reporting same-sex or casual contact. The most commonly collected and highest-yielding specimens from PCR-positive patients were from skin or mucosal lesions, whereas blood samples demonstrated the lowest percent positivity.

CONCLUSIONS

In the Capital Region, most PCR-positive cases were male patients in their 30s who had sexual contacts and exhibited symptoms, aligning with findings from previous studies. These results provide a foundation for the differential diagnosis concerning mpox infection and the selection of PCR-test samples in clinical settings.

Clinical features and viral load variations of Mpox: a retrospective study in Chongqing, China

PURPOSE

Since May 2022, Mpox has spread extensively outside of Africa, posing a serious threat to the health of people globally, and particularly to the men who have sex with men (MSM) population. Chongqing, a province in Southwest China, has relatively large MSM and people living with HIV (PLWH) populations, presenting conditions conducive to the wide dissemination of Mpox. In this study, we investigated the clinical characteristics of Mpox patients among MSM and PLWH in Chongqing, aiming to inform the development of targeted prevention, control, and treatment strategies for Mpox.

METHOD

We evaluated the clinical characteristics, travel history, time of onset, distribution and number of skin lesions of Mpox patients admitted to the Chongqing Public Health Medical Center between September 2022 and October 2023. Meanwhile, a series of clinical samples were collected and the pathogen of interest was identified as Mpox virus using quantitative polymerase chain reaction (qPCR). The results were presented in the form of cycle thresholds (Ct), which help to approximate the quantification of viral load.

RESULTS

As of October 11, 2023, the Chongqing Public Health Medical Center reported a total of nine Mpox virus infections. All the patients identified were male and belonged to the MSM population, among whom seven (77.8%) were living with HIV, and maintained a preserved immune system while achieving viral suppression via effective ART. We observed no discernible clinical differences between MSM with Mpox with or without HIV, and no fatalities were recorded. Viral loads were observed to be higher in samples taken from the skin than those from the throat, nasopharynx, blood, or semen.

CONCLUSION

In this retrospective study, the clinical manifestations of MPXV infection appeared consistent among MSM patients, regardless of HIV status. Elevated MPXV viral loads in the skin and mucosal tissues, particularly at genital and anal sites, indicate that transmission is more likely to occur via direct physical contact as opposed to respiratory pathways or through exposure to bodily fluids.

A global systematic evidence review with meta-analysis of the epidemiological characteristics of the 2022 Mpox outbreaks

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.

Clinical Features of Mpox Patients in Korea: A Multicenter Retrospective Study

BACKGROUND

Mpox is a viral illness with a characteristic skin rash caused by the monkeypox virus. In 2022, Mpox spread throughout the world, and an epidemic through domestic transmission started in South Korea in early 2023. This study aimed to summarize the clinical features of Mpox patients in South Korea.

METHODS

This is a multicenter retrospective study conducted at four hospitals in South Korea. All adult patients diagnosed with Mpox who were admitted to the study hospitals between June 1, 2022 and May 26, 2023 and were discharged by June 30, 2023 were reviewed.

RESULTS

Sixty patients were included, accounting for 65.9% of Mpox cases reported in South Korea during the study period. Median age was 32 years and 97% (58/60) of patients were male. In total, 85% (51/60) of patients reported their sexual orientation as homosexual or bisexual. The most common route of transmission was sexual or close contact (55/60). Every patient had a skin rash and 88% (53/60) had constitutional symptoms. In total, 42% (25/60) of patients had human immunodeficiency virus and 25% (15/60) had concomitant sexually transmitted infections. Severe manifestations of Mpox were identified in only two patients.

CONCLUSION

Mpox patients in South Korea were mainly young adult males and were infected through sexual contact. The clinical outcomes were favorable.

Clinical characteristics and predictors of human mpox outcome during the 2022 outbreak in Nigeria: a cohort study

BACKGROUND

Research from sub-Saharan Africa that contributes to our understanding of the 2022 mpox (formerly known as monkeypox) global outbreak is insufficient. Here, we describe the clinical presentation and predictors of severe disease among patients with mpox diagnosed between Feb 1, 2022, and Jan 30, 2023 in Nigeria.

METHODS

We did a cohort study among laboratory-confirmed and probable mpox cases seen in 22 mpox-treatment centres and outpatient clinics across Nigeria. All individuals with confirmed and probable mpox were eligible for inclusion. Exclusion criteria were individuals who could not be examined for clinical characterisation and those who had unknown mortality outcomes. Skin lesion swabs or crust samples were collected from each patient for mpox diagnosis by PCR. A structured questionnaire was used to document sociodemographic and clinical data, including HIV status, complications, and treatment outcomes from the time of diagnosis to discharge or death. Severe disease was defined as mpox associated with death or with a life-threatening complication. Two logistic regression models were used to identify clinical characteristics associated with severe disease and potential risk factors for severe disease. The primary outcome was the clinical characteristics of mpox and disease severity.

FINDINGS

We enrolled 160 people with mpox from 22 states in Nigeria, including 134 (84%) adults, 114 (71%) males, 46 (29%) females, and 25 (16%) people with HIV. Of the 160 patients, distinct febrile prodrome (n=94, 59%), rash count greater than 250 (90, 56%), concomitant varicella zoster virus infection (n=48, 30%), and hospital admission (n=70, 48%) were observed. Nine (6%) of the 160 patients died, including seven (78%) deaths attributable to sepsis. The clinical features independently associated with severe disease were a rash count greater than 10 000 (adjusted odds ratio 26·1, 95% CI 5·2-135·0, p<0·0001) and confluent or semi-confluent rash (6·7, 95% CI 1·9-23·9). Independent risk factors for severe disease were concomitant varicella zoster virus infection (3·6, 95% CI 1·1-11·5) and advanced HIV disease (35·9, 95% CI 4·1-252·9).

INTERPRETATION

During the 2022 global outbreak, mpox in Nigeria was more severe among those with advanced HIV disease and concomitant varicella zoster virus infection. Proactive screening, management of co-infections, the integration and strengthening of mpox and HIV surveillance, and preventive and treatment services should be prioritised in Nigeria and across Africa.

FUNDING

None.