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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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Hassan R, Meehan AA, Hughes S, Beeson A, Spencer H, Howard J, Tietje L, Richardson M, Schultz A, Zawitz C, Ghinai I, Hagan LM. Health Belief Model to Assess Mpox Knowledge, Attitudes, and Practices among Residents and Staff, Cook County Jail, Illinois, USA, July-August 2022. Emerg Infect Dis 2024; 30:S49-S55. [PMID: 38561645 PMCID: PMC10986831 DOI: 10.3201/eid3013.230643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
In summer 2022, a case of mpox was confirmed in a resident at the Cook County Jail (CCJ) in Chicago, Illinois, USA. We conducted in-depth interviews with CCJ residents and staff to assess mpox knowledge, attitudes, and practices; hygiene and cleaning practices; and risk behaviors. We characterized findings by using health belief model constructs. CCJ residents and staff perceived increased mpox susceptibility but were unsure about infection severity; they were motivated to protect themselves but reported limited mpox knowledge as a barrier and desired clear communication to inform preventive actions. Residents expressed low self-efficacy to protect themselves because of contextual factors, including perceived limited access to cleaning, disinfecting, and hygiene items. Our findings suggest correctional facilities can support disease prevention by providing actionable and tailored messages; educating residents and staff about risk and vaccination options; and ensuring access to and training for hygiene, cleaning, and disinfecting supplies.
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Baymon DE, Vakkalanka JP, Krishnadasan A, Mohr NM, Talan DA, Hagen MB, Wallace K, Harland KK, Aisiku IP, Hou PC. Race, Ethnicity, and Delayed Time to COVID-19 Testing Among US Health Care Workers. JAMA Netw Open 2024; 7:e245697. [PMID: 38598239 PMCID: PMC11007575 DOI: 10.1001/jamanetworkopen.2024.5697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Access to COVID-19 testing is critical to reducing transmission and supporting early treatment decisions; when made accessible, the timeliness of testing may also be an important metric in mitigating community spread of the infection. While disparities in transmission and outcomes of COVID-19 have been well documented, the extent of timeliness of testing and the association with demographic factors is unclear. Objectives To evaluate demographic factors associated with delayed COVID-19 testing among health care personnel (HCP) during the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional study used data from the Preventing Emerging Infections Through Vaccine Effectiveness Testing study, a multicenter, test-negative, case-control vaccine effectiveness study that enrolled HCP who had COVID-19 symptoms and testing between December 2020 and April 2022. Data analysis was conducted from March 2022 to Junne 2023. Exposure Displaying COVID-19-like symptoms and polymerase chain reaction testing occurring from the first day symptoms occurred up to 14 days after symptoms occurred. Main Outcomes and Measures Variables of interest included patient demographics (sex, age, and clinical comorbidities) and COVID-19 characteristics (vaccination status and COVID-19 wave). The primary outcome was time from symptom onset to COVID-19 testing, which was defined as early testing (≤2 days) or delayed testing (≥3 days). Associations of demographic characteristics with delayed testing were measured while adjusting for clinical comorbidities, COVID-19 characteristics, and test site using multivariable modeling to estimate relative risks and 95% CIs. Results A total of 5551 HCP (4859 female [82.9%]; 1954 aged 25-34 years [35.2%]; 4233 non-Hispanic White [76.3%], 370 non-Hispanic Black [6.7%], and 324 non-Hispanic Asian [5.8%]) were included in the final analysis. Overall, 2060 participants (37.1%) reported delayed testing and 3491 (62.9%) reported early testing. Compared with non-Hispanic White HCP, delayed testing was higher among non-Hispanic Black HCP (adjusted risk ratio, 1.18; 95%CI, 1.10-1.27) and for non-Hispanic HCP of other races (adjusted risk ratio, 1.17; 95% CI, 1.03-1.33). Sex and age were not associated with delayed testing. Compared with clinical HCP with graduate degrees, all other professional and educational groups had significantly delayed testing. Conclusions and Relevance In this cross-sectional study of HCP, compared with non-Hispanic White HCP and clinical HCP with graduate degrees, non-Hispanic Black HCP, non-Hispanic HCP of other races, and HCP all other professional and education backgrounds were more likely to have delayed COVID-19 testing. These findings suggest that time to testing may serve as a valuable metric in evaluating sociodemographic disparities in the response to COVID-19 and future health mitigation strategies.
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Affiliation(s)
- DaMarcus E. Baymon
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - J. Priyanka Vakkalanka
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Anusha Krishnadasan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
| | - Nicholas M. Mohr
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
- Department of Anesthesia Critical Care, Carver College of Medicine, University of Iowa, Iowa City
| | - David A. Talan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
- David Geffen School of Medicine, University of California, Los Angeles
| | - Melissa Briggs Hagen
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Kelli Wallace
- University of Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City
| | - Karisa K. Harland
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Imoigele P. Aisiku
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter C. Hou
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Androudi S, Kaufman AR, Kouvalakis A, Mitsios A, Sapounas S, Al-Khatib D, Schibler M, Pineda R, Baglivo E. Non-Healing Corneal Ulcer and Uveitis Following Monkeypox Disease: Diagnostic and Therapeutic Challenges. Ocul Immunol Inflamm 2024; 32:253-258. [PMID: 37140328 DOI: 10.1080/09273948.2023.2202746] [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: 01/29/2023] [Accepted: 04/10/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE The ocular manifestations of Monkeypox virus (Mpox) infection remain incompletely characterized. Our goal is to present a case series of non-healing corneal ulcers with associated uveitis caused by Mpox infection as well as management recommendations for Mpox-related ophthalmic disease (MPXROD). METHODS Retrospective case series. RESULTS Two male patients with recent hospitalization for systemic Mpox infection presented with non-healing corneal ulcer associated with anterior uveitis and severe IOP elevation. Despite initiation of conservative medical treatment including corticosteroid treatment for uveitis, in both cases, there was clinical progression with enlarging cornea lesions. Both cases received oral tecovirimat with complete healing of the corneal lesion. CONCLUSIONS Corneal ulcer and anterior uveitis are rare complications of Mpox infection. Although Mpox disease is generally anticipated to be self-limited, tecovirimat may be an effective intervention in poorly healing Mpox keratitis. Corticosteroids should be used with caution in Mpox uveitis, as they might lead to worsening infection.
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Affiliation(s)
- Sofia Androudi
- Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece
- Department of Medicine, University of Thessaly, Volos, Greece
| | - Aaron R Kaufman
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Andreas Mitsios
- Department of Medicine, University of Thessaly, Volos, Greece
| | - Spyros Sapounas
- Department of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization of Greece, Athens, Greece
| | - Danial Al-Khatib
- Department of Ophthalmology, Clinique de L'Oeil, Geneva, Switzerland
| | - Manuel Schibler
- Infectious Disease Department, Geneva University Hospital, Geneva, Switzerland
| | - Roberto Pineda
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Edoardo Baglivo
- Department of Ophthalmology, Clinique de L'Oeil, Geneva, Switzerland
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McNeil CJ, Barroso LF, Workowski K. Proctitis: An Approach to the Symptomatic Patient. Med Clin North Am 2024; 108:339-354. [PMID: 38331484 DOI: 10.1016/j.mcna.2023.09.002] [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] [Indexed: 02/10/2024]
Abstract
Proctitis is an inflammatory condition of the distal rectum that can be associated with common sexually transmitted infections (STIs), such as gonorrhea, chlamydia, and syphilis. For persons presenting with ulcerative findings on examination, in addition to syphilis, Mpox, lymphogranuloma venereum, and herpes simplex virus should be in the differential. Providers should also be aware that there are evolving data to support a role for Mycoplasma genitalium in proctitis. Performing a comprehensive history, clinical evaluation including anoscopy, and rectal nucleic amplification STI testing may be useful in identifying the cause of proctitis and targeting treatment.
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Affiliation(s)
- Candice J McNeil
- Department of Medicine, Section on Infectious Diseases, Wake Forest University School of Medicine.
| | - Luis F Barroso
- Department of Medicine, Section on Infectious Diseases, Wake Forest University School of Medicine
| | - Kimberly Workowski
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
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Rojas-Carabali W, Cifuentes-González C, Agrawal R, de-la-Torre A. Spectrum of ophthalmic manifestations in monkeypox virus infection worldwide: Systematic review and meta-analysis. Heliyon 2023; 9:e18561. [PMID: 37576249 PMCID: PMC10413003 DOI: 10.1016/j.heliyon.2023.e18561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Mpox virus infection is a significant public health concern worldwide due to its potential severity and the likelihood of outbreaks occurring across different regions. Ophthalmic manifestations of the disease have been linked with more severe cases, leading to the need for hospitalization and antiviral therapy. A systematic review and meta-analysis were conducted following PRISMA guidelines to summarize the literature available on this topic. The review revealed that ophthalmic manifestations, such as conjunctivitis and periocular umbilicated lesions, are the most common in Mpox virus infections. However, severe manifestations, such as corneal opacity, that can potentially cause blindness may also occur. Antiviral treatment with tecovirimat and topical management for conjunctivitis can be considered for severe cases. However, the evidence quality is poor due to the predominance of case reports and imprecise characterization of the ophthalmic manifestations. Overall, ophthalmologists and healthcare professionals should be aware of these manifestations for early diagnosis and timely treatment.
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Affiliation(s)
- William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Colombia
- Advanced Ophthalmic Imaging Laboratory, Department of Ophthalmology, New York University School of Medicine, USA
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Colombia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Ocular Infections and AntiMicrobials Group, Singapore Eye Research Institute, Singapore
- Duke NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Singapore
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Colombia
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Roth G, Barnes-Balenciaga J, Osmundson J, Smith MDR, Tran NK, Diamond N, Makofane K. Global North learning from Global South: A community-led response to mpox in New York City. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002042. [PMID: 37379259 DOI: 10.1371/journal.pgph.0002042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
- Grant Roth
- RESPND-MI Study Team, New York, New York, United States of America
- Project ACHIEVE, New York, New York, United States of America
| | - Jennifer Barnes-Balenciaga
- RESPND-MI Study Team, New York, New York, United States of America
- Crystal La'Beija Organizing Fellowship, New York, New York, United States of America
| | - Joseph Osmundson
- RESPND-MI Study Team, New York, New York, United States of America
- New York University, New York, New York, United States of America
| | - Martez D R Smith
- RESPND-MI Study Team, New York, New York, United States of America
- University of Rochester, Rochester, New York, United States of America
| | - Nguyen K Tran
- RESPND-MI Study Team, New York, New York, United States of America
- The PRIDE Study/PRIDEnet, Stanford University, Stanford, California, United States of America
| | - Nicholas Diamond
- RESPND-MI Study Team, New York, New York, United States of America
| | - Keletso Makofane
- RESPND-MI Study Team, New York, New York, United States of America
- Harvard University, Cambridge, Massachusetts, United States of America
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