Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Vicente A Benites-Zapata, Juan R Ulloque-Badaracco, Esteban A Alarcon-Braga, Enrique A Hernandez-Bustamante, Melany D Mosquera-Rojas, D Katterine Bonilla-Aldana, Alfonso J Rodriguez-Morales, Vicente A Benites-Zapata, Juan R Ulloque-Badaracco, Esteban A Alarcon-Braga, Enrique A Hernandez-Bustamante, Melany D Mosquera-Rojas, D Katterine Bonilla-Aldana, Alfonso J Rodriguez-Morales

Abstract

Introduction: A multicountry monkeypox disease (MPX) outbreak began in May 2022 in Europe, leading to the assessment as a potential Public Health Emergency of International Concern (PHEIC) on June 23, 2022. Some observational studies have partially characterised clinical features, hospitalisations, and deaths. However, no systematic reviews of this MPX outbreak have been published.

Methods: We performed a systematic review with meta-analysis, using five databases to assess clinical features, hospitalisations, complications and deaths of MPX confirmed or probable cases. Observational studies, case reports and case series, were included. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In addition, we carried out a subgroup analysis according to the continents and a sensitivity analysis excluding studies classified as having a high risk of bias.

Results: A total of 19 articles were included, using only 12 articles in the quantitative synthesis (meta-analysis). For 1958 patients, rash (93%, 95% CI 80-100%), fever (72%, 95% CI 30-99%), pruritus (65%, 95% CI 47-81%), and lymphadenopathy (62%, 47-76%), were the most prevalent manifestations. Among the patients, 35% (95% CI 14-59%) were hospitalised. Some 4% (95% CI 1-9%) of hospitalised patients had fatal outcomes (case fatality rate, CFR).

Conclusion: MPX is spreading rapidly, with a third of hospitalised patients, but less than 5% with fatal outcomes. As this zoonotic virus spreads globally, countries must urgently prepare human resources, infrastructure and facilities to treat patients according to the emerging guidelines and the most reliable clinical information.

Keywords: Clinical features; Epidemic; Laboratory; Monkeypox; Orthopoxvirus; Outcomes; Poxviridae; Zoonotic.

Conflict of interest statement

All authors report no potential conflicts, except AJRM. AJRM is Deputy Editor-in-Chief of Annals of Clinical Microbiology and Antimicrobials. All authors have submitted the ICMJE Form for Disclosure of Potential.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
PRISMA Flow Diagram
Fig. 2
Fig. 2
Pool prevalences forest plots of main clinical findings
Fig. 3
Fig. 3
Pool prevalences forest plots of the cutaneous lesion characteristics and sites
Fig. 4
Fig. 4
Pool prevalences forest plots of the MPX complications, hospitalisations and associated deaths

References

    1. Monkeypox—United Kingdom of Great Britain and Northern Ireland. . Accessed 23 June 2022.
    1. Monkeypox outbreak toolbox. . Accessed 23 June 2022.
    1. Bleyer JG. Ueber auftreten von variola unter affen der genera mycetes und cebus bei vordringen einer pockenepidemie im urwaldgebiete an den nebenflüssen des alto uruguay in südbrasilien. Muench Med Wochenschr. 1922;69:1009–1010.
    1. Magnus PV, Andersen EK, Petersen KB, Birch-Andersen A. A pox-like disease in cynomolgus monkeys. Acta Pathol Microbiol Scand. 1959;46(2):156–176. doi: 10.1111/j.1699-0463.1959.tb00328.x.
    1. Heberling RL, Kalter SS. Induction, course, and transmissibility of monkeypox in the baboon (Papio cynocephalus) J Infect Dis. 1971;124(1):33–38. doi: 10.1093/infdis/124.1.33.
    1. Bonilla-Aldana DK, Rodriguez-Morales AJ. Is monkeypox another reemerging viral zoonosis with many animal hosts yet to be defined? Vet Q. 2022;42(1):148–150. doi: 10.1080/01652176.2022.2088881.
    1. Farahat RA, Abdelaal A, Shah J, Ghozy S, Sah R, Bonilla-Aldana DK, Rodriguez-Morales AJ, McHugh TD, Leblebicioglu H. Monkeypox outbreaks during COVID-19 pandemic: are we looking at an independent phenomenon or an overlapping pandemic? Ann Clin Microbiol Antimicrob. 2022;21(1):26. doi: 10.1186/s12941-022-00518-2.
    1. Basgoz N, Brown CM, Smole SC, Madoff LC, Biddinger PD, Baugh JJ, Shenoy ES. Case 24–2022: a 31-year-old man with perianal and penile ulcers, rectal pain, and rash. N Engl J Med. 2022 doi: 10.1056/NEJMcpc2201244.
    1. Patrocinio-Jesus R, Peruzzu F. Monkeypox Genital Lesions. N Engl J Med. 2022 doi: 10.1056/NEJMicm2206893.
    1. Ortiz-Martínez Y, Rodríguez-Morales AJ, Franco-Paredes C, Chastain DB, Gharamti AA, Vargas Barahona L, Henao-Martínez AF. Monkeypox – a description of the clinical progression of skin lesions: a case report from Colorado, USA. Ther Adv Infect Dis. 2022;9:20499361221117726.
    1. Alakunle E, Moens U, Nchinda G, Okeke MI. Monkeypox virus in Nigeria: infection biology, epidemiology, and evolution. Viruses. 2020 doi: 10.3390/v12111257.
    1. Doty JB, Malekani JM, Kalemba LN, Stanley WT, Monroe BP, Nakazawa YU, Mauldin MR, Bakambana TL, LiyandjaDjaLiyandja T, Braden ZH, et al. Assessing monkeypox virus prevalence in small mammals at the human-animal interface in the democratic Republic of the Congo. Viruses. 2017 doi: 10.3390/v9100283.
    1. Nakazawa Y, Mauldin MR, Emerson GL, Reynolds MG, Lash RR, Gao J, Zhao H, Li Y, Muyembe JJ, Kingebeni PM, et al. A phylogeographic investigation of African monkeypox. Viruses. 2015;7(4):2168–2184. doi: 10.3390/v7042168.
    1. Sood A, Sui Y, McDonough E, Santamaria-Pang A, Al-Kofahi Y, Pang Z, Jahrling PB, Kuhn JH, Ginty F. Comparison of multiplexed immunofluorescence imaging to chromogenic immunohistochemistry of skin biomarkers in response to monkeypox virus infection. Viruses. 2020;12(8):78. doi: 10.3390/v12080787.
    1. León-Figueroa DA, Bonilla-Aldana DK, Pachar M, Romaní L, Saldaña-Cumpa HM, Anchay-Zuloeta C, Diaz-Torres M, Franco-Paredes C, Suárez JA, Ramirez JD, et al. The never ending global emergence of viral zoonoses after COVID-19? The rising concern of monkeypox in Europe, North America and beyond. Travel Med Infect Dis. 2022;49:102362. doi: 10.1016/j.tmaid.2022.102362.
    1. Cohen-Gihon I, Israeli O, Shifman O, Erez N, Melamed S, Paran N, Beth-Din A, Zvi A. Identification and Whole-Genome Sequencing of a Monkeypox Virus Strain Isolated in Israel. Microbiol Resour Announc. 2020 doi: 10.1128/MRA.01524-19.
    1. Rodriguez-Morales AJ. Monkeypox and the importance of cutaneous manifestations for disease suspicion. Microbes, Infection and Chemotherapy. 2022;2:e1450. doi: 10.54034/mic.e1450.
    1. Bížová B, Veselý D, Trojánek M, Rob F. Coinfection of syphilis and monkeypox in HIV positive man in Prague. Czech Republic. Travel Med Infect Dis. 2022 doi: 10.1016/j.tmaid.2022.102368.
    1. Mileto D, Riva A, Cutrera M, Moschese D, Mancon A, Meroni L, Giacomelli A, Bestetti G, Rizzardini G, Gismondo MR, et al. New challenges in human monkeypox outside Africa: a review and case report from Italy. Travel Med Infect Dis. 2022 doi: 10.1016/j.tmaid.2022.102386.
    1. Bragazzi NL, Kong JD, Mahroum N, Tsigalou C, Khamisy-Farah R, Converti M, Wu J. Epidemiological trends and clinical features of the ongoing monkeypox epidemic: a preliminary pooled data analysis and literature review. J Med Virol. 2022 doi: 10.1002/jmv.27931.
    1. Cardona-Ospina JA, Henao-SanMartin V, Acevedo-Mendoza WF, Nasner-Posso KM, Martinez-Pulgarin DF, Restrepo-Lopez A, Valencia-Gallego V, Collins MH, Rodriguez-Morales AJ. Fatal Zika virus infection in the Americas: a systematic review. Int J Infect Dis. 2019;88:49–59. doi: 10.1016/j.ijid.2019.08.033.
    1. Rodriguez-Morales AJ, Cardona-Ospina JA, Fernanda Urbano-Garzon S, Sebastian Hurtado-Zapata J. Prevalence of post-chikungunya infection chronic inflammatory arthritis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 2016;68(12):1849–1858. doi: 10.1002/acr.22900.
    1. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–2012. doi: 10.1001/jama.283.15.2008.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.
    1. Drevon D, Fursa SR, Malcolm AL. Intercoder Reliability and Validity of WebPlotDigitizer in Extracting Graphed Data. Behav Modif. 2017;41(2):323–339. doi: 10.1177/0145445516673998.
    1. Barker TH, Migliavaca CB, Stein C, Colpani V, Falavigna M, Aromataris E, Munn Z. Conducting proportional meta-analysis in different types of systematic reviews: a guide for synthesisers of evidence. BMC Med Res Methodol. 2021;21(1):189. doi: 10.1186/s12874-021-01381-z.
    1. Hunter JP, Saratzis A, Sutton AJ, Boucher RH, Sayers RD, Bown MJ. In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. J Clin Epidemiol. 2014;67(8):897–903. doi: 10.1016/j.jclinepi.2014.03.003.
    1. Formenty P, Muntasir MO, Damon I, Chowdhary V, Opoka ML, Monimart C, Mutasim EM, Manuguerra JC, Davidson WB, Karem KL, et al. Human monkeypox outbreak caused by novel virus belonging to Congo Basin clade, Sudan, 2005. Emerg Infect Dis. 2010;16(10):1539–1545. doi: 10.3201/eid1610.100713.
    1. Huhn GD, Bauer AM, Yorita K, Graham MB, Sejvar J, Likos A, Damon IK, Reynolds MG, Kuehnert MJ. Clinical characteristics of human monkeypox, and risk factors for severe disease. Clin Infect Dis. 2005;41(12):1742–1751. doi: 10.1086/498115.
    1. Yinka-Ogunleye A, Aruna O, Dalhat M, Ogoina D, McCollum A, Disu Y, Mamadu I, Akinpelu A, Ahmad A, Burga J, et al. Outbreak of human monkeypox in Nigeria in 2017–18: a clinical and epidemiological report. Lancet Infect Dis. 2019;19(8):872–879. doi: 10.1016/S1473-3099(19)30294-4.
    1. Whitehouse ER, Bonwitt J, Hughes CM, Lushima RS, Likafi T, Nguete B, Kabamba J, Monroe B, Doty JB, Nakazawa Y, et al. Clinical and Epidemiological Findings from Enhanced Monkeypox Surveillance in Tshuapa Province, Democratic Republic of the Congo During 2011–2015. J Infect Dis. 2021;223(11):1870–1878. doi: 10.1093/infdis/jiab133.
    1. Jezek Z, Grab B, Szczeniowski M, Paluku KM, Mutombo M. Clinico-epidemiological features of monkeypox patients with an animal or human source of infection. Bull World Health Organ. 1988;66(4):459–464.
    1. Kalthan E, Dondo-Fongbia JP, Yambele S, Dieu-Creer LR, Zepio R, Pamatika CM. Twelve cases of monkeypox virus outbreak in Bangassou District (Central African Republic) in December 2015. Bull Soc Pathol Exot. 2016;109(5):358–363. doi: 10.1007/s13149-016-0516-z.
    1. Pittman PR, Martin JW, Kingebeni PM, Tamfum JJM, Wan Q, Reynolds MG, Quinn X, Norris S, Townsend MB, Satheshkumar PS, et al. Clinical characterization of human monkeypox infections in the Democratic Republic of the Congo. MedRxiv. 2022;46:593.
    1. Breman JG, Kalisa R, Steniowski MV, Zanotto E, Gromyko AI, Arita I. Human monkeypox, 1970–79. Bull World Health Organ. 1980;58(2):165–182.
    1. Perez Duque M, Ribeiro S, Martins JV, Casaca P, Leite PP, Tavares M, Mansinho K, Duque LM, Fernandes C, Cordeiro R, et al. Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. Euro Surveill. 2022 doi: 10.2807/1560-7917.ES.2022.27.22.2200424.
    1. Learned LA, Reynolds MG, Wassa DW, Li Y, Olson VA, Karem K, Stempora LL, Braden ZH, Kline R, Likos A, et al. Extended interhuman transmission of monkeypox in a hospital community in the Republic of the Congo, 2003. Am J Trop Med Hyg. 2005;73(2):428–434. doi: 10.4269/ajtmh.2005.73.428.
    1. Mande G, Akonda I, De Weggheleire A, Brosius I, Liesenborghs L, Bottieau E, Ross N, Gembu G-C, Colebunders R, Verheyen E, et al. Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions. MedRxiv. 2022;32:238.
    1. Girometti N, Byrne R, Bracchi M, Heskin J, McOwan A, ... Epidemiological characteristics and clinical features of confirmed human monkeypox virus cases in individuals attending a sexual health Centre in London …. papersssrncom.
    1. Vaughan A, Aarons E, Astbury J, Balasegaram S, Beadsworth M, Beck CR, Chand M, O'Connor C, Dunning J, Ghebrehewet S, et al. Two cases of monkeypox imported to the United Kingdom, September 2018. Euro Surveill. 2018 doi: 10.2807/1560-7917.ES.2018.23.38.1800509.
    1. Antinori A, Mazzotta V, Vita S, Carletti F, Tacconi D, Lapini LE, D'Abramo A, Cicalini S, Lapa D, Pittalis S, et al. Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022. Euro Surveill. 2022 doi: 10.2807/1560-7917.ES.2022.27.22.2200421.
    1. Hammerschlag Y, MacLeod G, Papadakis G, Adan Sanchez A, Druce J, Taiaroa G, Savic I, Mumford J, Roberts J, Caly L, et al. Monkeypox infection presenting as genital rash, Australia, May 2022. Euro Surveill. 2022 doi: 10.2807/1560-7917.ES.2022.27.22.2200411.
    1. de Nicolas-Ruanes B, Vivancos MJ, Azcarraga-Llobet C, Moreno AM, Rodriguez-Dominguez M, Berna-Rico ED, Garcia-Mouronte E, Carron-Herrero A, McGee A, Galan JC, et al. Monkeypox virus case with maculopapular exanthem and proctitis during the Spanish outbreak in 2022. JEADV. 2022 doi: 10.1111/jdv.18300.
    1. Reynolds MG, Wauquier N, Li Y, Satheshkumar PS, Kanneh LD, Monroe B, Maikere J, Saffa G, Gonzalez JP, Fair J, et al. Human monkeypox in sierra leone after 44-year absence of reported cases. Emerg Infect Dis. 2019;25(5):1023–1025. doi: 10.3201/eid2505.180832.
    1. Erez N, Achdout H, Milrot E, Schwartz Y, Wiener-Well Y, Paran N, Politi B, Tamir H, Israely T, Weiss S, et al. Diagnosis of Imported Monkeypox, Israel, 2018. Emerg Infect Dis. 2019;25(5):980–983. doi: 10.3201/eid2505.190076.
    1. Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022;22(8):1153–1162. doi: 10.1016/S1473-3099(22)00228-6.
    1. Hutin YJ, Williams RJ, Malfait P, Pebody R, Loparev VN, Ropp SL, Rodriguez M, Knight JC, Tshioko FK, Khan AS, et al. Outbreak of human monkeypox, Democratic Republic of Congo, 1996 to 1997. Emerg Infect Dis. 2001;7(3):434–438. doi: 10.3201/eid0703.017311.
    1. Reed KD, Melski JW, Graham MB, Regnery RL, Sotir MJ, Wegner MV, Kazmierczak JJ, Stratman EJ, Li Y, Fairley JA, et al. The detection of monkeypox in humans in the Western Hemisphere. N Engl J Med. 2004;350(4):342–350. doi: 10.1056/NEJMoa032299.
    1. Cimerman S, Chebabo A, Cunha CAD, Barbosa AN, Rodriguez-Morales AJ. Human monkeypox preparedness in Latin America - Are we ready for the next viral zoonotic disease outbreak after COVID-19? Br J Infect Dis. 2022;26(3):102372. doi: 10.1016/j.bjid.2022.102372.
    1. Rodriguez-Morales AJ, Lopardo G, Verbanaz S, Orduna T, Lloveras S, Azeñas-Burgoa JM, Escalera-Antezana JP, Alvarado-Arnez LE, Barbosa AN, Diaz-Quijano F, et al. Latin America: Situation and preparedness facing the multi-country human monkeypox outbreak. Lancet Regional Health Am. 2022;13:100318. doi: 10.1016/j.lana.2022.100318.
    1. Rodriguez-Morales AJ, Lopardo G. Monkeypox: another sexually transmitted infection? Pathogens. 2022;11(7):713. doi: 10.3390/pathogens11070713.
    1. Zambrano PG, Acosta-España JD, Mosquera Moyano F, Altamirano Jara MB. Sexually or intimately transmitted infections: A look at the current outbreak of monkeypox in 2022. Travel Med Infect Dis. 2022 doi: 10.1016/j.tmaid.2022.102383.
    1. Paules CI, Marston HD, Fauci AS. Coronavirus Infections-More Than Just the Common Cold. JAMA. 2020 doi: 10.1001/jama.2020.0757.
    1. Cimerman S, Chebabo A, Cunha CAD, Rodríguez-Morales AJ. Deep impact of COVID-19 in the healthcare of Latin America: the case of Brazil. Br J Infect Dis. 2020;24(2):93–95. doi: 10.1016/j.bjid.2020.04.005.
    1. Cimerman S, Chebabo A, Cunha CAD, Rodríguez-Morales AJ. One year after the arrival of COVID-19 in Latin America: what have we learned in Brazil and other countries? Br J Infect Dis. 2021;25(2):101571. doi: 10.1016/j.bjid.2021.101571.
    1. Ihekweazu C, Yinka-Ogunleye A, Lule S, Ibrahim A. Importance of epidemiological research of monkeypox: is incidence increasing? Expert Rev Anti Infect Ther. 2020;18(5):389–392. doi: 10.1080/14787210.2020.1735361.
    1. Rodriguez-Morales AJ, Cardona-Ospina JA, Collins MH. Emerging and re-emerging vector-borne and zoonotic diseases. Front Med. 2021;8:714630. doi: 10.3389/fmed.2021.714630.
    1. Rodriguez-Morales AJ, Paniz-Mondolfi AE, Faccini-Martínez ÁA, Henao-Martínez AF, Ruiz-Saenz J, Martinez-Gutierrez M, Alvarado-Arnez LE, Gomez-Marin JE, Bueno-Marí R, Carrero Y, et al. The constant threat of zoonotic and vector-borne emerging tropical diseases: living on the edge. Front Trop Dis. 2021;2:676905. doi: 10.3389/fitd.2021.676905.
    1. Rodriguez-Morales AJ, Gallego V, Escalera-Antezana JP, Méndez CA, Zambrano LI, Franco-Paredes C, Suárez JA, Rodriguez-Enciso HD, Balbin-Ramon GJ, Savio-Larriera E, et al. COVID-19 in Latin America: the implications of the first confirmed case in Brazil. Travel Med Infect Dis. 2020;35:101613. doi: 10.1016/j.tmaid.2020.101613.
    1. Rudan I. The COVID-19 pandemic: SARS-CoV-2, childhood hepatitis and monkeypox raise five new questions for the global health research community. J Glob Health. 2022;22:01002. doi: 10.7189/jogh.12.01002.
    1. Kozlov M. Monkeypox outbreaks: 4 key questions researchers have. Nature. 2022;606(7913):238–239. doi: 10.1038/d41586-022-01493-6.
    1. Kupferschmidt K. Monkeypox vaccination plans take shape amid questions. Science (New York, NY) 2022;376(6598):1142–1143. doi: 10.1126/science.add3743.
    1. Costello V, Sowash M, Gaur A, Cardis M, Pasieka H, Wortmann G, Ramdeen S. Imported Monkeypox from International Traveler, Maryland, USA, 2021. Emerg Infect Dis. 2022;28(5):1002–1005. doi: 10.3201/eid2805.220292.
    1. Hobson G, Adamson J, Adler H, Firth R, Gould S, Houlihan C, Johnson C, Porter D, Rampling T, Ratcliffe L, et al. Family cluster of three cases of monkeypox imported from Nigeria to the United Kingdom, May 2021. Euro Surveill. 2021 doi: 10.2807/1560-7917.ES.2021.26.32.2100745.
    1. Kyaw WM, Vasoo S, Ho HJA, Chan M, Yeo TW, Manauis CM, Ang H, De Pratim P, Ang BSP, Chow ALP. Monitoring healthcare professionals after monkeypox exposure: experience from the first case imported to Asia. Infect Control Hosp Epidemiol. 2020;41(3):373–375. doi: 10.1017/ice.2019.362.
    1. Yong SEF, Ng OT, Ho ZJM, Mak TM, Marimuthu K, Vasoo S, Yeo TW, Ng YK, Cui L, Ferdous Z, et al. Imported Monkeypox, Singapore. Emerg Infect Dis. 2020;26(8):1826–1830. doi: 10.3201/eid2608.191387.
    1. Clinical management and infection prevention and control for monkeypox: Interim rapid response guidance, 2022. . Accessed 10 Jun 2022.
    1. Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, Steffen R. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16(2):e0010141. doi: 10.1371/journal.pntd.0010141.
    1. Paniz-Mondolfi AE, Rodriguez-Morales AJ, Blohm G, Marquez M, Villamil-Gomez WE. ChikDenMaZika Syndrome: the challenge of diagnosing arboviral infections in the midst of concurrent epidemics. Ann Clin Microbiol Antimicrob. 2016;15(1):42. doi: 10.1186/s12941-016-0157-x.
    1. Bhunu CP, Mushayabasa S, Hyman JM. Modelling HIV/AIDS and monkeypox co-infection. Appl Math Comput. 2012;218(18):9504–9518.
    1. Kluge H, Ammon A. Monkeypox in Europe and beyond—tackling a neglected disease together. Euro Surveill. 2022 doi: 10.2807/1560-7917.ES.2022.27.24.2200482.
    1. Miura F, van Ewijk CE, Backer JA, Xiridou M, Franz E, Op de Coul E, Brandwagt D, van Cleef B, van Rijckevorsel G, Swaan C et al: Estimated incubation period for monkeypox cases confirmed in the Netherlands, May 2022. Euro Surveill 2022. 10.2807/1560-7917.ES.2022.27.24.2200448
    1. Vivancos R, Anderson C, Blomquist P, Balasegaram S, Bell A, Bishop L, Brown CS, Chow Y, Edeghere O, Florence I, et al. Community transmission of monkeypox in the United Kingdom, April to May 2022. Euro Surveill. 2022 doi: 10.2807/1560-7917.ES.2022.27.22.2200422.
    1. Ortiz-Martínez Y, Zambrano-Sanchez G, Rodríguez-Morales AJ. Monkeypox and HIV/AIDS: When the outbreak faces the epidemic. Int J STD AIDS. 2022 doi: 10.1177/09564624221114191.
    1. Murphy S. Monkeypox. Br Dent J. 2022;232(11):760. doi: 10.1038/s41415-022-4358-8.
    1. McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014;58(2):260–267. doi: 10.1093/cid/cit703.
    1. Saxena SK, Ansari S, Maurya VK, Kumar S, Jain A, Paweska JT, Tripathi AK, Abdel-Moneim AS. Re-emerging human monkeypox: a major public-health debacle. J Med Virol. 2022 doi: 10.1002/jmv.27902.
    1. Quarleri J, Delpino MV, Galvan V. Monkeypox: considerations for the understanding and containment of the current outbreak in non-endemic countries. GeroScience. 2022 doi: 10.1007/s11357-022-00611-6.
    1. Dashraath P, Nielsen-Saines K, Mattar C, Musso D, Tambyah P, Baud D. Guidelines for pregnant individuals with monkeypox virus exposure. Lancet. 2022 doi: 10.1016/S0140-6736(22)01063-7.
    1. Mbala PK, Huggins JW, Riu-Rovira T, Ahuka SM, Mulembakani P, Rimoin AW, Martin JW, Muyembe JT. Maternal and fetal outcomes among pregnant women with human monkeypox infection in the democratic Republic of Congo. J Infect Dis. 2017;216(7):824–828. doi: 10.1093/infdis/jix260.
    1. European Centers for Disease Control and Prevention (ECDC): Monkeypox multi-country outbreak—apid risk assessment; 2022. . Accessed 23 June 2022.
    1. Hutson CL, Kondas AV, Mauldin MR, Doty JB, Grossi IM, Morgan CN, Ostergaard SD, Hughes CM, Nakazawa Y, Kling C, et al. Pharmacokinetics and efficacy of a potential smallpox therapeutic, brincidofovir, in a lethal monkeypox virus animal model. MSphere. 2021 doi: 10.1128/mSphere.00126-21.
    1. Rodríguez-Morales AJ, Ortiz-Martínez Y, Bonilla-Aldana DK. What has been researched about Monkeypox? A bibliometric analysis of an old zoonotic virus causing global concern. New Microbes New Infect. 2022;47:100993. doi: 10.1016/j.nmni.2022.100993.
    1. Amao LK, Olatunji DI, Igbodo G, Okoli SC, Amaechi I, Goni MI, Ehiakhamen O, Aderinola O, Ogunleye A, Ogunbode O, et al. Trend and enhanced surveillance of Monkeypox during COVID-19 pandemic in Nigeria. J Public Health Afr. 2022;13(1):2184. doi: 10.4081/jphia.2022.2184.
    1. Eseigbe EE, Akude C, Osagie IA, Eseigbe P. Human monkey pox virus infection in plateau state, north central nigeria: a report of two cases. West Afr J Med. 2021;38(12):1242–1246. doi: 10.55891/wajm.v38i12.55.
    1. Guagliardo SAJ, Monroe B, Moundjoa C, Athanase A, Okpu G, Burgado J, Townsend MB, Satheshkumar PS, Epperson S, Doty JB, et al. Asymptomatic orthopoxvirus circulation in humans in the wake of a monkeypox outbreak among chimpanzees in cameroon. Am J Trop Med Hyg. 2020;102(1):206–212. doi: 10.4269/ajtmh.19-0467.
    1. Ortiz-Martínez Y, Galvis-Cataño LM, Arias-Rodríguez D, Romero-Dager C, Bonilla-Aldana DK, Rodriguez-Morales AJ. YouTube and 2022 Monkeypox outbreak: opportunities for awareness and infection control. J Hosp Infect. 2022 doi: 10.1016/j.jhin.2022.07.007.
    1. Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, Palich R, Nori A, Reeves I, Habibi MS, et al. Monkeypox Virus Infection in Humans across 16 Countries—April-June 2022. N Engl J Med. 2022 doi: 10.1056/NEJMoa2207323.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere