Clinical Features, Antiviral Treatment, and Patient Outcomes: A Systematic Review and Comparative Analysis of the Previous and the 2022 Mpox Outbreaks

• Published in: The Journal of infectious diseases 2023-08, Vol.228 (4), p.391-401
• Main Authors: Li, Pengfei, Li, Jiajing, Ayada, Ibrahim, Avan, Amine, Zheng, Qinyue, Peppelenbosch, Maikel P, de Vries, Annemarie C, Pan, Qiuwei
• Format: Article
• Language: English
• Subjects: Adult; Antiviral Agents - therapeutic use; Antiviral drugs; Child; Clinical outcomes; Comparative analysis; Disease Outbreaks; Epidemics; Female; HIV; Homosexuality, Male; Human immunodeficiency virus; Humans; Major; Male; Meta-analysis; Mpox; Mpox (monkeypox); Outbreaks; Patients; Pelvic Pain; Sexual and Gender Minorities; Skin diseases; Skin lesions; Systematic review
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiad034

Abstract Background This study aims to comparatively analyze clinical features, treatment, and patient outcomes between the previous and the 2022 mpox (monkeypox) outbreaks. Methods Five bibliographic databases were searched for studies reporting clinical features, management, and patient outcomes of mpox. Systematic review and meta-analysis were performed. Results In total, 73 studies were included in the systematic review, of which 33 studies were subjected to meta-analysis. Previous outbreaks substantially affected children, whereas the 2022 outbreak primarily affected male adults, of which 94.66% (95% confidence interval [CI], 88.03–98.95) were men who have sex with men. Furthermore, 72.47% (95% CI, 51.04–89.71) reported high-risk sexual activity and the overall human immunodeficiency virus (HIV) prevalence was 37.65% (95% CI, 30.09–45.50). Skin lesions remain the typical symptom; however, their anatomic distribution differed. Systemic manifestations were common, but rectal pain was unique to the 2022 outbreak. The estimated overall fatality during past outbreaks in Africa was 4.61% (95% CI, 2.39%–7.35%), whereas 6.34% (95% CI, 3.35%–10.10%) of patients from the 2022 outbreak required hospitalization. Antiviral treatment, in particular tecovirimat, has been prescribed for a subset of patients, but the efficacy remains inconclusive. Conclusions These findings are important for better understanding the disease and guiding adequate response to mpox outbreaks. Mpox mainly causes skin injuries, but severe complications and even death can occur in vulnerable individuals. This systematic review and meta-analysis revealed distinct epidemiological and clinical features as well as patient outcomes between the previous and the 2022 mpox outbreaks.