Monkeypox: a systematic review of epidemiology, pathogenesis, manifestations, and outcomes

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Abstract

Introduction. Since May 2022, an unusually large number of new monkeypox infections-a previously rare viral zoonotic disease, mainly reported from central and western Africa has been reported globally, and the World Health Organization (WHO) declared a global health emergency in July 2022. We aimed to systematically review the monkeypox virus epidemiology, pathogenesis, transmission, presentations, and outcomes.

Materials and methods. Our aim is to systematically review the epidemiology, pathogenesis, manifestations, and outcomes of Monkeypox disease. We searched the keywords in the online databases of PubMed, Embase, Scopus, and Web of Science and investigated all English articles until December 2022. In order to ascertain the findings, this study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. In order to optimize the quality, this review study benefits from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. To minimize any probable bias risk, we utilized the Newcastle-Ottawa Scale (NOS) risk assessment tool.

Results. The most prevalent symptoms were rash and fever. The infection was accompanied by different complications such as, but not limited to, encephalitis (mainly in children), septicemia, bacterial cellulitis, retropharyngeal and parapharyngeal abscesses, etc. A wide range of hospitalization from 3.7% to 100% has been reported. The mortality rate ranged from 0% to 23%, which mainly occurred in infants and children. High mortality of the monkeypox rate was reported among pregnant women. The mortality rate of monkeypox is lower among women and those who received the smallpox vaccine compared to men and those who did not receive the vaccine. A wide range of the overall second-rate attack was reported, which is more pronounced in unvaccinated patients.

Conclusion. In our systematic review of 35 studies on monkeypox, we cast light on the existing evidence on its epidemiology, pathogenesis, manifestation, and outcomes. Further studies are needed to elucidate the natural history of the disease in various patients’ population, as well as detailing the monkeypox attack rate.

About the authors

SeyedAhmad SeyedAlinaghi

Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors

Email: s_a_alinaghi@yahoo.com

MD, MPhil, PhD, Clinical Epidemiologist, Associate Professor, Research Deputy 

Iran, Islamic Republic of, Tehran

Amir Masoud Afsahi

University of California

Email: amir.masoud.afsahi@gmail.com

PhD, Assistant Professor, Department of Radiology, School of Medicine

United States, San Diego

Arian Afzalian

Tehran University of Medical Sciences

Email: Arianafzalian@gmail.com

MD, School of Medicine

Iran, Islamic Republic of, Tehran

Ramin Shahidi

Bushehr University of Medical Sciences

Email: dr.raminshahidi1@gmail.com

MD, School of Medicine

Iran, Islamic Republic of, Bushehr

Seyed Saeed Tamehri Zadeh

Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors

Email: tamehrysaeed@gmail.com

MD, Student, School of Medicine

Iran, Islamic Republic of, Tehran

Sanaz Varshochi

Tehran University of Medical Sciences

Email: varshochi.sanaz@gmail.com

MD, Student, School of Medicine

Iran, Islamic Republic of, Tehran

Mohsen Dashti

Tabriz University of Medical Sciences

Email: Mohsen.d4shti@gmail.com

MD, Department of Radiology

Iran, Islamic Republic of, Tabriz

Afsaneh Ghasemzadeh

Tabriz University of Medical Sciences

Email: Afsanemqsz1996@gmail.com

MD, Department of Radiology

Iran, Islamic Republic of, Tabriz

Ava Pashaei

University of British Columbia

Email: zahra.pashaei243@gmail.com

PhD Student, School of Nursing

Canada, Vancouver

Parinaz Paranjkhoo

American University of Armenia

Email: parinazparanjkhoo@gmail.com

MD, MPH, Researcher, Turpanjian College of Health Sciences

Armenia, Yerevan

Zohal Parmoon

Tehran University of Medical Sciences

Email: Zohalparmoon@icloud.com

MD, Student, School of Medicine

Iran, Islamic Republic of, Tehran

Sahar N. Parikhani

Tehran University of Medical Sciences

Email: Sahar.nurse91@gmail.com

BS in Nursing, School of Medicine

Iran, Islamic Republic of, Tehran

Ahmadreza Shamsabadi

Esfarayen Faculty of Medical Sciences

Email: shamsabadi1010@gmail.com

PhD, Assistant Professor, Department of Health Information Technology

Iran, Islamic Republic of, Esfarayen

Pourya Pezeshgi

Maragheh University of Medical Sciences

Email: Pezeshgipourya@yahoo.com

MD, Student, School of Medicine

Iran, Islamic Republic of, Maragheh

Sepide Ahmadi

Tehran University of Medical Sciences

Email: Sepide2434@gmail.com

MD, Student, School of Medicine

Iran, Islamic Republic of, Tehran

Ghazal Arjmand

Shahid Beheshti University of Medical Sciences

Email: ghazalarjmand@sbmu.ac.ir

MD, Student, School of Medicine

Iran, Islamic Republic of, Tehran

Mohammad Javaherian

Tehran University of Medical Sciences

Email: Javaherian_m@razi.tums.ac.ir

MD, Student, Department of Physiotherapy,

Iran, Islamic Republic of, Tehran

Hooman Ebrahimi

Tehran University of Medical Sciences

Email: hooman.ebr@gmail.com

MD, Student, School of Medicine

Iran, Islamic Republic of, Tehran

Amirali Karimi

Tehran University of Medical Sciences

Email: karimi.amirali.1999@gmail.com

MD, Student, School of Medicine

Iran, Islamic Republic of, Tehran

Esmaeil Mehraeen

Khalkhal University of Medical Sciences

Author for correspondence.
Email: es.mehraeen@gmail.com

PhD, Assistant Professor, Department of Health Information Technology

Iran, Islamic Republic of, Khalkhal

Shayesteh Jahanfar

Tufts University School of Medicine

Email: jahan2s@cmich.edu

PhD, Associate Professor, MPH Program, Department of Public Health and Community Medicine

United States, Boston

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Copyright (c) 2023 SeyedAlinaghi S., Afsahi A., Afzalian A., Shahidi R., Tamehri Zadeh S., Varshochi S., Dashti M., Ghasemzadeh A., Pashaei A., Paranjkhoo P., Parmoon Z., Parikhani S.N., Shamsabadi A., Pezeshgi P., Ahmadi S., Arjmand G., Javaherian M., Ebrahimi H., Karimi A., Mehraeen E., Jahanfar S.

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