{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T01:57:13Z","timestamp":1790128633828,"version":"4.0.1"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T00:00:00Z","timestamp":1675382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Netherlands Organization for Scientific Research","award":["91719300"],"award-info":[{"award-number":["91719300"]}]},{"DOI":"10.13039\/501100004622","name":"Dutch Cancer Society","doi-asserted-by":"crossref","award":["10140"],"award-info":[{"award-number":["10140"]}],"id":[{"id":"10.13039\/501100004622","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aims to comparatively analyze clinical features, treatment, and patient outcomes between the previous and the 2022 mpox (monkeypox) outbreaks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Five bibliographic databases were searched for studies reporting clinical features, management, and patient outcomes of mpox. Systematic review and meta-analysis were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u201398.95) were men who have sex with men. Furthermore, 72.47% (95% CI, 51.04\u201389.71) reported high-risk sexual activity and the overall human immunodeficiency virus (HIV) prevalence was 37.65% (95% CI, 30.09\u201345.50). 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%\u20137.35%), whereas 6.34% (95% CI, 3.35%\u201310.10%) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings are important for better understanding the disease and guiding adequate response to mpox outbreaks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiad034","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T11:49:30Z","timestamp":1675424970000},"page":"391-401","source":"Crossref","is-referenced-by-count":67,"title":["Clinical Features, Antiviral Treatment, and Patient Outcomes: A Systematic Review and Comparative Analysis of the Previous and the 2022 Mpox Outbreaks"],"prefix":"10.1093","volume":"228","author":[{"given":"Pengfei","family":"Li","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center-University Medical Center , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center-University Medical Center , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Ayada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center-University Medical Center , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amine","family":"Avan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center-University Medical Center , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinyue","family":"Zheng","sequence":"additional","affiliation":[{"name":"School of International Affairs and Public Administration, Ocean University of China , Qingdao , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maikel P","family":"Peppelenbosch","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center-University Medical Center , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarie C","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center-University Medical Center , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9982-6184","authenticated-orcid":false,"given":"Qiuwei","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center-University Medical Center , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,2,3]]},"reference":[{"key":"2023081611091799800_jiad034-B1","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1086\/498155","article-title":"Reemergence of monkeypox: prevalence, diagnostics, and countermeasures","volume":"41","author":"Nalca","year":"2005","journal-title":"Clin Infect Dis"},{"key":"2023081611091799800_jiad034-B2","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/infdis\/jiaa559","article-title":"Exportation of monkeypox virus from the African continent","volume":"225","author":"Mauldin","year":"2022","journal-title":"J Infect Dis"},{"key":"2023081611091799800_jiad034-B3","author":"Centers for Disease Control and Prevention"},{"key":"2023081611091799800_jiad034-B4","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1056\/NEJMoa032299","article-title":"The detection of monkeypox in humans in the Western hemisphere","volume":"350","author":"Reed","year":"2004","journal-title":"N Engl J Med"},{"key":"2023081611091799800_jiad034-B5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010141","article-title":"The changing epidemiology of human monkeypox\u2014a potential threat? A systematic review","volume":"16","author":"Bunge","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"2023081611091799800_jiad034-B6","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijsu.2022.106703","article-title":"Monkeypox virus (MPX) in humans a concern: trespassing the global boundaries\u2014correspondence","volume":"104","author":"Thakur","year":"2022","journal-title":"Int J Surg"},{"key":"2023081611091799800_jiad034-B7","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.3201\/eid2206.150579","article-title":"Extended human-to-human transmission during a monkeypox outbreak in the democratic Republic of the Congo","volume":"22","author":"Nolen","year":"2016","journal-title":"Emerg Infect Dis"},{"key":"2023081611091799800_jiad034-B8","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s10393-019-01459-7","article-title":"Monkeypox rash severity and animal exposures in the democratic Republic of the Congo","volume":"17","author":"Doshi","year":"2020","journal-title":"Ecohealth"},{"key":"2023081611091799800_jiad034-B9","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/S1473-3099(22)00354-1","article-title":"Monkeypox outbreaks outside endemic regions: scientific and social priorities","volume":"22","author":"Zumla","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"2023081611091799800_jiad034-B10","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1038\/s41591-022-02090-w","article-title":"Low levels of monkeypox virus-neutralizing antibodies after MVA-BN vaccination in healthy individuals","volume":"29","author":"Zaeck","year":"2023","journal-title":"Nat Med"},{"key":"2023081611091799800_jiad034-B11","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/S1473-3099(20)30012-8","article-title":"WHO celebrates 40 years since eradication of smallpox","volume":"20","author":"Kirby","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"2023081611091799800_jiad034-B12","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1056\/NEJMoa1705688","article-title":"Oral tecovirimat for the treatment of smallpox","volume":"379","author":"Grosenbach","year":"2018","journal-title":"N Engl J Med"},{"key":"2023081611091799800_jiad034-B13","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2023081611091799800_jiad034-B14","author":"JBI"},{"key":"2023081611091799800_jiad034-B15","first-page":"295","article-title":"Fatal monkeypox in a child in Kikwit, Zaire","volume":"64","author":"Janseghers","year":"1984","journal-title":"Ann Soc Belg Med Trop"},{"key":"2023081611091799800_jiad034-B16","article-title":"A case report of monkeypox in a 4-year-old boy from the DR Congo: challenges of diagnosis and management","volume":"2020","author":"Eltvedt","year":"2020","journal-title":"Case Rep Pediatr"},{"key":"2023081611091799800_jiad034-B17","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1016\/S0140-6736(11)61142-2","article-title":"Maculopapular lesions in the Central African Republic","volume":"378","author":"Berthet","year":"2011","journal-title":"Lancet"},{"key":"2023081611091799800_jiad034-B18","doi-asserted-by":"crossref","first-page":"718","DOI":"10.4269\/ajtmh.15-0095","article-title":"Human monkeypox in the Kivus, a conflict region of the democratic Republic of the Congo","volume":"93","author":"McCollum","year":"2015","journal-title":"Am J Trop Med Hyg"},{"key":"2023081611091799800_jiad034-B19","doi-asserted-by":"crossref","first-page":"23","DOI":"10.11604\/pamj.2015.22.23.6620","article-title":"Pox-like lesions and haemorrhagic fever in two concurrent cases in the Central African Republic: case investigation and management in difficult circumstances","volume":"22","author":"Froeschl","year":"2015","journal-title":"Pan Afr Med J"},{"key":"2023081611091799800_jiad034-B20","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1097\/01.inf.0000101821.61387.a5","article-title":"A case of severe monkeypox virus disease in an American child: emerging infections and changing professional values","volume":"22","author":"Anderson","year":"2003","journal-title":"Pediatr Infect Dis J"},{"key":"2023081611091799800_jiad034-B21","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/S1473-3099(22)00228-6","article-title":"Clinical features and management of human monkeypox: a retrospective observational study in the UK","volume":"22","author":"Adler","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"2023081611091799800_jiad034-B22","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2022.27.22.2200411","article-title":"Monkeypox infection presenting as genital rash, Australia, May 2022","volume":"27","author":"Hammerschlag","year":"2022","journal-title":"Euro Surveill"},{"key":"2023081611091799800_jiad034-B23","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s15010-022-01874-z","article-title":"Clinical and virological features of first human monkeypox cases in Germany","volume":"51","author":"Noe","year":"2022","journal-title":"Infection"},{"key":"2023081611091799800_jiad034-B24","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.7326\/L22-0300","article-title":"Monkeypox virus-associated severe proctitis treated with oral tecovirimat: a report of two cases","volume":"175","author":"Lucar","year":"2022","journal-title":"Ann Intern Med"},{"key":"2023081611091799800_jiad034-B25","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1001\/jama.2022.15336","article-title":"Compassionate use of tecovirimat for the treatment of monkeypox infection","volume":"328","author":"Desai","year":"2022","journal-title":"JAMA"},{"key":"2023081611091799800_jiad034-B26","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofac377","article-title":"Tecovirimat for the treatment of human monkeypox: an initial series from Massachusetts, United States","volume":"9","author":"Matias","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"2023081611091799800_jiad034-B27","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1056\/NEJMoa2207323","article-title":"Monkeypox virus infection in humans across 16 countries\u2014April-June 2022","volume":"387","author":"Thornhill","year":"2022","journal-title":"N Engl J Med"},{"key":"2023081611091799800_jiad034-B28","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1001\/jamaophthalmol.2022.4568","article-title":"Ocular pox lesions in a male patient with monkeypox treated with tecovirimat","volume":"140","author":"Rai","year":"2022","journal-title":"JAMA Ophthalmol"},{"key":"2023081611091799800_jiad034-B29","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1093\/cid\/ciac971","article-title":"The use of vaccinia immune globulin in the treatment of severe mpox virus infection in HIV\/AIDS","volume":"76","author":"Thet","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2023081611091799800_jiad034-B30","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1016\/S1473-3099(22)00411-X","article-title":"Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis","volume":"22","author":"Girometti","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"2023081611091799800_jiad034-B31","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3389\/fpubh.2018.00241","article-title":"Emergence of monkeypox as the most important orthopoxvirus infection in humans","volume":"6:","author":"Sklenovska","year":"2018","journal-title":"Front Public Health"},{"key":"2023081611091799800_jiad034-B32","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1111\/tmi.13785","article-title":"Monkeypox 2022 outbreak: an update","volume":"27","author":"Velavan","year":"2022","journal-title":"Trop Med Int Health"},{"key":"2023081611091799800_jiad034-B33","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1038\/s41591-022-01907-y","article-title":"Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of monkeypox virus","volume":"28","author":"Isidro","year":"2022","journal-title":"Nat Med"},{"key":"2023081611091799800_jiad034-B34","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.1016\/S2352-4642(22)00250-4","article-title":"Monkeypox virus infections in children in Spain during the first months of the 2022 outbreak","volume":"6","author":"Aguilera-Alonso","year":"2022","journal-title":"Lancet Child Adolesc Health"},{"key":"2023081611091799800_jiad034-B35","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1126\/science.ade7115","article-title":"Protect the vulnerable from monkeypox","volume":"377","author":"Titanji","year":"2022","journal-title":"Science"},{"key":"2023081611091799800_jiad034-B36","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/S0140-6736(22)01063-7","article-title":"Guidelines for pregnant individuals with monkeypox virus exposure","volume":"400","author":"Dashraath","year":"2022","journal-title":"Lancet"},{"key":"2023081611091799800_jiad034-B37","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.3201\/eid1207.051531","article-title":"Smallpox during pregnancy and maternal outcomes","volume":"12","author":"Nishiura","year":"2006","journal-title":"Emerg Infect Dis"},{"key":"2023081611091799800_jiad034-B38","article-title":".","author":"Centers for Disease Control and Prevention"},{"key":"2023081611091799800_jiad034-B39","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.15585\/mmwr.mm7144e1","article-title":"Severe monkeypox in hospitalized patients\u2014United States, August 10-October 10, 2022","volume":"71","author":"Miller","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2023081611091799800_jiad034-B40","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.15585\/mmwr.mm7138e1","article-title":"Two cases of monkeypox-associated encephalomyelitis\u2014Colorado and the District of Columbia, July-August 2022","volume":"71","author":"Pastula","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2023081611091799800_jiad034-B41","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.15585\/mmwr.mm7135e2","article-title":"Modeling the impact of sexual networks in the transmission of monkeypox virus among gay, bisexual, and other men who have sex with men\u2014United States, 2022","volume":"71","author":"Spicknall","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2023081611091799800_jiad034-B42","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1093\/infdis\/156.2.293","article-title":"Human monkeypox: clinical features of 282 patients","volume":"156","author":"Jezek","year":"1987","journal-title":"J Infect Dis"},{"key":"2023081611091799800_jiad034-B43","doi-asserted-by":"crossref","first-page":"539","DOI":"10.3201\/eid1104.040907","article-title":"Experimental infection of prairie dogs with monkeypox virus","volume":"11","author":"Xiao","year":"2005","journal-title":"Emerg Infect Dis"},{"key":"2023081611091799800_jiad034-B44","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1056\/NEJMoa2109072","article-title":"COVID-19 breakthrough infections in vaccinated health care workers","volume":"385","author":"Bergwerk","year":"2021","journal-title":"N Engl J Med"},{"key":"2023081611091799800_jiad034-B45","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.15585\/mmwr.mm7149a5","article-title":"Reduced risk for mpox after receipt of 1 or 2 doses of JYNNEOS vaccine compared with risk among unvaccinated persons\u201443 U.S. jurisdictions, July 31-October 1, 2022","volume":"71","author":"Payne","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2023081611091799800_jiad034-B46","doi-asserted-by":"crossref","DOI":"10.1016\/j.antiviral.2021.105182","article-title":"Benefit-risk assessment for brincidofovir for the treatment of smallpox: U.S. Food and Drug Administration's evaluation","volume":"195","author":"Chan-Tack","year":"2021","journal-title":"Antiviral Res"},{"key":"2023081611091799800_jiad034-B47","doi-asserted-by":"crossref","first-page":"13139","DOI":"10.1128\/JVI.79.20.13139-13149.2005","article-title":"An orally bioavailable antipoxvirus compound (ST-246) inhibits extracellular virus formation and protects mice from lethal orthopoxvirus challenge","volume":"79","author":"Yang","year":"2005","journal-title":"J Virol"},{"key":"2023081611091799800_jiad034-B48","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1093\/cid\/ciac622","article-title":"Antivirals with activity against mpox: a clinically oriented review","volume":"76","author":"Siegrist","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2023081611091799800_jiad034-B49","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1056\/NEJMc2212136","article-title":"Drug sensitivity of currently circulating mpox viruses","volume":"388","author":"Bojkova","year":"2023","journal-title":"N Engl J Med"},{"key":"2023081611091799800_jiad034-B50","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.19325","article-title":"Limitations of meta-analyses of studies with high heterogeneity","volume":"3","author":"Imrey","year":"2020","journal-title":"JAMA Netw Open"}],"container-title":["The Journal of Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jid\/advance-article-pdf\/doi\/10.1093\/infdis\/jiad034\/49509985\/jiad034.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jid\/article-pdf\/228\/4\/391\/51115610\/jiad034.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jid\/article-pdf\/228\/4\/391\/51115610\/jiad034.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T07:10:01Z","timestamp":1692169801000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jid\/article\/228\/4\/391\/7025706"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,3]]},"references-count":50,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2,3]]},"published-print":{"date-parts":[[2023,8,16]]}},"URL":"https:\/\/doi.org\/10.1093\/infdis\/jiad034","relation":{},"ISSN":["0022-1899","1537-6613"],"issn-type":[{"value":"0022-1899","type":"print"},{"value":"1537-6613","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,8,15]]},"published":{"date-parts":[[2023,2,3]]}}}