{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T20:23:03Z","timestamp":1775852583131,"version":"3.50.1"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T00:00:00Z","timestamp":1721952000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>Recent outbreaks of monkeypox (Mpox) have occurred in countries outside of Africa, with large numbers of cases spreading rapidly to almost every continent. We aimed to analyze the correlation between the Global Health Security (GHS) Index (categories and indicators) and the Mpox case rate in different regions and globally.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>In this cross-sectional study, we used data from Mpox cases from the WHO, and the GHS categories and indicators for detection, prevention, reporting, health system, rapid response, international norms compliance, and risk environment. Outcome measures were the relationship between GHS index (categories and indicators) and Mpox case rate using crude and adjusted non-linear regression models.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>After performing adjusted analyses, only risk environment and detection and reporting index were associated with Mpox case rates in the 99 countries and the Region of the Americas, respectively. Antimicrobial resistance (AMR) indicators of the prevention category, risk communication of the rapid response category, the joint external evaluation and performance veterinary services of the norms category, and the infrastructure adequacy of the risk environment category were associated with Mpox case rates in the 99 countries (<jats:italic>p<\/jats:italic>&lt;0.05). Laboratory systems strength and quality indicator of the detection and reporting category, and emergency response operation indicator of the response rapid category were associated with Mpox case rates in the countries of the region of the Americas (<jats:italic>p<\/jats:italic>&lt;0.05). AMR indicator of the prevention of the emergence category, and the infrastructure adequacy of the risk environment category were associated with Mpox case rates in the countries of the European Region (<jats:italic>p<\/jats:italic>&lt;0.05). In the countries of the other regions, only the trade and travel restrictions indicator of the rapid response category was associated with Mpox case rates (<jats:italic>p<\/jats:italic>&lt;0.05).<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>Countries, particularly in the Americas region, with high levels of infrastructure adequacy and laboratory system strength and quality as measured by the GHS index are better equipped to detect more Mpox cases. Therefore, they have higher Mpox case detection rates and can successfully respond to Mpox outbreaks.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0307503","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T17:47:56Z","timestamp":1722016076000},"page":"e0307503","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["High Global Health Security Index is a determinant of early detection and response to monkeypox: A cross-sectional study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0471-6746","authenticated-orcid":true,"given":"Max Carlos","family":"Ram\u00edrez-Soto","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5128-7820","authenticated-orcid":true,"given":"Hugo","family":"Arroyo-Hern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,7,26]]},"reference":[{"issue":"19","key":"pone.0307503.ref001","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1056\/NEJMra2208860","article-title":"Monkeypox","volume":"387","author":"A Gessain","year":"2022","journal-title":"N Engl J Med"},{"issue":"10","key":"pone.0307503.ref002","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1016\/j.jiph.2022.09.008","article-title":"Emergence and dissemination of monkeypox, an intimidating global public health problem","volume":"15","author":"H Ejaz","year":"2022","journal-title":"J Infect Public Health"},{"issue":"2","key":"pone.0307503.ref003","doi-asserted-by":"crossref","first-page":"e0010141","DOI":"10.1371\/journal.pntd.0010141","article-title":"The changing epidemiology of human monkeypox-A potential threat? A systematic review","volume":"16","author":"EM Bunge","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"8","key":"pone.0307503.ref004","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/S1473-3099(19)30294-4","article-title":"Outbreak of human monkeypox in Nigeria in 2017\u201318: a clinical and epidemiological report","volume":"19","author":"A Yinka-Ogunleye","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"pone.0307503.ref005","unstructured":"World Health Organization (WHO). WHO Health Emergency Dashboard. Monkeypox. Geneva: WHO 2022. Available online: https:\/\/worldhealthorg.shinyapps.io\/mpx_global\/ (accessed on 17 January 2024)."},{"issue":"7","key":"pone.0307503.ref006","doi-asserted-by":"crossref","first-page":"e1012","DOI":"10.1016\/S2214-109X(23)00198-5","article-title":"Description of the first global outbreak of mpox: an analysis of global surveillance data","volume":"11","author":"H Laurenson-Schafer","year":"2023","journal-title":"Lancet Glob Health"},{"issue":"6","key":"pone.0307503.ref007","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.3390\/medicina59061096","article-title":"Monkeypox Outbreak in Peru","volume":"59","author":"MC Ram\u00edrez-Soto","year":"2023","journal-title":"Medicina (Kaunas)"},{"key":"pone.0307503.ref008","unstructured":"WHO. WHO Director-General\u2019s statement at the press conference following IHR Emergency Committee regarding the multi-country outbreak of monkeypox\u201423 July 2022. 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Rethinking countries\u2019 capacity based on the Global Health Security Index","volume":"106","author":"Y Ji","year":"2021","journal-title":"Int J Infect Dis"},{"issue":"12","key":"pone.0307503.ref012","doi-asserted-by":"crossref","first-page":"e007581","DOI":"10.1136\/bmjgh-2021-007581","article-title":"Analysing COVID-19 outcomes in the context of the 2019 Global Health Security (GHS) Index","volume":"6","author":"SM Rose","year":"2021","journal-title":"BMJ Glob Health"},{"issue":"7","key":"pone.0307503.ref013","doi-asserted-by":"crossref","first-page":"e012203","DOI":"10.1136\/bmjgh-2023-012203","article-title":"Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure","volume":"8","author":"JR Ledesma","year":"2023","journal-title":"BMJ Glob Health"},{"issue":"4","key":"pone.0307503.ref014","doi-asserted-by":"crossref","first-page":"e0229","DOI":"10.1097\/GH9.0000000000000229","article-title":"Exploring the relationship between the Global Health Security Index and monkeypox: an analysis of preparedness and response capacities","volume":"6","author":"MN Hasan","year":"2023","journal-title":"IJS Global Health"},{"key":"pone.0307503.ref015","doi-asserted-by":"crossref","first-page":"e003648","DOI":"10.1136\/bmjgh-2020-003648","article-title":"The value proposition of the global health security index","volume":"5","author":"SJ Ravi","year":"2020","journal-title":"BMJ Glob Health"},{"key":"pone.0307503.ref016","unstructured":"Nuclear Threat Initiative, Johns Hopkins Center for Health Security, The Economist Intelligence Unit. 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