Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: May 25, 2023
Date Accepted: Jan 20, 2024
Integrated network analysis of symptom clusters across monkeypox epidemics from 1970 to 2023：A systematic review and meta-analysis
ABSTRACT
Background:
The global spread of monkeypox (mpox) has witnessed a significant increase, particularly in non-endemic countries.
Objective:
In this systematic review and meta-analysis, we aim to shed light on the current state of symptomatology associated with mpox and explore the correlations among different symptoms.
Methods:
Four electronic databases were searched for English language peer-reviewed studies conducted between 01/1970-04/2023 that reported any symptoms among confirmed mpox cases. We categorised the mpox epidemics by three periods, 1970-2002 (within the African region), 2003-2021(epidemics outside Africa) and 2022-2023 (global outbreak) in this review. Following the PRISMA guidelines, meta-analysis was used to estimate pooled prevalence for each symptom. The correlation among symptoms was analysed and visualized by network analysis.
Results:
The meta-analysis included 62 studies that reported 21 symptoms in 720 patients from 1970 to 2002, 39 of 1722 from 2003 to 2021, and 37 of 11,012 from 2022 to 2023. The most common symptoms among patients from all three periods were rash (86.4%, 95% CI [79.6%-93.3%]from 1970 to 2022, 99.2%, [94.1%-100.0%] from 2003 to 2021, and 94.4% [92.6%-96.2%] since 2022), fever (98.6%[90.8%-100.0%], 95.3% [90.2%-100.0%], and 52.1%[50.7%-53.4%]), headache (98.6% [87.1%-110.1%], 70.0% [65.6%-74.4%], and 37.2%[36.0%-38.4%]), and lymphadenopathy (61.1%, [55.3%-66.8%], 82.6%, [77.5%-87.7%], 52.2%, [50.2%-54.2%]). Nausea/vomiting was highly variable but had the highest degree of correlation and was positively correlated with 13 symptoms from 2003 to 2021. In contrast, rash and headache became the two symptoms with the highest degree of correlation, and they were positively correlated with 21 symptoms from 2022 to 2023.
Conclusions:
The manifestation of symptoms in mpox patients has become more diverse, leading to an increase in their correlation. While the prevalence of rash remains steady, other symptoms have decreased. Clinical Trial: PROSPERO, CRD42023403282
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