Integrated Network Analysis of Symptom Clusters Across Monkeypox Epidemics From 1970 to 2023: Systematic Review and Meta-Analysis

作者全名："Su, Shu; Jia, Meng; Yu, Yingni; Li, Hu; Yin, Wenwei; Lu, Yi; Huang, Rongzhong; Xiang, Rong; Huang, Huizhe; Hu, Peng"

作者地址："[Su, Shu; Jia, Meng; Yu, Yingni; Li, Hu; Yin, Wenwei; Lu, Yi; Huang, Rongzhong; Xiang, Rong; Huang, Huizhe; Hu, Peng] Chongqing Med Univ, Affiliated Hosp 2, Dept Infect Dis, Key Lab Mol Biol Infect Dis, Tianwen Rd 288, Chongqing 400060, Peoples R China"

通信作者："Hu, P (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Dept Infect Dis, Key Lab Mol Biol Infect Dis, Tianwen Rd 288, Chongqing 400060, Peoples R China."

来源：JMIR PUBLIC HEALTH AND SURVEILLANCE

ESI学科分类：　

WOS号：WOS:001169533200001

JCR分区：Q1

影响因子：8.5

年份：2024

卷号：10

期号：　

开始页：　

结束页：　

文献类型：Review

关键词：monkeypox; mpox; symptoms; prevalence; meta-analysis; network analysis; evolution trends

摘要："Background: The worldwide spread of monkeypox (mpox) has witnessed a significant increase, particularly in nonendemic countries. Objective: We aimed to investigate the changing clinical symptoms associated with mpox from 1970 to 2023 and explore their interrelations. Methods: In this systematic review and meta -analysis, 3 electronic databases were searched for English peer-reviewed studies conducted from January 1970 to April 2023 that reported any symptoms among confirmed mpox cases. We categorized the mpox epidemics into 3 periods: 1970-2002 (period 1, within the African region), 2003-2021(period 2, epidemics outside Africa), and 2022-2023 (period 3, worldwide outbreak). Following PRISMA guidelines, a meta -analysis was performed to estimate the pooled prevalence for each symptom. The correlation among symptoms was analyzed and visualized using network analysis. Results: The meta -analysis included 61 studies that reported 21 symptoms in 720 patients from period 1, 39 symptoms in 1756 patients from period 2, and 37 symptoms in 12,277 patients from period 3. The most common symptom among patients from all 3 periods was rash (period 1: 92.6%, 95% CI 78.2%-100%; period 2: 100%, 95% CI 99.9%-100%; and period 3: 94.8%, 95% CI 90.9%-98.8%), followed by lymphadenopathy (period 1: 59.8%, 95% CI 50.3%-69.2%; period 2: 74.1%, 95% CI 64.2%-84.1%; and period 3: 61.1%, 95% CI 54.2%-68.1%). Fever (99%, 95% CI 97%-100%), enlarged lymph nodes (80.5%, 95% CI 75.4%-85.0%), and headache (69.1%, 95% CI 4%-100%) were the main symptoms in period 1, with a significant decrease in period 3: 37.9%, 31.2%, and 28.7%, respectively. Chills/rigors (73.3%, 95% CI 60.9%-85.7%), fatigue (68.2%, 95% CI 51.6%-84.8%), and dysphagia/swallowing difficulty (61.2%, 95% CI 10.5%-100%) emerged as primary new symptoms in period 2 and decreased significantly in period 3. Most other symptoms remained unchanged or decreased in period 3 compared to the former 2 periods. Nausea/vomiting had the highest degree of correlation (with 13 symptoms) and was highly positively correlated with lymphadenopathy (r=0.908) and conjunctivitis (r=0.900) in period 2. In contrast, rash and headache were 2 symptoms with the highest degree of correlation (with 21 and 21 symptoms, respectively) in period 3 and were highly positively correlated with fever (r=0.918 and 0.789, respectively). Conclusions: The manifestation of symptoms in patients with mpox has become more diverse, leading to an increase in their correlation. Although the prevalence of rash remains steady, other symptoms have decreased. It is necessary to surveil the evolving nature of mpox and the consequential changes in clinical characteristics. Epidemic countries may shift their focus on the potential association among symptoms and the high synergy risk. Trial Registration: PROSPERO Registration: CRD42023403282; http://tinyurl.com/yruuas5n"

基金机构：National Natural Science Foundation of China [82304246]; Natural Science Foundation of Chongqing [CSTB2023NSCQ-MSX0198]; Chongqing Health Commission and Science and Technology Bureau [2024QNXM056]; Second Affiliated Hospital of Chongqing Medical University Research [2023IITXG26]

基金资助正文："SS is supported by the National Natural Science Foundation of China (82304246) , the Natural Science Foundation of Chongqing (CSTB2023NSCQ-MSX0198) , the joint project of the Chongqing Health Commission and Science and Technology Bureau (2024QNXM056) , and the Second Affiliated Hospital of Chongqing Medical University Research (grant 2023IITXG26) ."