lancet-header

Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.

A Rapid Systematic Review and Meta-Analysis of Monkeypox Case Hospitalization Rates Since 2003

18 Pages Posted: 10 Aug 2022

See all articles by Michael DeWitt

Michael DeWitt

Wake Forest University - Section on Infectious Diseases

Christopher Polk

Wake Forest University - Section on Infectious Diseases

John Williamson

Wake Forest University - Section on Infectious Diseases

Avinash Shetty

Wake Forest University - Section on Infectious Diseases

Catherine L. Passaretti

Wake Forest University - Center for the Study of Microbial Ecology and Emerging Diseases

Candice J. McNeil

Wake Forest University - Section on Infectious Diseases

Robert T. Fairman

Wake Forest University - Center for the Study of Microbial Ecology and Emerging Diseases

Mindy M. Sampson

Wake Forest University - Section on Infectious Diseases

Cynthia Dalton

Wake Forest University - Section on Infectious Diseases

John W. Sanders

Wake Forest University - Section on Infectious Diseases

More...

Abstract

Background: Estimates of the case hospitalization rate and case fatality rate when hospital care is available for monkeypox (MPX) infections have not been well defined. This systematic review and meta-analysis aimed to estimate the case hospitalization rate and case fatality rate where hospital care is available as well as describe differences in demographics, treatments, the epidemiology of documented cases, and outcomes.

Methods: We systematically search PubMed for studies published between 1995 and 2022. We included documents which contained both the number of cases and associated hospitalizations of MPX infections. We excluded studies that were duplicates, were multiple characterizations of the same outbreak, single case reports, or characterization of only hospitalized individuals. From eligible studies we extracted the country, the year of the study, the study design type, the clade of MPX, the participant characteristics, transmission type, any treatments used, number of cases, number of hospitalizations, hospitalized patient outcomes, and case definition. Case hospitalization rate (CHR) was defined as the proportion of cases that were admitted to hospital care while case fatality rate (CFR) was defined as the proportion of cases that died. CHR and CFR were analyzed in a fully Bayesian meta-analytic framework using both fully pooled and random effects models.

Findings: Of the 110 unique documents identified, fifteen studies were eligible for inclusion. Included studies represented 7131 reported cases among which there were 542 hospitalizations. Of the 7118 cases for whom outcomes were available there were seven recorded deaths. Overall pooled CHR was estimated to be 7·6% (95% credible interval, CrI, 7·0 - 8·2) while the random effects CHR was estimated to be 19·2% (8·2-35·6), with some difference reported for the West African genetic clade. CFR was estimated to be 0.1% (95% CrI 0·0-0·2) and 0·1% (95% CrI 0·0-0·8) in the fully pooled and random effects models.

Interpretation: MPX infections have a relatively high rate of hospitalization. Public health organizations should prepare for the potential increase in healthcare utilization. Rapid identification of infection and use of appropriate therapies such as antivirals play a role reducing the CHR and associated CFR.

Funding: None.

Declaration of Interest: CP served on an advisory board for Gilead Science, Inc. within the last year. JW has significant financial interest in the publicly traded company Bavarian Nordic. There are no other relevant conflicts of interest to disclose.

Keywords: Monkeypox, vaccination, surveillance, OUTBREAK, hospitalization

Suggested Citation

DeWitt, Michael and Polk, Christopher and Williamson, John and Shetty, Avinash and Passaretti, Catherine L. and McNeil, Candice J. and Fairman, Robert T. and Sampson, Mindy M. and Dalton, Cynthia and Sanders, John W., A Rapid Systematic Review and Meta-Analysis of Monkeypox Case Hospitalization Rates Since 2003. Available at SSRN: https://ssrn.com/abstract=4185926 or http://dx.doi.org/10.2139/ssrn.4185926

Michael DeWitt (Contact Author)

Wake Forest University - Section on Infectious Diseases

Christopher Polk

Wake Forest University - Section on Infectious Diseases ( email )

John Williamson

Wake Forest University - Section on Infectious Diseases ( email )

Avinash Shetty

Wake Forest University - Section on Infectious Diseases ( email )

Catherine L. Passaretti

Wake Forest University - Center for the Study of Microbial Ecology and Emerging Diseases ( email )

Candice J. McNeil

Wake Forest University - Section on Infectious Diseases ( email )

Robert T. Fairman

Wake Forest University - Center for the Study of Microbial Ecology and Emerging Diseases ( email )

Mindy M. Sampson

Wake Forest University - Section on Infectious Diseases ( email )

Cynthia Dalton

Wake Forest University - Section on Infectious Diseases ( email )

John W. Sanders

Wake Forest University - Section on Infectious Diseases ( email )

Click here to go to TheLancet.com

Paper statistics

Downloads
105
Abstract Views
519
PlumX Metrics