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A Rapid Systematic Review and Meta-Analysis of Monkeypox Case Hospitalization Rates Since 2003
18 Pages Posted: 10 Aug 2022More...
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.
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
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