Systematic Review of the Epidemiology, disease severity and preventive measures of Mpox disease: A public health guideline for densely-populated countries

Data sources and search strategy

Initially, various databases and search engines including PubMed, BanglaJol, WHO and Google Scholar were searched, and related literatures were retrieved by incorporating keywords such as “Mpox,” “Monkeypox,” “Monkeypox Outbreak,” “Control of Monkeypox,” “Prevention of monkeypox,” “Epidemiology of Monkeypox,” “Symptoms of Monkeypox,” “Densely Populated Countries,” and “Preventive Guidelines for Monkeypox.” A snowball technique was then applied to search for relevant articles for further investigation. We also searched the websites of national and international health organizations to retrieve recent statistics.

Eligibility criteria

The inclusion criteria were as follows: (i) articles and webpage describing the current epidemiology, clinical symptoms, and preventive strategies, and (ii) articles published in English. The exclusion criteria were as follows: (i) studies describing other parameters that were not of interest and (ii) studies published in other languages.

Data collection and analysis

All records in the literature were managed using the Mendeley (version 1.19.4) reference manager, and duplications were eliminated. The epidemiology of MPOX has been reported in graphs. The severity of MPOX disease has been reported using a bar diagram. Six preventive guidelines for controlling Mpox were incorporated into the reviewed literature.

Literature search

Systematic research was conducted in which a total of 55 and four webpage reports articles were identified via an initial search removing duplicates. Of these, 10 studies including eight articles with two websites of WHO met the eligibility criteria and were included for further assessment. The details search strategies are presented in supplementary Figure S1.¹⁸

Epidemiology of Mpox

The global numbers of confirmed cases and deaths due to Mpox disease are presented in Figure 1. Most cases were reported in different regions of America and Europe (Figure 1a). In Asia, the number of MPOX cases was comparatively lower. The number of deaths due to the disease was also the highest in the American region (Figure 1b). The second highest level was in Africa. South Asia was the least affected region by Mpox. Most of the affected patients were male (96.3%) and 3.65% were female. Males between 18-44 years old were disproportionately affected by this outbreak and accounted for 79.0% of cases, with a median age of 34 years.¹⁰ Households were the most common exposure setting (45%), and the most common form of transmission was sexual encounters (51%).¹⁹

Figure 1. Global epidemiology of Mpox.

(a) Cases from January 1, 2022 to July 2024, 2023; (b) Deaths due from March 1, 2022 to June 1, 2023. This figure has been reproduced based on the dataset retrieved from the website of the World Health Organization.¹⁹

Common symptoms and severity due to Mpox disease

Rash and fever were the most frequent symptoms of Mpox diseases (Figure 2). More than 90% of MPOX-affected patients suffered from any rash. Systemic and Genital rashes were the most common symptoms in the affected patients. The second most frequent symptom was fever, affecting more than 50% of the patients suffered by fever. Literature suggests that the symptoms of Mpox are similar to those of smallpox, but the disease is generally milder. The mean incubation period for the virus is usually 9.1 (95% CI 6.5–10.9) days, with 5th and 95th percentiles of the distribution being 2–20 days.²⁰ Initial symptoms include fever, headache, muscle aches, and fatigue.¹⁰ A rash then develops, starting on the face and spreading to other parts of the body. The rash usually progresses to the blister stage before crusting and healing over several weeks.¹⁰ Mpox is generally a self-limiting disease; however, severe cases can occur, particularly in people with weakened immune systems. The disease can be fatal in some cases, with mortality rates ranging from 1% to 10%, depending on the outbreak and the population affected.²¹

Figure 2. Proportion of Mpox cases with reported symptoms.

This figure has been reproduced based on the dataset retrieved from the website of the World Health Organization.¹⁹

Treatment and possible control strategies for the densely populated countries

MPOX is a viral disease that poses a significant threat to public health, particularly in highly populated countries. The virus is primarily transmitted from animals to humans and can spread rapidly in areas with dense populations. There is no specific treatment for MPOX, but the disease can be managed through supportive care, including the use of antiviral medications, antibiotics to prevent secondary infections, and pain relief. In some cases, vaccination with the smallpox vaccine may provide protection against Mpox.²² As there is no specific treatment for MPOX, effective control strategies are essential to prevent outbreaks and minimize the impact of the disease.

Strategy 1: The first step in controlling MPOX is the identification and isolation of infected individuals.²³ Rapid detection and reporting of cases are critical for preventing the spread of the virus. Public health agencies should establish effective surveillance systems to monitor outbreaks and ensure that all suspected cases are investigated promptly. Early diagnosis and treatment can help reduce the severity of the disease and limit its spread.²²

Strategy 2: Another key control strategy is the implementation of strict infection control measures in healthcare settings.²⁴ Healthcare workers should take precautions to avoid contact with infected individuals and wear appropriate protective equipment such as gloves and masks. Patients with suspected Mpox should be isolated to prevent the spread of the virus to others.

Strategy 3: Vaccination is another important control strategy for MPOX. The smallpox vaccine, which provides protection against Mpox, has been successfully used in some outbreaks. In highly populated countries, mass vaccination campaigns are necessary to prevent outbreaks.²² The effectiveness of the vaccine may vary depending on the population being vaccinated and the specific strain of virus involved.

Strategy 4: Healthcare professionals play a vital role in controlling the spread of MPOX in highly populated countries.²⁵ They take steps to improve the infection control measures in healthcare settings. Healthcare workers should wear appropriate protective equipment, such as gloves and masks, and implement effective disinfection procedures to prevent the spread of the virus. Patients with suspected Mpox should be isolated to prevent the spread of the virus to others.²⁶

Strategy 5: Education and public awareness campaigns are also critical for controlling the spread of Mpox.²² Public health agencies should educate the public about the disease, its mode of transmission, and the importance of promptly seeking medical attention if they suspect that they may have been exposed to the virus. Individuals should be encouraged to practice good hygiene, such as regular hand washing, to prevent the spread of the virus.²²

Strategy 6: Finally, it is essential to invest in research to better understand the virus and to develop more effective prevention and treatment strategies. These include studying the transmission of the virus from animals to humans, developing improved diagnostic tests, and developing new therapies and vaccines.^27,28