Table 3.
Confirmed, probable, and suspected case definitions of the included studies (only available data are mentioned), compared to WHO and CDC case definitions.
| First Author | Confirmed | Probable | Suspected |
|---|---|---|---|
| Nolen et al. [15] | (PCR of Orthopoxvirus OR DNA signature of MPOX) AND fever/rash AND 1/3 criteria * |
Fever AND rash AND 1/3 criteria * AND contact in 14d |
Fever AND Rash AND 1/3 criteria * |
| Reynolds et al. [47] | PCR assay | NA | Vesicular pustular eruption characterized by a hard and deep pustule AND 1/3 criteria * |
| Hoff et al. [16] | qPCR | NA | Preceding fever AND rash AND (face/palms/soles OR >5 smallpox-type scabs) |
| Mbala et al. [48] | WHO (pan-orthopoxvirus MGB-hemagglutinin real-time PCR assay) | WHO criteria | WHO criteria |
| Osadebe et al. [17] | MPOXV-specific RT-PCR OR OPXV-specific assay |
NA | Plan A (for endemic situations): preceding fever AND rash AND (face/palms/soles OR >5 smallpox type scabs); Plan B (discriminate VZV and MPOX): vesicular or pustular eruption with deep-seated AND 1/3 criteria * |
| Kalthan et al. [50] | Suspected case AND (PCR OR virus isolation on baby mouse brain cell culture |
NA | Living in the district of Alindao AND fever AND rash |
| Doshi et al. [18] | PCR Only | NA | Sudden preceding fever AND rash |
| Doshi et al. [19] | OPXV DNA detection by PCR | One of the epidemiologic criteria *** AND demonstrated elevated levels of OPXV-specific IgM AND having an unexplained rash and fever and >2 other signs or symptoms from the clinical criteria |
Unexplained rash and fever |
| Yinka-Ogunleye et al. [20] | Suspected case AND (viral identification by RT-PCR OR virus isolation OR antibody detection) |
Suspected AND link with a known case AND no access to laboratory test |
Sudden preceding fever AND rash on the face, palms, and soles |
| Ogoina et al. [21] | Suspected AND (positive IgM antibody and PCR OR virus isolation) |
Suspected AND link with a known case AND no access to the laboratory |
Sudden preceding fever AND rash on the face, palms, and soles |
| Hughes et al. [22] | MPOXV-specific RT-PCR OR OPXV-specific assay |
NA | Vesicular pustular eruption characterized by a hard and deep pustule AND 1/3 criteria * |
| Ogoina et al. [56] | Suspected AND (positive IgM antibody and PCR OR virus isolation) |
Suspected AND link with a known case AND no access to the laboratory |
Sudden preceding fever AND rash on the face, palms, and soles |
| Whitehouse et al. [23] | RT-PCR OR virus isolation |
NA | Vesicular and pustular eruptions characterized by a hard and deep pustule AND 1/3 criteria * |
| CDC ** [82] | Monkeypox virus DNA by PCR by next-generation sequencing OR isolation of Monkeypox virus in culture |
No suspicion of other recent OPXV exposure AND (OPXV DNA OR immunohistochemical OR electron microscopy OR detectable levels of anti-OPXV IgM antibody during the period of 4 to 56 days after rash onset) |
New characteristic rash OR one epidemiologic criterion *** |
| WHO (21 May 2022) [83] | Viral DNA by RT-PCR OR sequencing |
Suspected case AND (epidemiological link OR multiple or anonymous sexual partners in the 21 days before symptom onset OR anti-OPXV IgM 4–56 days before rash onset OR four-fold rise in IgG Ab 5–7 days before rash onset and convalescent on day 21 onwards OR known exposure to OPXV OR OPXV-specific PCR without MPOXV-specific PCR or sequencing) |
Unexplained acute rash/ skin lesion AND cannot be explained by other causes of skin lesions AND (headache OR acute onset fever OR lymphadenopathy OR myalgia OR back pain OR asthenia) |
| ECDC [84] | MPOXV-specific PCR assay OR OPXV-specific PCR assay positive confirmed by MPOXV sequencing with symptoms |
Unexplained generalized or localized maculopapular or vesiculopustular rash with centrifugal spread, with lesions showing umbilication or scabbing, lymphadenopathy, and one or more other MPOX-compatible symptoms OR unexplained rash AND (positive OPXV PCR OR epidemiological link OR travel to MPOX endemic countries OR multiple or anonymous sexual partners OR man who has sex with men) |
NA |
| India CDC [85] | Viral DNA by RT-PCR OR sequencing |
Suspected case definition AND epidemiological link with a confirmed case OR a compatible case |
Unexplained acute rash AND (swollen lymph nodes OR fever OR headache OR body aches OR profound weakness) |
PCR: polymerase chain reaction; RT-PCR: real-time PCR; MPOXV: human monkeypox virus; OPXV: orthopoxvirus; CDC: center for disease control and prevention; ECDC: European CDC; NA: not available; Ab: antibody * 1/3 criteria: one of three criteria of fever preceding the eruption, lymphadenopathy, pustules or crusts on the palms of the hands or soles of the feet; ** CDC exclusion criteria: alternative diagnosis can fully explain the illness OR an individual with symptoms consistent with monkeypox does not develop a rash within 5 days of illness onset OR a case where high-quality specimens do not demonstrate the presence of Orthopoxvirus or Monkeypox virus or antibodies to orthopoxvirus; *** CDC Epidemiologic criteria (within 21 days of illness onset) exposure with probable case/similar appearing rash OR traveled outside the US to a country with confirmed cases of monkeypox or where Monkeypox virus is endemic OR had contact with a dead or live wild animal or exotic pet that is an African endemic species or used a product derived from such animals OR intimate in-person contact with individuals in a social network experiencing monkeypox activity, and this includes men who have sex with men.