Table 4.
Demographic and epidemiologic characteristics of the study population (confirmed cases).
| Authors | Mean Age | Gender | Nationality | Epidemiological History and Associated Risk Factors | Diagnostic Confirmation Tool |
|---|---|---|---|---|---|
| Johnston et al. [45] | 11.7 | 7M, 12F | NA | NA | NA |
| McCollum et al. [46] | 25 | 2M, 1F | African | Traveling from a highly forested area, animal contact (monkey), eating monkey meat, farmer occupation | PCR (vesicular swab, crust, blood) |
| Nolen et al. [15] | 20.4 | 12M, 8F | DRC | NA | NA |
| Reynolds et al. [47] | 11.5 | 2F | African | Human contact | PCR (vesicular swab) |
| Hoff et al. [16] |
<5 years: 193 (153MPX only + 40MPX/VZV) 5–14 years: 353 (297MPX only + 56MPX/VZV) 15–29 years: 198 (154MPX only + 44MPX/VZV) >30 years: 41 (29MPX only + 12MPX/VZV) |
480M (388MPX only + 92MPX/VZV), 305F (245MPX only + 60MPX/VZV) | NA | NA | PCR (vesicular fluid or crust) |
| Mbala et al. [48] | 24 | 4F | NA | NA | PCR |
| Osadebe et al. [17] | 5.77 | 178M, 154F | Congo | NA | NA |
| Nakoune et al. [49] | 17 | 2M, 1F | Central African | Animal contact, human contact | Viral DNA minikit (Qubit dsDNA BR Assay kit), PCR |
| Yinka-Ogunleye et al. [51] | 30 | 28M, 14F | Nigeria | Animal contact | PCR, IgG, sequencing |
| Vaughan et al. [52] | Adult | NA | 1 UK, 1 Nigerian | Traveling from Africa, human contact | PCR, molecular assay |
| Doshi et al. [18] | 12 | 155M, 68F | DRC | Animal contact (eating, cooking, butchering/skinning, and hunting rodents and non-human primates), visiting a forest Occupation: 134 students, 26 farmers |
PCR |
| Raynolds et al. [53] | 17.95 | 2M | Sierra Leone | Animal contact (rodents), consuming wild animal meat, farmer occupation | PCR, IgG, IgM |
| Doshi et al. [19] | 17.71 | 2M, 5F | DRC | Hunter occupation | PCR, IgM |
| Ye et al. [54] | 35 | 1M | Sierra Leone | Traveling from Pelewahun gee bu, animal contact (hunting and eating squirrels) | PCR, IgG, sequencing |
| Yinka-Ogunleye et al. * [20] | 29 | 84M, 38F | Nigerian | Human contact (living in the same household or prison with patients, healthcare occupation) | PCR, IgM |
| Besombes et al. [55] | 17 | 6F | Central African Republic | Animal contact (butchering small mammals), human contact | PCR |
| Ogoina et al. * [21] | 29 | 17M, 4F | Nigerian | NA | RT-PCR of blood, swab, or crust (at least 2 specimens), serology, culture |
| Hughes et al. [22] | 15.7 (MPX only: 15.9, MPX/VZV: 15.5) |
279M (212MPX only + 65MPX/VZV), 255F (188MPX only+ 67MPX/VZV) |
NA | NA | PCR |
| Ogoina et al. [56] | 28 | 31M, 9F | Nigerian | NA | NM |
| Whitehouse et al. [23] | 14 | 568/1054M, 486/1054F | Congo | Animal contact, human contact | PCR, QIAamp DNA Blood Mini Kit (Qiagen) |
| Hobson et al. [57] | NA | NA | NA | Traveling from Nigeria, household transmission | PCR (vesicular swab) |
| Ng et al. [58] | 38 | 1M | Nigerian | Traveling from Africa | PCR, electron microscopy, genome sequencing of blister fluid |
| Besombes et al. [24] | 15.5 (median) | 45M, 51F, 3 missing data | NA |
Human contact: 44/99 reported contact with a human case Transmission route: 504/528 sexual close contact, 4/528 nonsexual close contact, 17/528 other or unknown Occupation: 16/99 farmer, 6/99 hunter/fisherman, 0/99 healthcare worker, 2/99 mine worker, 2/99 market trader, 9/99 other, 27/99 missing data MSM: 509/528 |
RT-PCR |
| Pittman et al. [59] | 14 | 138M, 78F | NA |
Animal contact: 133/216 handled uncooked, freshly butchered meat, 88/216 meat of ground squirrel, 82/216 meat of monkey, 47/216 dead animal, 11/216 meat of Gambian rat or other rodents, 156/216 clean/dressed consumption of wild game, 46/216 other wild game Human contact: 86/216 household, 57/216 initial Mpx contact with blood, body fluid, or person with tissue or secretion |
RT-PCR |
| Adler et al. [26] | NA | 4M, 3F | NA |
Travel: 6/7 travel history Human contact: 3/7 human contact Occupation: 1/7 healthcare worker |
PCR |
| Tarín-Vicente et al. [27] | 37 (median) | 175M, 6F | 79 Spanish, 82 south and central American, 19 other, 1 missing data |
Travel: 26/181 travel out of Spain, 0/181 travel to endemic regions Human contact: 47/181 regular sexual partner with monkeypox, 6/181 household contact with monkeypox, 66/181 attendance at a Pride event MSM: 166/181 Mentioned behavioral risk factors: number of sexual partners in past 14 days: 2 (median), number of sexual partners in past 3 months: 6.5 (median), 99 sexually transmitted infections in the past 12 months, 107 use of social media apps to identify sexual partners, 15 sex outside of Spain in past 3 months, 8 sex with a sex worker, 57 use of recreational drugs during sex, 11 vaginal-insertive sex, 6 vaginal-receptive sex, 131 anal-insertive sex, 108 anal-receptive sex, 160 oral-insertive sex, 158 oral-receptive sex |
RT-PCR |
| Vallejo-Plaza et al. [60] | In women: 34 (median) In men: 37 (median) |
7235M, 158F | NA |
Transmission route:
4639/5023 sexual transmission (women 69/105. men 4570/4918) human to human, non-sexual: 347/5023 (women: 23/105, men 324/4918) other, not specified: 37/5023 (women 13/105, men 24/4918) |
RT-PCR |
| Thornhill et al. [61] | 38 (median) | 527M | Race: 398 White, 25 Black, 19 mixed, 66 Latinx, 20 other or unknown |
Travel: 147/528 travel abroad in the month before diagnosis Human contact: 135/528 contact with a person known to have monkeypox Transmission route: 504/528 sexual close contact, 4/528 nonsexual close contact, 17/528 other or unknown, 3/528 household contact MSM: 509/528 Mentioned behavioral risk factors: 5 median number of sex partners in 406 patients in the previous 3 months, 169/406 visited sex-on-site venues within the previous month, 106/406 engaged in chemsex. |
RT-PCR |
| Perez-Duque et al. [62] | 34.1 | 27M | NA |
Travel: 4/27 Animal contact: 3/23 Human contact: 1/10 MSM: 18/19 Mentioned behavioral risk factors: 14/16 multiple sex partners, 6/27 attendance at the sauna |
RT-PCR and/or nucleotide sequencing |
| Angelo et al. [28] | 37 (median) | 226M | NA |
Travel: 37/210 international travel in the 21 days before symptom onset (the most frequently reported travel destinations and reasons were European countries for tourism (30 [83%] of 36 trips)). Animal contact: 10/134 touched any live animals in the 21 days before symptom onset (all contact was with domesticated cats or dogs), 3/140 touched any dead animals in the 21 days before symptom onset (exposures included butchering, handling, or cooking meat from wild animals (n = 2) and eating animal products from a store (n = 1)). Human contact: 78/195 known close contact with a suspect or confirmed human monkeypox case (type of contact: 70/71 sexual or close intimate contact, 8/71 household contact, 2/71 face-to-face contact not in the household, 3/71 other) Occupation: 8/168 healthcare workers (all eight were MSM and four (50%) met sexual partners at a mass gathering; there was no evidence of nosocomial transmission.) MSM: 208/211 Mentioned behavioral risk factors: 37/161 met their sexual partners at mass gatherings, including the Maspalomas Festival in Spain, and various other Pride-related festivities in Europe and the USA, 216/219 reported sexual or close intimate contact in the 21 days before illness onset, 1/169 lived in congregate setting |
PCR |
| Betancort-Plata et al. [29] | 40 (median) | 42M | 18/42 Spanish, 3/42 Germany, 1/42 France, 1/42 United Kingdom, 3/42 Italy, 3/42 Poland, 1/42 Portugal, 1/42 Russia, 1/42 Switzerland, 1/42 Argentina, 1/42 Brazil, 1/42 Colombia, 3/42 Cuba, 1/42 Honduras, 1/42 Peru, 1/42 Dominican Republic, 1/42 Morocco |
Human contact: 37/42 recent sexual contact with other men, 2/42 contact with women, 1/1 contact with a person with a skin lesion MSM: 37/42 |
RT-PCR |
| Rodríguez-Cuadrado et al. [63] | 40.5 | 20M | NA | NA | RT-PCR |
| Caria et al. [30] | 37.2 | 40M, 1F | 18/41 Brazilian, 15/41 Portuguese, 2/41 French, 2/41 Colombian, 1/41 Spanish, 1/41 Peruvian, 1/41 Cape Verdean, 1/41 Lebanese |
Travel: 7/41 recent international travel to countries in Europe (1/41 Germany, 1/41 Spain, 1/41 Belgium, and 1/41 the UK), Asia (2/41 Israel), and the Americas (1/41 Dominican Republic) in the month preceding symptom onset Human contact: 16/41 sex contact with MPX-confirmed cases MSM: 38/41 Mentioned behavioral risk factors: 37/41 sex with multiple and/or anonymous partners or unprotected sex in the previous month, 16/41 sex with MPX-confirmed case, 6/41 sex party or venue attendance in the previous month, 8/41 “Chemsex” in the previous month |
Laboratory-confirmation |
| Vanhamel et al. [31] | 38 (median) | 139M | NA |
Travel: 52/139 travel outside Belgium in the 21 days before symptom onset Human contact: 119/139 Transmission route: 115/139 sexual contact, 4/139 other person-to-person transmission MSM: 113/136 |
PCR |
| Fink et al. [32] | 35 (median) | 153M, 3F | Race: 105/156 White, 12/156 Black, 11/156 Latinx, 6/156 South Asian, 14/156 other, 8/156 unknown | MSM: 139/155 | PCR |
| Thornhill et al. * [64] | 34 (median) | 136F (69 cis women, 62 trans women, 5 non-binary individuals assigned female at birth) |
Race: 61 Latinx, 40 White, 28 Black, 3 Asian, 2 mixed, 1 First nation, Inuit, or Métis 1 other or unknown |
Human contact: 38/136 known contact with the monkeypox virus Occupation: 35/136 sex work, 13/136 health care, 11/136 business or office work, 7/136 student, 3/136 cleaning, 4/136 food service, 2/136 beauty, 5/136 sales or marketing, 1/136 arts, 1/136 teaching or childcare, 6/136 other, 19/136 unemployed, 29/136 unknown Transmission route: 4/136 occupational exposure (health-care workers), 7/136 household, 7/136 non-sexual close contact, 100/136 sexual contact, 18/136 unknown Mentioned behavioral risk factors: 14/136 injecting drugs, 36/136 current sex work, 9/136 attended Pride events or similar within the month preceding symptom onset, 10/136 attended large event or festival within the month preceding symptom onset, 8/136 homeless |
RT-PCR |
| Patel et al. [25] | 38 (median) | 197M | NA |
Travel: 54/197 participants had a history of travel abroad within four weeks before symptom onset. The most common destinations were within western Europe: Spain (20), France (8), Belgium (4), Germany (4), and Greece (4). One participant had returned from an endemic area (West Africa). Human contact: 41/155 known close contact with someone who showed symptoms of or had confirmed monkeypox infection MSM: 196/197 Mentioned behavioral risk factors: 170/177 reported sexual contact with a male partner within 21 days of symptoms developing |
RT-PCR |
| Girometti et al. [33] | 41 (median) | 54M | 26/54 born in the UK, 38/54 White, 8/54 Black or mixed race, 4/54 Asian, 4/54 other ethnicities |
Travel: 25/54 a history of travel outside the UK within the previous 2 months (eight to Spain, five to France, and two to the Netherlands; none reported travel to sub-Saharan Africa.) Human contact: 2 contacts of a confirmed monkeypox virus case MSM: 54/54 Mentioned behavioral risk factors: 29/52 reported more than five sexual partners in the 12 weeks before the monkeypox virus diagnosis, 18/52 individuals reported more than ten sexual partners in the 12 weeks before the monkeypox virus diagnosis, 49/52 individuals reported inconsistent condom use in the 3 weeks before symptom onset, 47/52 reported at least one new sexual partner during the same period. |
RT-PCR |
| Vivancos-Gallego et al. [65] | 39.5 (median) | 25M | NA | MSM: 25/25 | RT-PCR |
| Sheffer et al. [66] | 35 (median) | 203M | NA |
Travel: 61/203 trips outside of Israel, mostly in Europe Human contact: 195/205 reported having sexual contact as the source of infection in the 3 weeks before disease onset Occupation: 1 physician working in the emergency service who had provided medical care for patients with MPX Transmission route: 197 sexual contact/ close physical contact, 1 nosocomial infection, 5 unknown MSM: 195/203 Mentioned behavioral risk factors: 110/203 had more than three sexual partners |
RT-PCR |
| Antinori et al. [67] | 30 | 4M | NA |
Travel: 4/4 Mentioned behavioral risk factors: 3/4 mass gathering |
RT-PCR |
| Orviz et al. [34] | 35 (median) | 48M | NA |
Travel: 16.7% of the patients had traveled outside of Spain three weeks before the onset of the symptoms, 0 patients had traveled or had contact with people from endemic areas Human contact: 7/48 knew other people living in the same household with similar symptoms Occupation: 2/48 homosexual sex worker MSM: 42/48 Mentioned behavioral risk factors: 89.5% of the patients had unprotected sex in the three weeks before the onset of the symptoms, 5 median number of different sexual partners per person for 21 days before the onset of the symptoms, 39/48 people practicing unprotected oral sex, 41/48 unprotected anal intercourse, 2/48 unprotected vaginal sex, 24/48 had participated in a chemsex session within the 21 days before the onset of symptoms |
PCR |
| Hoffmann et al. [35] | 39 (median) | 301M | 166/229 German | MSM: 301/301 | PCR |
| Cobos et al. [36] | 33 | 30M | Spanish 13/30, Venezuelan 9/30, Syrian 2/30, Italian 1/30, Cuban 1/30, Honduran 1/30, Peruvian 1/30, Ecuadorian 1/30, Brazilian 1/30 |
Travel: none had a history of travel to Central Africa in the previous 3 months MSM: 30/30 Mentioned behavioral risk factors: 30/30 unprotected sex in the 4 weeks before the clinical onset |
PCR |
| Hoffmann et al. [37] | 39 (median) | 546M | 313/439 German | MSM: 546/546 | PCR |
| Van Ewijk et al. [38] | 37 (median) | 987M, 10F, 3 Unknown | Netherlands (511/893), Turkey (2/893), Morocco (4/893), Netherlands Antilles-Surinam and Aruba (44/893), other Western countries, including Europe, North America, Oceania, Indonesia, and Japan (159/893), and other non-Western countries (173/893), all other (107/893) |
Human contact: 227 notified contact of a mpox case, 822/1000 sexual contact, 15/1000 direct unprotected contact, 5/1000 household, 20/1000 prolonged face-to-face contact, 3/1000 Occupation: 55 healthcare workers MSM: 935/987 |
RT-PCR |
| Mailhe et al. [39] | 35 (median) | 262M, 1F, 1 transgender woman | 178/245 born in France |
Travel: 76/227 Animal contact: 38/206 Human contact: 112/236 were aware of being in contact with a confirmed case of MPXV of whom 86/91 had sexual contact MSM: 245/259 Mentioned behavioral risk factors: 90/216 chemsex, 106/264 condomless sex, 5 median number of sexual partners over the last month |
PCR |
| Núñez et al. [40] | 34 (median) | 549M, 16F | NA |
Travel: 63/565 recent national flights, 46/565 recent international flight Occupation: 10/565 healthcare worker Transmission route: 94/565 sexual contact, 10/565 non-sexual contact, 461/565 unknown MSM: 327/335 Mentioned behavioral risk factors: 3/565 participated in group sex event |
RT-PCR |
| Maldonado-Barrueco et al. [68] | 36 | 30M | 11/30 natives of South or Central America | MSM: 29/30 | RT-PCR |
| Catala et al. [41] | 38.7 | 185M | NA |
Travel: 51/185 travel outside the home town or city in the 3 weeks before the first sign or symptom Animal contact: 28/185 pets in the household, 16/185 exotic pets in the household Human contact: 1/126 healthcare worker, 43/185 other contact with a case Occupation: 1/126 healthcare worker MSM: 184/185 Mentioned behavioral risk factors: 102/185 use of social networks to meet partners, 11/185 sex with sex workers in the previous 3 months, 62/185 use of drugs during sexual relationships in the previous 3 months |
PCR |
| Relhan et al. [69] | 31.2 | 3M, 2F | 1 Indian, 4 Nigerian |
Human contact: 1 Indian, 4 Nigerian Occupation: 1/5 data analyst, 1/5 chef, 1/5 businessman, 1/5 cloth factory worker, 1/5 student |
RT-PCR |
| Cassir et al. [42] | 36 (median) | 133M, 3F | NA |
Travel: 17/136 recent travel to an epidemic country, which includes Spain (n = 11 patients), United States (n = 2 patients), Germany (n = 1 patient), Belgium (n = 1 patient), Canada (n = 1 patient), and Italy (n = 1 patient). Human contact: 21/136 sexual partner with monkeypox MSM: 125/136 Mentioned behavioral risk factors: 7/30 attendance at a Pride event |
RT-PCR |
| Pascom et al. * [70] | 32 (median) | 5881M, 542F, 6 transvestite, 70 non-binary, 104 other, 1564 not informed | Race: 3572/8176 White, 3332/8176 Black, 87/8176 Asian, 13/8176 Indigenous, 1163/8176 not informed | MSM: 4502/5189 | |
| Martins-Filho et al. [71] | NA | 8386M, 714F | NA | Human contact: 579/1457 sexual exposure before the onset of signs and symptoms | NA |
| Wong et al. [72] | 41 (median) | 7M | NA |
Travel: 1/7 traveled to the Bahamas about six weeks before Human contact: 26% had known monkeypox contact MSM: 7/7 |
NA |
| Suner et al. [43] | 35 (median) | 75M, 1F, 1 transgender female | 36 Spain, 31 latin America, 9 other EU, 1 West Africa | MSM: 70/75 | RT-qPCR |
| Cash-Goldwasser et al. [73] | 33 (median) | 4M, 1F | NA | NA | PCR |
| Ciccarese et al. [74] | 37 (median) | 16M | 10/16 Italian, 3/16 Ecuadorian, 1/16 Russian, 1/16 Jumaican, 1/16 Brazilian |
Travel: 3/16 history of foreign travel in the month before the disease onset Human contact: 4/16 had sexual exposure to an individual known to have MPX in the week before the diagnosis, and 12/16 had risk factors for STIs, such as multiple sexual partners and/or unprotected sex in the 2 weeks before the onset of symptoms MSM: 14/16 |
RT-PCR |
| Aguilera-Alonso et al. [75] | 15 (median) | 10M, 6F | 16/16 Spain | Transmission route: 3/16 houshold contact, 1/16 unknown, 9/16 Contact with contaminated material, 3/16 sexual close contact | RT-PCR |
| Gnanaprakasam et al. [76] | NA | 23M |
Race:
9/23 Black/African American,10/23 Hispanic, 1/23White, 1/23Unknown |
Travel: 1 recent travel to a large social event for gay and bisexual men in Florida MSM: 21/23 |
RT-PCR |
| Choudhury et al. [77] | 38 (median) | 179M | NA |
Transmission route: 137/179 sexually, 13/179 not sexually, 29/179 unknown MSM: 164/179 |
Laboratory-confirmation |
| Srichawla et al. [78] | 28.4 | 9M | NA |
Travel: 1/9 traveled to Europe in the past 30 days MSM: 9/9 Mentioned behavioral risk factors: 9/9 unprotected sexual encounter within 4 weeks of the onset of symptoms, 1/9 engaged in high-risk sexual activity involving condomless penetrative sexual intercourse with multiple men |
RT-PCR |
| Maldonado et al. [44] | 32 (median) | 202M, 3F | NA |
Travel: 27/205 Human contact: 17/205 MSM: 166/205 Mentioned behavioral risk factors: 179/205 sexual encounters in the past 21 days, 3 median number of sex partners in the last year, 112/205 last sexual encounter with an unknown partner, 133/205 casual sex partners, 17/205 identified sexual contact with a confirmed mpox diagnosis |
RT-PCR |
| Rekik et al. [79] | 33 (median) | 20M | NA |
Human contact: 9/20 past contact with a person infected with MPX Occupation: 1 transsexual sex worker MSM: 20/20 Mentioned behavioral risk factors: 8 median number of sexual partners in the last three months, 11/20 had chemsex, 18/20 anal receptive intercourse |
RT-PCR |
| Prasad et al. [80] | 35 (median) | 98M, 3F | Race: 63/101White, 11/101 Black/African American, 20/101 Hispanic/Latino, 3/101Asian, 2/101 other, 3/101 missing |
Human contact: 26/32 sexual contact (majority engaged in same sex sexual behavior (87%) and group sex activities (27%)) Mentioned behavioral risk factors: 87% same-sex sexual behavior, 27% sexual activity between greater than two people |
RT-PCR and biopsy |
| Assiri et al. [81] | 30.14 | 7M | NA |
Travel: 7/7 Human contact: 2/7 heterosexual contact with a female who appeared healthy, 1/7 heterosexual contact (with a female who appeared healthy but had earlier exposure to a known MPX case), 1/7 intimate (skin-to-skin) contact with a female partner Transmission route: 4/7 acquired the Mpox virus probably through heterosexual contact with individuals who did not have obvious signs or symptoms, 3/7 seemed to have contracted Mpox virus infection through skin-to-skin contact with other individuals or indirect contact with contaminated objects in locations where outbreaks of Mpox were ongoing Mentioned behavioral risk factors: 1/7 attending music festivals and nightclubs in the community with ongoing MPX outbreaks, 2/7 body massage at unlicensed parlors |
PCR |
NA: not available, M: male, F: female, MSM: male having sex with males. * Data were not defined in confirmed patients and were reported in the total population; however, available data were included according to the majority number of confirmed patients among the total population.