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. 2022 Nov 7;35(10):878–887. doi: 10.3967/bes2022.115

2022 Multiple-country Monkeypox Outbreak and Its Importation Risk into China: An Assessment Based on the Risk Matrix Method

Min DU a, Shi Mo ZHANG a, Wei Jing SHANG a, Wen Xin YAN a, Qiao LIU a, Chen Yuan QIN a, Min LIU a, Jue LIU a,b,c,#
PMCID: PMC9641896  PMID: 36443265

Abstract

Objective

To analyze the 2022 multiple-country monkeypox outbreak and assess its importation risk into China.

Methods

Data was from United States Centers for Disease Control and Prevention. We described the global epidemic and calculated concentration index to measure economic-related inequality. Importation risk into China was evaluated and ranked by using risk matrix method and Borda count method, respectively.

Results

As of July 29, 2022, of 79 countries or territories, 39 (49.37%, 39/79), 17 (21.52%, 17/79), 6 (7.59%, 6/79), 12 (15.19%, 12/79), and 5 (6.33%, 5/79) country or territories identified cases < 10, 10–, 51–, 101–, and > 1,000. There were economic-related health disparities exist in the distribution of cases (the concentration index = 0.42, P = 0.027), and the inequality disadvantageous to the rich (pro-poor). There were 12 (15.38%, 12/78), 15 (19.23%, 15/78), 6 (7.69%, 6/78), and 45 (57.69%, 45/78) countries or territories with extremely high, high, moderate, and low importation risk. United States and France ranked first with the highest Borda points of 156, and counts of zero.

Conclusion

Of 78 countries or territories, the key attention need be paid to the United States and France, relatively. As the epidemic progresses, preparing prevention and control measures to further reduce importation risk was crucial.

Key words: Monkeypox, Importation risk, China, Risk matrix method

Biography

Biographical note of the first author: DU Min, female, born in 1998, PhD Candidate, majoring in epidemiology and biostatistics.

Footnotes

This work was partly supported by the National Natural Science Foundation of China [grant numbers 72122001, 71934002]; the National Key Research and Development Project of China [grant number 2021ZD0114101, 2021ZD0114104, 2021ZD0114105]; National Statistical Science Research Project [grant numbers 2021LY038]; the Fundamental Research Funds for the Central Universities supported by Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, of Peking University [grant number 202204]; and National Science and Technology Project on Development Assistance for Technology, Developing China-ASEAN Public Health Research and Development Collaborating Center [grant number KY202101004].

REFERENCES

  • 1.Rezza G. Emergence of human monkeypox in west Africa. Lancet Infect Dis. 2019;19:797–799. doi: 10.1016/S1473-3099(19)30281-6. [DOI] [PubMed] [Google Scholar]
  • 2.Mukinda VBK, Mwema G, Kilundu M, et al. Re-emergence of human monkeypox in Zaire in 1996. Lancet. 1997;349:1449–1450. doi: 10.1016/S0140-6736(05)63725-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.African CDC Monkeypox. https://africacdc.org/disease/monkeypox/ [2022-09-05].
  • 4.Walter K, Malani PN. What is monkeypox? JAMA. 2022;328:222. doi: 10.1001/jama.2022.10259. [DOI] [PubMed] [Google Scholar]
  • 5.Ng OT, Lee V, Marimuthu K, et al. A case of imported Monkeypox in Singapore. Lancet Infect Dis. 2019;19 doi: 10.1016/S1473-3099(19)30537-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Costello V, Sowash M, Gaur A, et al. Imported Monkeypox from International Traveler, Maryland, USA, 2021. Emerg Infect Dis. 2022;28:1002–1005. doi: 10.3201/eid2805.220292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Vaughan A, Aarons E, Astbury J, et al. Two cases of monkeypox imported to the United Kingdom, September 2018. Euro Surveill. 2018;23 doi: 10.2807/1560-7917.ES.2018.23.38.1800509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.World Health Organization Multi-country monkeypox outbreak: situation update. https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON393 [2022-09-05].
  • 9.USA Centers for Disease Control and Prevention 2022 Monkeypox Outbreak Global Map. https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html [2022-09-05].
  • 10.World Health Organization Second meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country outbreak of monkeypox. https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multicountry-outbreak-of-monkeypox [2022-09-05].
  • 11.Notice on printing and distributing the monkeypox diagnosis and treatment guide (2022 Edition) http://www.nhc.gov.cn/yzygj/s7653p/202206/d687b12fe8b84bbfaede2c7a5ca596ec.shtml [2022-09-05]. (In Chinese)
  • 12.Announcement No. 65 of the General Administration of Customs in 2022 (announcement on preventing monkeypox epidemic from being introduced into China) http://www.customs.gov.cn/customs/302249/302266/302267/4482275/index.html [2022-09-05]. (In Chinese)
  • 13.Zhou XW, Yang R, Jiang JY, et al. Lancang-Mekong collaboration in response to the challenge of vector-borne diseases: Control of malaria and dengue through Lancang-Mekong Cooperation. J Pathog Biol. 2021;16:109–116. (In Chinese) [Google Scholar]
  • 14.Ministry of Education, Department of International Cooperation and Exchange. Concise statistics of International Students 280 in 2018, 2018; 348. (In Chinese)
  • 15.World Health Organization Monkeypox. https://www.who.int/news-room/fact-sheets/detail/monkeypox [2022-09-05]
  • 16.Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16 doi: 10.1371/journal.pntd.0010141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.López-Feldman A. Decomposing inequality and obtaining marginal effects. Stata J. 2006;6:106–111. [Google Scholar]
  • 18.Espy MJ, Cockerill FR, III, Meyer RF, et al. Detection of smallpox virus DNA by LightCycler PCR. J Clin Microbiol. 2002;40:1985–1988. doi: 10.1128/JCM.40.6.1985-1988.2002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Chen PJ, Li FZ, Harmer P. Healthy China 2030: moving from blueprint to action with a new focus on public health. Lancet Public Health. 2019;4 doi: 10.1016/S2468-2667(19)30160-4. [DOI] [PubMed] [Google Scholar]
  • 20.Wang XY, Liu J, Wang Q, et al. Economic-related inequalities in hepatitis B virus infection among 115.8 million pregnant women in China from 2013 to 2020. EClinicalMedicine. 2022;49 doi: 10.1016/j.eclinm.2022.101465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Yang Y, Sun H, Kang Z, et al. Health emergency assessment: Risk matrix and Borda sequence value method. Chin J Public Health. 2016;32:815–817. (In Chinese) [Google Scholar]
  • 22.Kang LY, Liu J, Liu M. Progress in researches on methods for risk assessment of infectious diseases. Chin J Public Health. 2021;37:1454–1458. (In Chinese) [Google Scholar]
  • 23.Yun L, Wang FC, Zhang QF, et al. Integrated application of risk matrix method and borda sequence value method to assess the risks of vectors for 2016 international horticultural exposition. Chin J Vect Bio Control. 2017;28:557–560. (In Chinese) [Google Scholar]
  • 24.Przybyła-Kasperek M, Marfo KF. Neural network used for the fusion of predictions obtained by the K-nearest neighbors algorithm based on independent data sources. Entropy (Basel) 2021;23 doi: 10.3390/e23121568. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.USA Centers for Disease Control and Prevention Past U. S. Cases and Outbreaks. https://www.cdc.gov/poxvirus/monkeypox/outbreak/us-outbreaks.html [2022-09-05]
  • 26.Reynolds MG, Yorita KL, Kuehnert MJ, et al. Clinical manifestations of human monkeypox influenced by route of infection. J Infect Dis. 2006;194:773–780. doi: 10.1086/505880. [DOI] [PubMed] [Google Scholar]
  • 27.Rao AK, Schulte J, Chen TH, et al. Monkeypox in a traveller returning from Nigeria - Dallas, Texas, July 2021. MMWR Morb Mortal Wkly Rep. 2022;71:509–516. doi: 10.15585/mmwr.mm7114a1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Angelo KM, Petersen BW, Hamer DH, et al. Monkeypox transmission among international travellers-serious monkey business? J Travel Med. 2019;26 doi: 10.1093/jtm/taz002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Girometti N, Byrne R, Bracchi M, et al. Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis. Lancet Infect Dis. 2022;22:1321–1328. doi: 10.1016/S1473-3099(22)00411-X. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox virus infection in humans across 16 countries - April-June 2022. N Engl J Med. 2022;387:679–691. doi: 10.1056/NEJMoa2207323. [DOI] [PubMed] [Google Scholar]
  • 31.Han TL, Duan XJ, Wang Y, et al. Risk assessment of poliomyelitis imported into China from Afghanistan using risk matrix. Int J Virol. 2021;28:321–324. (In Chinese) [Google Scholar]
  • 32.Hao YW, Tian T, Zhu ZL, et al. Transmission risk matrix assessment of imported leishmaniasis in China. Chin J Schistosom Control. 2018;30:428–432. doi: 10.16250/j.32.1374.2018063. (In Chinese) [DOI] [PubMed] [Google Scholar]
  • 33.Abuhabib AA, Abu-Aita SN, Procter C, et al. Unique situation of Gaza Strip dealing with COVID-19 crisis. Int J Infect Dis. 2020;100:149–151. doi: 10.1016/j.ijid.2020.08.070. [DOI] [PMC free article] [PubMed] [Google Scholar]

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