A multicountry monkeypox disease (MPX) outbreak began in May 2022 in Europe, leading to the assessment as a potential Public Health Emergency of International Concern (PHEIC) on June 23, 2022. Some observational studies have partially characterised clinical features, hospitalisations, and deaths. However, no systematic reviews of this MPX outbreak have been published.We performed a systematic review with meta-analysis, using five databases to assess clinical features, hospitalisations, complications and deaths of MPX confirmed or probable cases. Observational studies, case reports and case series, were included. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In addition, we carried out a subgroup analysis according to the continents and a sensitivity analysis excluding studies classified as having a high risk of bias.A total of 19 articles were included, using only 12 articles in the quantitative synthesis (meta-analysis). For 1958 patients, rash (93%, 95% CI 80-100%), fever (72%, 95% CI 30-99%), pruritus (65%, 95% CI 47-81%), and lymphadenopathy (62%, 47-76%), were the most prevalent manifestations. Among the patients, 35% (95% CI 14-59%) were hospitalised. Some 4% (95% CI 1-9%) of hospitalised patients had fatal outcomes (case fatality rate, CFR).MPX is spreading rapidly, with a third of hospitalised patients, but less than 5% with fatal outcomes. As this zoonotic virus spreads globally, countries must urgently prepare human resources, infrastructure and facilities to treat patients according to the emerging guidelines and the most reliable clinical information. 

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Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

https://ann-clinmicrob.biomedcentral.com/counter/pdf/10.1186/s12941-022-00527-1

The biggest-ever outbreak of monkeypox disease in non-endemic countries started in May, 2022. Though no monkeypox case has been reported from India, till mid-June, 2022, yet, considering the rate of spread to the non-endemic countries, there is an urgent need of better understanding of the monkeypox virus and disease epidemiology to help clinicians, public health specialists, and policymakers to be prepared for any eventuality. This review summarises the monkeypox disease epidemiology, clinical features, therapies, vaccines and outlines the measures for preparedness and response for a possible outbreak. The disease is known to cause severe outcome in children, pregnant women, and immunocompromised hosts and this group need to be given special attention. The monkeypox disease outbreak (2022) in non-endemic countries should be used as an opportunity by India and other low and middle income countries to strengthen public health surveillance and health system capacity for outbreak and epidemic preparedness and response. 

/pdf/monkeypox-disease-outbreak-2022-epidemiology-challenges-and-1fnj38pu.pdf

Monkeypox Disease Outbreak (2022): Epidemiology, Challenges, and the Way Forward

Decision-makers discussing landmark agreements on health and biodiversity must include four actions to reduce the risk of animals and people exchanging viruses. Decision-makers discussing landmark agreements on health and biodiversity must include four actions to reduce the risk of animals and people exchanging viruses. 

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Want to prevent pandemics? Stop spillovers

COVID-19 is the latest zoonotic RNA virus epidemic of concern. Learning how it began and spread will help to determine how to reduce the risk of future events. We review major RNA virus outbreaks since 1967 to identify common features and opportunities to prevent emergence, including ancestral viral origins in birds, bats, and other mammals; animal reservoirs and intermediate hosts; and pathways for zoonotic spillover and community spread, leading to local, regional, or international outbreaks. The increasing scientific evidence concerning the origins of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is most consistent with a zoonotic origin and a spillover pathway from wildlife to people via wildlife farming and the wildlife trade. We apply what we know about these outbreaks to identify relevant, feasible, and implementable interventions. We identify three primary targets for pandemic prevention and preparedness: first, smart surveillance coupled with epidemiological risk assessment across wildlife-livestock-human (One Health) spillover interfaces; second, research to enhance pandemic preparedness and expedite development of vaccines and therapeutics; and third, strategies to reduce underlying drivers of spillover risk and spread and reduce the influence of misinformation. For all three, continued efforts to improve and integrate biosafety and biosecurity with the implementation of a One Health approach are essential. We discuss new models to address the challenges of creating an inclusive and effective governance structure, with the necessary stable funding for cross-disciplinary collaborative research. Finally, we offer recommendations for feasible actions to close the knowledge gaps across the One Health continuum and improve preparedness and response in the future. 

Pandemic origins and a One Health approach to preparedness and prevention: Solutions based on SARS-CoV-2 and other RNA viruses

At least 10,000 virus species have the ability to infect humans but, at present, the vast majority are circulating silently in wild mammals1,2. However, changes in climate and land use will lead to opportunities for viral sharing among previously geographically isolated species of wildlife3,4. In some cases, this will facilitate zoonotic spillover-a mechanistic link between global environmental change and disease emergence. Here we simulate potential hotspots of future viral sharing, using a phylogeographical model of the mammal-virus network, and projections of geographical range shifts for 3,139 mammal species under climate-change and land-use scenarios for the year 2070. We predict that species will aggregate in new combinations at high elevations, in biodiversity hotspots, and in areas of high human population density in Asia and Africa, causing the cross-species transmission of their associated viruses an estimated 4,000 times. Owing to their unique dispersal ability, bats account for the majority of novel viral sharing and are likely to share viruses along evolutionary pathways that will facilitate future emergence in humans. Notably, we find that this ecological transition may already be underway, and holding warming under 2 °C within the twenty-first century will not reduce future viral sharing. Our findings highlight an urgent need to pair viral surveillance and discovery efforts with biodiversity surveys tracking the range shifts of species, especially in tropical regions that contain the most zoonoses and are experiencing rapid warming. 

https://doi.org/10.1038/s41586-022-04788-w

Climate change increases cross-species viral transmission risk

http://www.ijidonline.com/article/S1201971222003903/pdf

Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions

Antimicrobial resistance (AMR) is a critical global health threat, and drivers of the emergence of novel strains of antibiotic-resistant bacteria in humans are poorly understood at the global scale. We examined correlates of AMR emergence in humans using global data on the origins of novel strains of AMR bacteria from 2006 to 2017, human and livestock antibiotic use, country economic activity, and reporting bias indicators. We found that AMR emergence is positively correlated with antibiotic consumption in humans, whereas the relationship with antibiotic consumption in livestock is modified by gross domestic product (GDP), with only higher GDP countries showing a slight positive association. We also found that human travel may play a role in AMR emergence, likely driving the spread of novel AMR strains into countries where they are subsequently detected for the first time. Finally, we produced predictive models and country-level maps of the global distribution of AMR risk. We assessed these against spatial patterns of reported AMR emergence, to identify gaps in surveillance that can be used to direct prevention and intervention policies.

/pdf/global-patterns-and-correlates-in-the-emergence-of-3giwmijf.pdf

Global patterns and correlates in the emergence of antimicrobial resistance in humans

The fungal pathogen Batrachochytrium salamandrivorans (Bsal) is a major potential threat to salamander biodiversity in North America, where it is not yet known to occur. In the United States, a 2016 policy restricted the trade in 20 salamander genera in attempts to prevent Bsal introduction. However, little comprehensive data is available to evaluate the impact of this policy action. Here, we collated a dataset of United States amphibian imports from 1999 to 2021 and show that reported legal trade in the targeted taxa was effectively reduced by the ban. Unfortunately, amphibian trade into the United States continues to risk Bsal introduction given that other species and genera now known to carry Bsal are still traded in large quantities (millions of live individuals annually). Additional policy responses focused on Bsal carrier taxa, especially frogs in the genus Rana, could help mitigate the impact of Bsal on North American salamanders.

Noam Ross

Papers

Climate change increases cross-species viral transmission risk

Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions

Global patterns and correlates in the emergence of antimicrobial resistance in humans

Ongoing amphibian trade into the United States threatens salamander biodiversity