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Peer reviewedOpen accessMonkeypoxSmallpox

The changing epidemiology of human monkeypox—A potential threat? A systematic review

PLOS Neglected Tropical Diseases·

Eveline M. Bunge, Bernard Hoet, Liddy Chen, Florian Lienert, Heinz Weidenthaler, Lorraine R. Baer, Robert Steffen

DOI
10.1371/journal.pntd.0010141
PMID
35148313
PMCID
PMC8870502
OpenAlex
W4211060053
Study type
Systematic review
Publisher
Public Library of Science (PLoS)
Article type
journal-article
Integrity
current

Why this research matters now

The review highlights the global relevance of monkeypox given its spread beyond endemic African settings and suggests that enhanced surveillance is needed to monitor its evolving epidemiology.

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Structured evidence summary

Research question

How has the epidemiology of human monkeypox evolved over time, with attention to case counts, age at presentation, mortality, and geographic spread.

Study design

Systematic review of peer-reviewed and grey literature, registered with PROSPERO (CRD42020208269), drawing on 48 peer-reviewed articles and 18 grey literature sources.

Population and setting

Reported human monkeypox cases globally, with particular emphasis on endemic regions of Central and West Africa and occasional import- and travel-related cases outside Africa since 2003.

Main findings

The authors describe a rising number of human monkeypox cases since the 1970s, with the most pronounced increases in the Democratic Republic of the Congo. The median age at presentation rose from 4 years in the 1970s to 21 years in 2010–2019. The overall case fatality rate was 8.7%, with a clade-based difference reported between Central African (10.6%, 95% CI 8.4%–13.3%) and West African (3.6%, 95% CI 1.7%–6.8%) clades. Interactions with infected animals or individuals are described as associated risk behaviors, and outbreaks beyond Africa are noted since 2003.

Public-health relevance

The review highlights the global relevance of monkeypox given its spread beyond endemic African settings and suggests that enhanced surveillance is needed to monitor its evolving epidemiology.

Important limitations

The supplied abstract does not enumerate explicit study limitations. The summary is constrained to the supplied single-article abstract and metadata, and the original full paper is required for decision-grade interpretation.

GIDS interpretation

This systematic review provides historical and epidemiological context relevant to monkeypox discoverability, including its geographic expansion and shifts in age distribution; however, no connection to a live surveillance signal is made here.

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Related GIDS surveillance

Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.

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Evidence relationships

This article has 14 auditable classifier relationships to diseases, places, topics, and study design.

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