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Paediatric, maternal, and congenital mpox: a systematic review and meta-analysis

Sanchez Clemente, N; Coles, C; Paixao, ES; Brickley, EB; Whittaker, E; Alfven, T; Rulisa, S; Agudelo Higuita, N; Torpiano, P; Agravat, P; et al. Sanchez Clemente, N; Coles, C; Paixao, ES; Brickley, EB; Whittaker, E; Alfven, T; Rulisa, S; Agudelo Higuita, N; Torpiano, P; Agravat, P; Thorley, EV; Drysdale, SB; Le Doare, K; Muyembe Tamfum, J-J (2024) Paediatric, maternal, and congenital mpox: a systematic review and meta-analysis. The Lancet Global Health, 12 (4). e572-e588. ISSN 2214-109X https://doi.org/10.1016/s2214-109x(23)00607-1
SGUL Authors: Sanchez Clemente, Nuria Le Doare, Kirsty

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Abstract

Background Although mpox has been detected in paediatric populations in central and west Africa for decades, evidence synthesis on paediatric, maternal, and congenital mpox, and the use of vaccines and therapeutics in these groups, is lacking. A systematic review is therefore indicated to set the research agenda. Methods We conducted a systematic review and meta-analysis, searching articles in Embase, Global Health, MEDLINE, CINAHL, Web of Science, Scopus, SciELO, and WHO databases from inception to April 17, 2023. We included studies reporting primary data on at least one case of confirmed, suspected, or probable paediatric, maternal, or congenital mpox in humans or the use of third-generation smallpox or mpox vaccines, targeted antivirals, or immune therapies in at least one case in our population of interest. We included clinical trials and observational studies in humans and excluded reviews, commentaries, and grey literature. A pooled estimate of the paediatric case fatality ratio was obtained using random-effects meta-analysis. This study is registered with PROSPERO (CRD420223336648). Findings Of the 61 studies, 53 reported paediatric outcomes (n=2123 cases), seven reported maternal or congenital outcomes (n=32 cases), two reported vaccine safety (n=28 recipients), and three reported transmission during breastfeeding (n=4 cases). While a subset of seven observational studies (21 children and 12 pregnant individuals) reported uneventful treatment with tecovirimat, there were no randomised trials reporting safety or efficacy for any therapeutic agent. Among children, the commonest clinical features included rash (86 [100%] of 86), fever (63 [73%] of 86), and lymphadenopathy (40 [47%] of 86). Among pregnant individuals, rash was reported in 23 (100%) of 23; fever and lymphadenopathy were less common (six [26%] and three [13%] of 23, respectively). Most paediatric complications (12 [60%] of 20) arose from secondary bacterial infections. The pooled paediatric case fatality ratio was 11% (95% CI 4–20), I2=75%. Data from 12 pregnancies showed half resulted in fetal death. Research on vaccine and immune globulin safety remains scarce for children and absent for pregnant individuals. Interpretation Our review highlights critical knowledge gaps in the epidemiology, prevention, and treatment of mpox in children and pregnant individuals, especially those residing in endemic countries. Increased funding, international collaboration, and equitable research is needed to inform mpox control strategies tailored for at-risk communities in endemic countries.

Item Type: Article
Additional Information: Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Keywords: 0605 Microbiology, 1117 Public Health and Health Services
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: The Lancet Global Health
ISSN: 2214-109X
Language: en
Dates:
DateEvent
12 March 2024Published
21 February 2024Published Online
19 December 2023Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
MR/X011100/1UK Research and Innovationhttp://dx.doi.org/10.13039/100014013
225925/Z/22/ZWellcome Trusthttp://dx.doi.org/10.13039/100004440
URI: https://openaccess.sgul.ac.uk/id/eprint/116259
Publisher's version: https://doi.org/10.1016/s2214-109x(23)00607-1

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