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Infection prevention and control measures to reduce the transmission of mpox: A systematic review
Rebecca Kuehn1, Tilly Fox1, Gordon Guyatt2
1Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
Objectives:
To make inferences regarding the effectiveness of respiratory interventions and case isolation measures in reducing or preventing the transmission of mpox based on synthesis of available literature.
Methods:
The WHO Clinical Management and Infection Prevention and Control 2022 guideline and droplet precautions in healthcare facilities and home isolation infection prevention control measures for patients with mpox. We conducted a systematic review that included a broad search of five electronic databases. In a two-stage process, we initially sought only randomized controlled trials and observational comparative studies; when the search failed to yield eligible studies, the subsequent search included all study designs including clinical and environmental sampling studies.
Results:
No studies were identified that directly addressed airborne and droplet precautions and home isolation infection prevention control measures. To inform the review questions the review team synthesized route of transmission data in mpox. There were 2366/4309 (54.9%) cases in which investigators identified mpox infection occurring following transmission through direct physical sexual contact. There were no reported mpox cases in which investigators identified inhalation as a single route of transmission. There were 2/4309 cases in which investigators identified fomite as a single route of transmission. Clinical and environmental sampling studies isolated mpox virus in a minority of saliva, oropharangeal swabs, mpox skin lesions, and hospital room air.
Conclusions:
Current findings provide compelling evidence that transmission of mpox occurs through direct physical contact. Because investigators have not reported any cases of transmission via inhalation alone, the impact of airborne and droplet infection prevention control measures in reducing transmission will be minimal. Avoiding physical contact with others, covering mpox lesions and wearing a medical mask is likely to reduce onward mpox transmission; there may be minimal reduction in transmission from additionally physically isolating patients with mild disease at home.
Insights
Mpox transmission primarily occurs through direct physical contact, not inhalation. Respiratory interventions and airborne precautions are unlikely to significantly reduce mpox spread, but avoiding contact and covering lesions is effective.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- Mpox (formerly monkeypox) transmission dynamics require clarification to optimize infection control strategies.
- Understanding the primary routes of mpox transmission is crucial for developing effective public health interventions.
Purpose of the Study:
- To synthesize available literature and infer the effectiveness of respiratory interventions and isolation measures in preventing mpox transmission.
- To evaluate the impact of airborne, droplet, and home isolation precautions on mpox spread.
Main Methods:
- Systematic review of literature using five electronic databases.
- Initial search focused on randomized controlled trials and observational comparative studies, expanded to include all study designs when necessary.
- Synthesis of route of transmission data for mpox.
Main Results:
- No studies directly addressed airborne, droplet, or home isolation precautions for mpox.
- Direct physical (sexual) contact was identified as the primary transmission route in 54.9% of cases.
- Inhalation was not identified as a sole transmission route; fomite transmission was reported in 2 out of 4309 cases.
- Mpox virus was isolated from saliva, oropharyngeal swabs, skin lesions, and hospital room air in a minority of samples.
Conclusions:
- Compelling evidence indicates mpox transmission occurs predominantly through direct physical contact.
- Airborne and droplet infection control measures are expected to have minimal impact on reducing mpox transmission.
- Avoiding physical contact, covering lesions, and mask-wearing are recommended to reduce onward transmission; home isolation for mild cases may offer minimal benefit.
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