Integrated Network Analysis of Symptom Clusters Across Monkeypox Epidemics From 1970 to 2023: Systematic Review and...

Area of Science:

• Epidemiology
• Infectious Diseases
• Virology

Background:

• The global spread of monkeypox (mpox) has significantly increased, particularly in non-endemic regions.
• Understanding the changing clinical presentation of mpox is crucial for effective public health responses.

Purpose of the Study:

• To investigate the evolution of clinical symptoms associated with mpox from 1970 to 2023.
• To explore the interrelations and correlations among mpox symptoms over different epidemic periods.

Main Methods:

• A systematic review and meta-analysis of English peer-reviewed studies from January 1970 to April 2023.
• Categorization of mpox epidemics into three periods: 1970-2002, 2003-2021, and 2022-2023.
• Network analysis to visualize correlations among symptoms.

Main Results:

• Rash remains the most common symptom across all periods (92.6%-100%).
• Fever, enlarged lymph nodes, and headache decreased significantly in the 2022-2023 period compared to earlier periods.
• Newer symptoms like chills/rigors and fatigue emerged in period 2 (2003-2021) but decreased in period 3.
• Nausea/vomiting showed high correlation with lymphadenopathy and conjunctivitis in period 2; rash and headache showed high correlation with fever in period 3.

Conclusions:

• Mpox symptom presentation has become more diverse, with increased symptom interrelations.
• While rash prevalence is stable, other symptoms have shifted, highlighting the evolving nature of the disease.
• Continuous surveillance of mpox clinical characteristics and symptom associations is essential for managing outbreaks.