Evidence map›Paper›PMID 35973747›Full record

SynthesisBMJ global health2022

Availability, scope and quality of monkeypox clinical management guidelines globally: a systematic review.

Eika Webb, Ishmeala Rigby, Melina Michelen, Andrew Dagens, Vincent Cheng, Amanda M Rojek, Dania Dahmash, Susan Khader, Keerti Gedela, Alice Norton and 12 more

Open access · goldAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 4 pooled it
4.1field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 4 syntheses or guidelines pooled it, 56 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. The use of antivirals in the treatment of human monkeypox outbreaks: a systematic review.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2023
    Pooled it
  4. Pooled it
  5. Article
  6. Article
  7. Article
  8. Review
  9. Review
  10. Article
  11. Article
  12. Monkeypox infection and pregnancy in lower and middle-income countries: Precautions & recommendations.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2024
    Review
  13. Review
  14. Article
  15. Article
  16. Mpox-A Rapidly Evolving Disease.JAMA dermatology · 2023
    Article
  17. Review
  18. Review
  19. Article
  20. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors at 8 institutions in 4 countries.

Eika WebbLiverpool School of Tropical Medicine, Liverpool, Liverpool, UK.
Ishmeala RigbyISARIC Global Support Centre, Pandemic Sciences Institute, University of Oxford, Oxford, Oxfordshire, UK.ORCID 0000-0001-9236-7317
Melina MichelenISARIC Global Support Centre, Pandemic Sciences Institute, University of Oxford, Oxford, Oxfordshire, UK.ORCID 0000-0003-3659-7788
Andrew DagensISARIC Global Support Centre, Pandemic Sciences Institute, University of Oxford, Oxford, Oxfordshire, UK.
Vincent ChengBristol Medical School, Unversity of Bristol, Bristol, UK.ORCID 0000-0002-6162-4146
Amanda M RojekISARIC Global Support Centre, Pandemic Sciences Institute, University of Oxford, Oxford, Oxfordshire, UK.
Dania DahmashISARIC Global Support Centre, Pandemic Sciences Institute, University of Oxford, Oxford, Oxfordshire, UK.
Susan KhaderGloPID-R, University of Oxford, Oxford, Oxfordshire, UK.
Keerti GedelaChelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Alice NortonGloPID-R, University of Oxford, Oxford, Oxfordshire, UK.
Muge CevikDivison of Infection and Global Health Research, School of Medicine, University of St. Andrews, St Andrews, UK.
Erhui CaiISARIC Global Support Centre, Pandemic Sciences Institute, University of Oxford, Oxford, Oxfordshire, UK.
Eli HarrissBodleian Health Care Libraries, University of Oxford, Oxford, UK.
Samuel LipworthOxford University Hospitals NHS Foundation Trust, Oxford, UK.
Robert NartowskiISARIC Global Support Centre, Pandemic Sciences Institute, University of Oxford, Oxford, Oxfordshire, UK.
Helen GrovesWellcome Trust, London, London, UK.
Peter HartWellcome Trust, London, London, UK.
Lucille BlumbergNational Institute for Communicable Diseases, Johannesburg, South Africa.
Tom FletcherLiverpool School of Tropical Medicine, Liverpool, Liverpool, UK.
Shevin T JacobLiverpool School of Tropical Medicine, Liverpool, Liverpool, UK.ORCID 0000-0003-2425-9394
Louise SigfridISARIC Global Support Centre, Pandemic Sciences Institute, University of Oxford, Oxford, Oxfordshire, UK louise.sigfrid@gmail.com.ORCID 0000-0003-2764-1177
Peter W HorbyISARIC Global Support Centre, Pandemic Sciences Institute, University of Oxford, Oxford, Oxfordshire, UK.ORCID 0000-0002-9822-1586
University of Oxford · GBLiverpool School of Tropical Medicine · GBWellcome Trust · GBChelsea and Westminster Hospital NHS Foundation Trust · GBNational Center for Communicable Diseases · MNThe Royal Melbourne Hospital · AUUniversity of Bristol · GBUniversity of St Andrews · GB

Funding

Medical Research Council MR/S019987/1Medical Research Council MR/T001151/1Wellcome Trust
6 · The paper itself

Abstract

backgroundMonkeypox (MPX) is an important human Orthopoxvirus infection. There has been an increase in MPX cases and outbreaks in endemic and non-endemic regions in recent decades. We appraised the availability, scope, quality and inclusivity of clinical management guidelines for MPX globally.

methodsFor this systematic review, we searched six databases from inception until 14 October 2021, augmented by a grey literature search until 17 May 2022. MPX guidelines providing treatment and supportive care recommendations were included, with no exclusions for language. Two reviewers assessed the guidelines. Quality was assessed using the Appraisal of Guidelines for Research and Evaluation II tool.

resultsOf 2026 records screened, 14 guidelines were included. Overall, most guidelines were of low-quality with a median score of 2 out of 7 (range: 1-7), lacked detail and covered a narrow range of topics. Most guidelines focused on adults, five (36%) provided some advice for children, three (21%) for pregnant women and three (21%) for people living with HIV. Treatment guidance was mostly limited to advice on antivirals; seven guidelines advised cidofovir (four specified for severe MPX only); 29% (4/14) tecovirimat, and 7% (1/14) brincidofovir. Only one guideline provided recommendations on supportive care and treatment of complications. All guidelines recommended vaccination as post-exposure prophylaxis (PEP). Three guidelines advised on vaccinia immune globulin as PEP for severe cases in people with immunosuppression.

conclusionOur results highlight a lack of evidence-based clinical management guidelines for MPX globally. There is a clear and urgent need for research into treatment and prophylaxis including for different risk populations. The current outbreak provides an opportunity to accelerate this research through coordinated high-quality studies. New evidence should be incorporated into globally accessible guidelines, to benefit patient and epidemic outcomes. A 'living guideline' framework is recommended. PROSPERO REGISTRATION NUMBER: CRD42020167361.

Indexed as

Mpox, MonkeypoxAdultAntiviral AgentsChildDatabases, FactualDisease OutbreaksFemaleHumansPregnancyAntiviral Agentshealth policyinfections, diseases, disorders, injuriessystematic review

Identifiers

PMID35973747
PMCPMC9472169
OpenAlexW4295759487

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.