SynthesisBMJ global health2025
Decoding mpox: a systematic review and meta-analysis of the transmission and severity parameters of the 2022-2023 global outbreak.
Synthesis in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Systematic Review and Meta-Analysis of Emerging Viral Zoonotic Diseases, 2016-2026.Transboundary and emerging diseases · 2026Pooled it
- Decoding mpox: a systematic review and meta-analysis of the transmission and severity parameters of the 2022-2023 global outbreak.BMJ global health · 2025Pooled it
- The epidemiological and clinical differences between patients with mpox and patients without mpox among suspected cases during the recent global mpox outbreaks: a systematic review and meta-analysis.Frontiers in cellular and infection microbiology · 2025Pooled it
- From clinical fluids to environmental matrices: quantitative monitoring of infectious monkeypox virus based on PMA-qPCR during the Guangdong outbreak.Tropical medicine and health · 2026Article
- Epidemic Mitigation and Marginal Mortality Gains Using Self-Testing as a Diagnostic Intervention for Epidemic-Prone Diseases in Africa.Diagnostics (Basel, Switzerland) · 2026Article
- Monkeypox Virus (MPXV) Transmission Dynamics in Neighboring Countries as a Potential Threat to Kazakhstan.Viruses · 2026Review
- A Review of Epidemiological Modeling Studies on Monkeypox.China CDC weekly · 2026Article
- Viral introductions and return to baseline sexual behaviors maintain low-level mpox incidence in Los Angeles.Nature communications · 2026Article
- Dynamic shift in the dominant transmission route of clade Ib monkeypox virus across networks with sexual and nonsexual contacts.Science advances · 2026Article
- From forest to frontline: A comprehensive review of Mpox's global leap and viral evolution (2022-2024).One health (Amsterdam, Netherlands) · 2025Review
- Optimal deployment of limited vaccine supplies to control mpox outbreaks.NPJ vaccines · 2025Article
- Global transmission characteristics of mpox outbreaks: a systematic review and meta-analysis.EClinicalMedicine · 2025Article
- Viral introductions and return to baseline sexual behaviors maintain low-level mpox incidence in Los Angeles County, USA, 2023-2024.medRxiv : the preprint server for health sciences · 2025Article
- Mpox: current knowledge and understanding-a scoping review.FEMS microbiology reviews · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe 2022-2023 mpox outbreak has been the largest in history. We aim to synthesise the key epidemiological parameters related to the dynamics, transmission, and severity of mpox (incubation period, serial interval, generation time, infectious period, basic (R0) and effective (R(t)) reproductive number, and case fatality rate (CFR)).
methodsSystematic review of observational studies in MEDLINE, EMBASE and other sources up to September 2023 (PROSPERO: CRD42023404503). Quality assessment using the Joanna Briggs Institute Critical Appraisal for case series, cross-sectional and cohort studies, and a designed quality assessment questionnaire for mathematical models. Meta-analysis was performed using a random effects model.
resultsFor transmissibility parameters, we estimated a pooled incubation period of 7.60 (95% CI 7.14 to 8.10) days and a pooled serial interval of 8.30 (95% CI 6.74 to 10.23) days. One study reported a generation time of 12.5 days (95% CI 7.5 to 17.3). Three studies reported presymptomatic transmission in 27-50% of paired cases investigated. R(t) varied between 1.16 and 3.74 and R0 varied between 0.006 and 7.84. The epidemic peaked between August and September 2022 in Europe and the Americas whereas transmission has continued in African countries. For severity parameters, we estimated a pooled CFR by continent: 0.19% (95% CI 0.09% to 0.37%) for the Americas and 0.33% (95% CI 0.15% to 0.7%) for Europe. For Africa, we found that the CFRs of countries associated with group I were higher (range 17-64%) than those associated with group IIb (range 0-6%).
conclusionPooled mpox serial interval was slightly larger than pooled incubation period, suggesting transmission occurs mostly postsymptom onset, although presymptomatic transmission can occur in an important proportion of cases. CFR estimates varied by geographical region and were higher in Africa, in countries linked with clade I. Our results contribute to a better understanding of mpox dynamics, and the development of mathematical models to assess the impact of current and future interventions.
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