Mpox person-to-person transmission: Where have we got so far? - a systematic review.

Abstract

The recent multi-country outbreak of Mpox (Monkeypox disease) constitutes a public health emergency. Although animal-to-human transmission is known to be the primary way of transmission, an increasing number of cases transmitted by person-to-person contact have been reported. During recent Mpox outbreak sexual or intimate contact has been considered the most important way of transmission. However, other routes of transmission must not be ignored. The knowledge on how the Monkeypox Virus (MPXV) spreads is important to consider what measures should be taken to control the dissemination of the disease. Therefore, this systematic review aimed to collect scientific data published concerning other implicated sources of infection beyond sexual interaction, such as the involvement of respiratory particles, contact with contaminated surfaces and skin-to-skin contact. The current study was performed using the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Only publications analyzing contacts of Mpox index cases and their outcome after contact were included. A total of 7235 person-to-person contacts were surveyed, of which 252 became positive cases. Positive secondary transmission of MPXV was verified after contact with people cohabiting in the same household, with family members, with healthcare workers or within healthcare facilities, and sexually or with contaminated surfaces. Using the same cup, sharing the same dishes, and sleeping in the same room or bed were also positively associated with transmission. Four studies showed no evidence of transmission despite contact with surfaces, skin-to-skin contact or through airway particles within healthcare facilities where containment measures were taken. These records support person-to-person transmission and suggest that other types of contact beyond sexual contact compose significant risk to acquire the infection. Further investigation is crucial to elucidate MPXV transmission dynamics and to implement adequate measures to contain the spread of the infection.