AUTHOR=Rani Isha , Goyal Anmol , Shamim Muhammad Aaqib , Satapathy Prakasini , Pal Amit , Squitti Rosanna , Goswami Kalyan , Sah Ranjit , Barboza Joshuan J. , Padhi Bijaya K. TITLE=Prevalence of mpox viral DNA in cutaneous specimens of monkeypox-infected patients: a systematic review and meta-analysis JOURNAL=Frontiers in Cellular and Infection Microbiology VOLUME=13 YEAR=2023 URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1179885 DOI=10.3389/fcimb.2023.1179885 ISSN=2235-2988 ABSTRACT=Background

Human monkeypox (mpox) disease is a multicountry outbreak driven by human–human transmission which has resulted in an international public health emergency. However, there is limited evidence on the positivity rate of skin lesions for mpox viral DNA. We aim to fill this gap by estimating the pooled positivity rate of skin samples with mpox viral DNA from mpox patients globally.

Methods

In this systematic review and meta-analysis, seven databases and several preprint servers have been extensively searched until 17 January 2023 according to a prospectively registered protocol (PROSPERO: CRD42023392505). Articles including the positivity rate of skin samples with mpox viral DNA in mpox-confirmed patients were considered eligible. After a quality assessment, a random-effect meta-analysis was used for pooled prevalence. To explore and resolve heterogeneity, we used statistical methods for outlier detection, influence analysis, and sensitivity analysis.

Findings

Among the 331 articles retrieved after deduplication, 14 studies were finally included. The pooled positivity rate of the skin samples was 98.77% (95% CI: 94.74%–99.72%). After the removal of an influential outlier, I2 for heterogeneity dropped from 92.5% to 10.8%. Meta-regression did not reveal any significant moderator.

Conclusion/interpretation

The present findings reinforce that skin lesions act as a reservoir of mpox viral DNA and contribute to a high infectivity risk. This may be a prevailing basis of prompt transmission during the current multicountry outbreak and also needs further investigation. The present imperative outcome may benefit in producing valuable preventive and management procedures in an appropriate health strategy.