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      Prevalence of mpox viral DNA in cutaneous specimens of monkeypox-infected patients: a systematic review and meta-analysis

      systematic-review

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          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, I 2 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.

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          Most cited references42

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Quantifying heterogeneity in a meta-analysis.

            The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity. Copyright 2002 John Wiley & Sons, Ltd.
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              Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.

              Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
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                Author and article information

                Contributors
                Journal
                Front Cell Infect Microbiol
                Front Cell Infect Microbiol
                Front. Cell. Infect. Microbiol.
                Frontiers in Cellular and Infection Microbiology
                Frontiers Media S.A.
                2235-2988
                29 June 2023
                2023
                : 13
                : 1179885
                Affiliations
                [1] 1 Department of Biochemistry, Maharishi Markandeshwar College of Medical Sciences and Research (MMCMSR), Sadopur , Ambala, India
                [2] 2 Department of Community Medicine, Maharishi Markandeshwar College of Medical Sciences and Research (MMCMSR), Sadopur , Ambala, India
                [3] 3 Department of Pharmacology, All India Institute of Medical Sciences , Jodhpur, Rajasthan, India
                [4] 4 Department of Virology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
                [5] 5 Department of Biochemistry, All India Institute of Medical Sciences (AIIMS) , Kalyani, India
                [6] 6 Department of Laboratory Science, Research and Development Division, Fatebenefratelli Isola Tiberina, Gemelli Isola , Rome, Italy
                [7] 7 Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine , Kathmandu, Nepal
                [8] 8 Department of Microbiology, Dr. D.Y Patil Medical College, Hospital and Research Centre , Pune, Maharashtra, India
                [9] 9 Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune , Maharashtra, India
                [10] 10 Escuela de Medicina, Universidad Cesar Vallejo , Trujillo, Peru
                [11] 11 Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research , Chandigarh, India
                Author notes

                Edited by: Mehboob Hoque, Aliah University, Kolkata, India

                Reviewed by: Ramesh Kandimalla, Indian Institute of Chemical Technology (CSIR), Hyderabad, India; Luca Busani, National Institute of Health (ISS), Rome, Italy

                *Correspondence: Bijaya K. Padhi, bkpadhi@ 123456gmail.com ; Joshuan J. Barboza, jbarboza-me@ 123456ucvvirtual.edu.pe

                †These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fcimb.2023.1179885
                10349178
                56f95d8c-314a-4bc7-bfd2-ef9dd04257b3
                Copyright © 2023 Rani, Goyal, Shamim, Satapathy, Pal, Squitti, Goswami, Sah, Barboza and Padhi

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 17 April 2023
                : 05 May 2023
                Page count
                Figures: 4, Tables: 1, Equations: 0, References: 46, Pages: 10, Words: 4921
                Categories
                Cellular and Infection Microbiology
                Systematic Review
                Custom metadata
                Virus and Host

                Infectious disease & Microbiology
                monkeypox,mpox viral dna,skin lesion,cutaneous,meta-analysis,infectivity potential,transmission

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