Knowing the unknown: The underestimation of monkeypox cases. Insights and implications from an integrative review of the literature

Journal Article · Thu Sep 22 20:00:00 EDT 2022 · Frontiers in Microbiology

DOI: https://doi.org/10.3389/fmicb.2022.1011049 · OSTI ID:1922796

Bragazzi, Nicola Luigi ^[1]; Woldegerima, Woldegebriel Assefa ^[1]; Iyaniwura, Sarafa Adewale ^[2]; Han, Qing ^[1]; Wang, Xiaoying ^[3]; Shausan, Aminath ^[4]; Badu, Kingsley ^[5]; Okwen, Patrick ^[6]; Prescod, Cheryl ^[7]; Westin, Michelle ^[8]; Omame, Andrew ^[9]; Converti, Manlio ^[10]; Mellado, Bruce ^[11]; Wu, Jianhong ^[1]; Kong, Jude Dzevela ^[1]

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1. York Univ., Toronto, ON (Canada)
2. Los Alamos National Lab. (LANL), Los Alamos, NM (United States)
3. Trent Univ., Peterborough, ON (Canada)
4. Univ. of Queensland, Brisbane, QLD (Australia)
5. Kwame Nkrumah University of Science and Technology, Kumasi (Ghana)
6. Effective Basic Services (eBASE), Bamenda (Cameroon)
7. Black Creek Community Health Centre, Toronto, ON (Canada)
8. Black Creek Community Health Centre, Toronto, ON (Canada)
9. Federal University of Technology, Owerri (Nigeria); Government College University, Lahore (Pakistan)
10. ASL Napoli 2 Nord, Naples (Italy)
11. University of the Witwatersrand, Johannesburg (South Africa); iThemba Laboratory for Accelerator Based Sciences, Somerset West (South Africa)

Monkeypox is an emerging zoonotic disease caused by the monkeypox virus, which is an infectious agent belonging to the genus Orthopoxvirus. Currently, commencing from the end of April 2022, an outbreak of monkeypox is ongoing, with more than 43,000 cases reported as of 23 August 2022, involving 99 countries and territories across all the six World Health Organization (WHO) regions. On 23 July 2022, the Director-General of the WHO declared monkeypox a global public health emergency of international concern (PHEIC), since the outbreak represents an extraordinary, unusual, and unexpected event that poses a significant risk for international spread, requiring an immediate, coordinated international response. However, the real magnitude of the burden of disease could be masked by failures in ascertainment and under-detection. As such, underestimation affects the efficiency and reliability of surveillance and notification systems and compromises the possibility of making informed and evidence-based policy decisions in terms of the adoption and implementation of ad hoc adequate preventive measures. In this review, synthesizing 53 papers, we summarize the determinants of the underestimation of sexually transmitted diseases, in general, and, in particular, monkeypox, in terms of all their various components and dimensions (under-ascertainment, underreporting, under-detection, under-diagnosis, misdiagnosis/misclassification, and under-notification).

• Research Organization: Los Alamos National Laboratory (LANL), Los Alamos, NM (United States)
• Sponsoring Organization: International Development Research Centre (IDRC); National Institutes of Health (NIH); Natural Sciences and Engineering Research Council of Canada (NSERC); Swedish International Development Cooperation Agency (SIDA); USDOE
• Grant/Contract Number: 89233218CNA000001
• OSTI ID: 1922796
• Report Number(s): LA-UR-22-29314
• Journal Information: Frontiers in Microbiology, Journal Name: Frontiers in Microbiology Vol. 13; ISSN 1664-302X
• Publisher: Frontiers Research FoundationCopyright Statement
• Country of Publication: United States
• Language: English