Containment and response strategies for mpox outbreaks: a systematic review

Background: Mpox, primarily endemic to Central and West Africa, has seen a concerning global rise in recent years. There is a critical need to synthesize evidence on successful strategies that have been used to contain and respond to mpox globally to inform policy and best practices.

Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Four databases were searched for publications between 2017 to August 2024. Articles were included if they reported on mpox response and containment strategies.

Results: A total of 72 studies were included in this systematic review. During mpox outbreaks, screening was primarily conducted at sexual health clinics, including Sexually Transmitted Infections and PrEP (Pre-exposure prophylaxis) clinics. PCR (Polymerase chain reaction) testing was the most commonly reported diagnostic method. Three treatment options were identified: Tecovirimat, Vaccinia Immune Globulin, and Cidofovir. Additionally, vaccines were classified into two main categories: (i) JYNNEOS (also known as MVA-BN and IMVANEX) and (ii) ACAM2000. Studies highlighted several challenges associated with isolation measures, including difficulties in maintaining consistent follow-up, ensuring patient compliance, and managing large-scale isolation logistics. Surveillance strategies emphasized effective data collection, case investigations, and public health coordination to strengthen outbreak response. Pre-emergency preparedness efforts focused on international collaboration, the development of distribution networks, models of care for Mpox treatment, and the analysis of past outbreaks to improve future response strategies.

Conclusion: This review synthesized strategies for mpox outbreak response and containment, highlighting the need to expand vaccine access beyond GBMSM/LGBTQIA + populations, integrate screening into routine sexual health services, adopt alternative delivery and diagnostic approaches, strengthen surveillance and pre-emergency preparedness, and promote context-specific research in low- and middle-income countries to inform evidence-based policy and practice.