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

Nicola Luigi Bragazzi; Woldegebriel Assefa Woldegerima; Sarafa Adewale Iyaniwura; Qing Han; Xiaoying Wang; Aminath Shausan; Kingsley Badu; Patrick Okwen; Cheryl Prescod; Michelle Westin; Andrew Omame; Manlio Converti; Bruce Mellado; Jianhong Wu; Jude Dzevela Kong

doi:10.3389/fmicb.2022.1011049

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

Front Microbiol. 2022 Sep 23:13:1011049. doi: 10.3389/fmicb.2022.1011049. eCollection 2022.

Authors

Nicola Luigi Bragazzi¹, Woldegebriel Assefa Woldegerima¹, Sarafa Adewale Iyaniwura², Qing Han¹, Xiaoying Wang³, Aminath Shausan⁴, Kingsley Badu⁵, Patrick Okwen⁶, Cheryl Prescod⁷, Michelle Westin⁷, Andrew Omame^{8

9}, Manlio Converti¹⁰, Bruce Mellado^{11

12}, Jianhong Wu¹, Jude Dzevela Kong¹

Affiliations

¹ Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada.
² Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, United States.
³ Department of Mathematics, Trent University, Peterborough, ON, Canada.
⁴ School of Mathematics and Physics, University of Queensland, Saint Lucia, QLD, Australia.
⁵ Vector-borne Infectious Disease Group, Theoretical and Applied Biology, 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 Department of Mathematics, Federal University of Technology, Owerri, Nigeria.
⁹ Abdus Salam School of Mathematical Sciences, Government College University, Lahore, Pakistan.
¹⁰ ASL Napoli 2 Nord, Naples, Italy.
¹¹ School of Physics and Institute for Collider Particle Physics, University of the Witwatersrand, Johannesburg, South Africa.
¹² Subatomic Physics, iThemba Laboratory for Accelerator Based Sciences, Somerset West, South Africa.

Abstract

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).

Keywords: emerging and re-emerging infectious disease; monkeypox; under-ascertainment; under-detection; under-diagnosis; underestimation; underreporting; zoonotic disease.

Publication types

Review