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Abstract：
Monkeypox (MPX) is an important human Orthopoxvirus infection. There has been an increase in MPX cases and outbreaks in endemic and non-endemic regions in recent decades. We appraised the availability, scope, quality and inclusivity of clinical management guidelines for MPX globally.
For this systematic review, we searched six databases from inception until 14 October 2021, augmented by a grey literature search until 17 May 2022. MPX guidelines providing treatment and supportive care recommendations were included, with no exclusions for language. Two reviewers assessed the guidelines. Quality was assessed using the Appraisal of Guidelines for Research and Evaluation II tool.
Of 2026 records screened, 14 guidelines were included. Overall, most guidelines were of low-quality with a median score of 2 out of 7 (range: 1-7), lacked detail and covered a narrow range of topics. Most guidelines focused on adults, five (36%) provided some advice for children, three (21%) for pregnant women and three (21%) for people living with HIV. Treatment guidance was mostly limited to advice on antivirals; seven guidelines advised cidofovir (four specified for severe MPX only); 29% (4/14) tecovirimat, and 7% (1/14) brincidofovir. Only one guideline provided recommendations on supportive care and treatment of complications. All guidelines recommended vaccination as post-exposure prophylaxis (PEP). Three guidelines advised on vaccinia immune globulin as PEP for severe cases in people with immunosuppression.
Our results highlight a lack of evidence-based clinical management guidelines for MPX globally. There is a clear and urgent need for research into treatment and prophylaxis including for different risk populations. The current outbreak provides an opportunity to accelerate this research through coordinated high-quality studies. New evidence should be incorporated into globally accessible guidelines, to benefit patient and epidemic outcomes. A \'living guideline\' framework is recommended.
CRD42020167361.
For this systematic review, we searched six databases from inception until 14 October 2021, augmented by a grey literature search until 17 May 2022. MPX guidelines providing treatment and supportive care recommendations were included, with no exclusions for language. Two reviewers assessed the guidelines. Quality was assessed using the Appraisal of Guidelines for Research and Evaluation II tool.
Of 2026 records screened, 14 guidelines were included. Overall, most guidelines were of low-quality with a median score of 2 out of 7 (range: 1-7), lacked detail and covered a narrow range of topics. Most guidelines focused on adults, five (36%) provided some advice for children, three (21%) for pregnant women and three (21%) for people living with HIV. Treatment guidance was mostly limited to advice on antivirals; seven guidelines advised cidofovir (four specified for severe MPX only); 29% (4/14) tecovirimat, and 7% (1/14) brincidofovir. Only one guideline provided recommendations on supportive care and treatment of complications. All guidelines recommended vaccination as post-exposure prophylaxis (PEP). Three guidelines advised on vaccinia immune globulin as PEP for severe cases in people with immunosuppression.
Our results highlight a lack of evidence-based clinical management guidelines for MPX globally. There is a clear and urgent need for research into treatment and prophylaxis including for different risk populations. The current outbreak provides an opportunity to accelerate this research through coordinated high-quality studies. New evidence should be incorporated into globally accessible guidelines, to benefit patient and epidemic outcomes. A \'living guideline\' framework is recommended.
CRD42020167361.
摘要：
猴痘（MPX）是一种重要的人类正痘病毒感染。近几十年来，流行和非流行地区的MPX病例和疫情有所增加。我们评估了可用性，范围,全球MPX临床管理指南的质量和包容性。
对于本系统综述，从开始到2021年10月14日,我们检索了6个数据库,并进行了灰色文献检索,直至2022年5月17日.包括提供治疗和支持性护理建议的MPX指南，不排除语言。两名审核员对准则进行了评估。使用“评估研究和评估指南II”工具评估质量。
在筛选的2026条记录中，包括14条准则。总的来说,大多数指南都是低质量的，中位数为7分2分（范围：1-7），缺乏细节，涵盖的主题范围狭窄。大多数指南都集中在成年人身上，五名(36%)为儿童提供了一些建议，三个（21％）孕妇和三个（21％）艾滋病毒感染者。治疗指导主要限于抗病毒药物的建议;七个指南建议西多福韦（四个指定为严重的MPX）;29％（4/14）tecovirimat，和7%(1/14)的布林多福韦。只有一个指南提供了有关支持性护理和并发症治疗的建议。所有指南都建议接种疫苗作为暴露后预防（PEP）。三个指南建议牛痘免疫球蛋白作为免疫抑制患者重症病例的PEP。
我们的研究结果凸显了全球缺乏基于证据的MPX临床管理指南。对包括不同风险人群在内的治疗和预防研究有明确和紧迫的需要。当前的爆发为通过协调的高质量研究加速这项研究提供了机会。新的证据应纳入全球可访问的指南中，有利于患者和流行病的结果。建议使用“生活指南”框架。
CRD42020167361。
对于本系统综述，从开始到2021年10月14日,我们检索了6个数据库,并进行了灰色文献检索,直至2022年5月17日.包括提供治疗和支持性护理建议的MPX指南，不排除语言。两名审核员对准则进行了评估。使用“评估研究和评估指南II”工具评估质量。
在筛选的2026条记录中，包括14条准则。总的来说,大多数指南都是低质量的，中位数为7分2分（范围：1-7），缺乏细节，涵盖的主题范围狭窄。大多数指南都集中在成年人身上，五名(36%)为儿童提供了一些建议，三个（21％）孕妇和三个（21％）艾滋病毒感染者。治疗指导主要限于抗病毒药物的建议;七个指南建议西多福韦（四个指定为严重的MPX）;29％（4/14）tecovirimat，和7%(1/14)的布林多福韦。只有一个指南提供了有关支持性护理和并发症治疗的建议。所有指南都建议接种疫苗作为暴露后预防（PEP）。三个指南建议牛痘免疫球蛋白作为免疫抑制患者重症病例的PEP。
我们的研究结果凸显了全球缺乏基于证据的MPX临床管理指南。对包括不同风险人群在内的治疗和预防研究有明确和紧迫的需要。当前的爆发为通过协调的高质量研究加速这项研究提供了机会。新的证据应纳入全球可访问的指南中，有利于患者和流行病的结果。建议使用“生活指南”框架。
CRD42020167361。
