Methods for conducting a living evidence profile on mpox: An evidence map of the literature

Abstract

Background: In May of 2022, several cases of mpox were identified in multiple nonendemic countries and on July 23, 2022 the World Health Organization declared mpox a Public Health Emergency of International Concern. During the first six months of the outbreak there was an urgent need to have up-to-date synthesized evidence on mpox to inform public health decision-making. At this point, evidence is changing too quickly for traditional evidence synthesis methods, as systematic reviews were out-of-date before publication. This paper describes the framework developed to manage and maintain a living evidence profile (LEP) to systematically identify, classify and synthesize evidence on a broad range of mpox topics at a rapid pace as the outbreak unfolded.

Methods: The LEP framework was based on principles of evidence synthesis, risk assessment, priority epidemiological parameters for infectious disease modeling and consultation with experts. The framework consisted of a systematic search conducted twice weekly; study selection; categorization into pre-determined foci and data extraction; integration and synthesis of evidence; internal peer-review and dissemination to stakeholders.

Results: Between April 14 and December 15, 2022, 2287 citations were identified, 687 were primary research studies or surveillance reports on the 2022 mpox outbreak and 496 were included in the final LEP. Each study was mapped to one of 32 foci and evidence was narratively synthesized. From June to December 2022, 23 LEPs were produced (approximately weekly) along with a searchable database of extracted data of the mpox literature. They were disseminated globally to public health researchers and decision-makers to inform public health response efforts.

Conclusions: The LEP framework is applicable to other public health emergencies when a rapid synthesis cycle is required because the evidence is evolving quickly. This efficient methodology for creating up-to-date summaries of the current evidence during the first few months of an outbreak or emergency supports public health decision-making and response activities.

Keywords: evidence synthesis; literature surveillance; living evidence; living evidence profile; monkeypox; mpox.

Figure 1

The weekly mpox living evidence profile framework.

Figure 2

Weekly volume of primary and nonprimary mpox literature from May 31 to December 15, 2023.

Figure 3

PRISMA flow diagram of the 2287 citations evaluated during the first 6 months of the outbreak.

Figure 4

Weekly count of the primary mpox literature by study design from May 31 to December 15, 2023.

Figure 5

Weekly number primary studies on mpox by the 32 foci reported in the LEP from May 31 to December 15, 2023.