Risk assessment of human monkeypox infections: A systematic review and meta-analysis

Human monkeypox is a zoonotic disease with increasing global prevalence. Although several studies have identified its potential risk factors, findings remain inconsistent, highlighting the need for a systematic evaluation. To systematically investigate risk factors associated with human monkeypox infections using meta-analysis. A comprehensive search of PubMed, Scopus, Web of Science, Embase, and The Cochrane Library databases was conducted on all records up to February 19, 2024. Eligible studies assessing risk factors for monkeypox were included. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated, and heterogeneity was evaluated using I2 statistics. Of the 1,844 articles identified, 9 studies met the inclusion criteria after screening, no publication bias was identified, and the meta-analysis results showed strong robustness. Human immunodeficiency virus (HIV) infection significantly increased monkeypox risk (OR = 2.21, 95% CI: 1.13-4.34, p = 0.02, I2 = 93%). Concurrent sexually transmitted infections (STIs) were also a significant risk factor (OR = 1.84, 95% CI: 1.46-2.33), as was body mass index (BMI) higher than 30 kg/m2 (OR = 1.18, 95% CI: 0.19-7.53, p = 0.86), lower economic status (OR = 0.33, 95% CI: 0.01-9.36, p = 0.52), education level (OR = 0.74, 95% CI: 0.30-1.79, p = 0.50), or men who have sex with men (MSM) status (OR = 1.22, 95% CI: 0.84-1.75, p = 0.29). HIV infection and concurrent STIs significantly increase monkeypox risk, underscoring the need for targeted prevention, including screening and risk reduction strategies in vulnerable populations, particularly MSM.