Epidemiology and clinical manifestation of mpox in children: Systematic review and meta-analysis

To conduct a systematic review and meta-analysis on the observed test positivity rates, risk factors, clinical manifestations and management of Mpox in paediatric populations globally. We searched relevant articles from databases, including PubMed, the Cochrane Library, Scopus, Web of Science and ProQuest, as well as gray literature sources, for studies published between 2023 and 2024. The inclusion criteria encompassed primary studies (including case reports) focused on paediatric mpox, with an emphasis on epidemiology, clinical manifestations and management. Data extraction was performed independently by two reviewers. We calculated pooled positivity rates and identified and reported risk factors and clinical manifestations (PROSPERO id: CRD42024600945). Among the 1414 records from databases and 24 from gray literature, 22 studies met the inclusion criteria. Paediatric mpox cases show considerable variability in PCR positivity rates, ranging from 6.95% in non-endemic regions to 35.6% in endemic areas. The clinical manifestations include progressive skin lesions and fever, with younger children being more susceptible to severe complications. The key risk factors included close household contact, coinfections and socioeconomic factors. Paediatric Mpox poses significant challenges, particularly in endemic regions. The observed frequency of infection and severity of complications emphasise the need for age-specific public health interventions, improved diagnostic capabilities and harmonised clinical guidelines to reduce morbidity and improve clinical outcomes.