Study shows monkeypox guidelines around the world are unhelpful and lack quality

Researchers are questioning the clinical guidelines around Monkeypox.

As the virus spreads around the world there is increasing reason to practice caution in our every day lives. Health authorities have issued guidelines to explain how to stay safe.

But an international team of researchers, including collaborators in Australia, has found the guidelines often lack detail, fail to include the needs of different risk groups and are sometimes contradictory.

The research, published in the BMJ Global Health, looked at 14 different guidelines from around the world.

The international team scoured six major research databases to assess the quality, scope and inclusivity of available international clinical advice on the treatment and care of patients with the monkeypox infection.

Relevant content was published up to mid-October 2021 or May 2022 in the case of policy documents, newsletters, reports and other so-called “grey literature.”

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Using the Appraisal of Guidelines for Research and Evaluation II (AGREE) system, the researchers assessed the quality of the guidelines. Out of a possible score of seven, the guidelines scored on average two points. Most also lacked detail and were narrowly focused.

There was little consideration of different risk groups in the guidelines. For example, only five (36%) provided any advice for children; and only three (21%) gave information for pregnant women or people living with HIV.

Treatment recommendations was largely limited to antivirals and was inconsistent. Seven of the guidelines advised cidofovir, four of which specified this only for severe infection. Only four (29%) advised the use of the antiviral medication tecovirimat, and one (7%) brincidofovir. More recently, the WHO and other authorities’ guidelines have advised the use of tecovirimat rather than cidofovir.

None of the guidelines detailed optimal dose, timing or length of treatment. Only one provided recommendations on supportive care and any possible treatment of complications.

Many of the guidelines were not up to date on newer generation vaccines available for pox viruses.

While acknowledging that our scientific understanding of monkeypox – and this outbreak in particular – is evolving, the authors write: “Even with a limited evidence base, clinical management guidelines are important tools for guiding decision-making and to reduce risk of inappropriate treatments.

They conclude: “…our study highlights a need for a rigorous framework for producing guidelines ahead of epidemics and a recognised platform for rapidly reviewing and updating guidance during outbreaks, as new evidence emerges. 

“Human [moneypox] is providing a challenge even in high-resource settings with well-resourced healthcare systems. The lack of guidelines may especially impact clinics with limited previous experience in managing patients with [monkeypox]. 

“Given the recent global publicity surrounding monkeypox, this is an opportune moment to harness interest and investment in further research to make sure that everyone is given the best treatment.”

Read more: Monkeypox: World Health Organization declares it a global health emergency – here’s what that means

According to the World Health Organization (WHO), cases have increased by more than 20% over the last week. There are 35,000 recorded cases of monkeypox across 92 countries. Historically, the smallpox-related virus has never been seen outside Africa.

There remain many unanswered questions about the current outbreak. It is still unclear what is driving the global surge in cases or how fatal the virus is. But, even with limited knowledge, clinical guidelines provide important standards for patient care and for enabling further research.

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