Availability, scope and quality of monkeypox clinical management guidelines globally : a systematic review

This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z) and the Bill & Melinda Gates Foundation (OPP1209135). The GloPID-R Secretariat is a project that receives funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 874667. SL is an MRC Clinical Research Training fellow (MR/T001151/1).Background 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. Methods 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. Results 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. Conclusion 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. PROSPERO registration number CRD42020167361.Publisher PDFPeer reviewe

An evaluation of global Chikungunya clinical management guidelines: A systematic review.

Background Chikungunya virus (CHIKV) has expanded its geographical reach in recent decades and is an emerging global health threat. CHIKV can cause significant morbidity and lead to chronic, debilitating arthritis/arthralgia in up to 40% of infected individuals. Prevention, early identification, and clinical management are key for improving outcomes. The aim of this review is to evaluate the quality, availability, inclusivity, and scope of evidence-based clinical management guidelines (CMG) for CHIKV globally. Methods We conducted a systematic review. Six databases were searched from Jan 1, 1989, to 14 Oct 2021 and grey literature until Sept 16, 2021, for CHIKV guidelines providing supportive care and treatment recommendations. Quality was assessed using the appraisal of Guidelines for Research and Evaluation tool. Findings are presented in a narrative synthesis. PROSPERO registration: CRD42020167361. Findings 28 CMGs were included; 54% (15/28) were produced more than 5 years ago, and most were of low-quality (median score 2 out of 7 (range 1–7)). There were variations in the CMGs’ guidance on the management of different at-risk populations, long-term sequelae, and the prevention of disease transmission. While 54% (15/28) of CMGs recommended hospitalisation for severe cases, only 39% (11/28) provided guidance for severe disease management. Further, 46% (13/28) advocated for steroids in the chronic phase, but 18% (5/28) advised against its use. Interpretation There was a lack of high-quality CMGs that provided supportive care and treatment guidance, which may impact patient care and outcomes. It is essential that existing guidelines are updated and adapted to provide detailed evidence-based treatment guidelines for different at-risk populations. This study also highlights a need for more research into the management of the acute and chronic phases of CHIKV infection to inform evidence-based care

A Cross-Sectional Study of Polish Immigrants in London, England and Edinburgh, Scotland

In Europe, one of the largest Polish diasporas is located in the United Kingdom, where it is estimated that over 650,000 Polish-born individuals currently reside. The continued growth of the population of Polish migrants in the United Kingdom highlights the need to keep this area of research up-to-date. Therefore, the research objectives of this studyare to examine the demographic characteristics, plans of return migration, opinion on the introduction of the euro in Poland, and access to health care services of Polish migrants living in United Kingdom. To answer these objectives, a cross-sectional survey of adult Polish immigrants and migrant workers residing in London and Edinburgh was undertaken. Overall, 119 respondents completed the questionnaire (76 from London and43 from Edinburgh). The study sample was mostly female (70%), young (63% under the age of 35 years), in a married or common-law relationship (54%), did not have children (54%) and did not have closest family in the United Kingdom (51%). They were highly educated with 55% having post-secondary degrees, living mostly in London. The respondents came from all sixteen Polish provinces with most originating from Małopolskie, Lubelskie, and Mazowieckie provinces. Over 60% of the sample moved to the United Kingdom post-Poland’s accession to the European Union in 2004, with a quarter coming within the last year. The most quoted reason for moving was employment and over 90% of the sample was working with common employment sectors being retail, food services, and hospitality and tourism. 36% of the respondents were planning to return back to Poland with most planning to do so within the next fouryears, while 33% were unsure about whether they would consider moving back. Among those individuals planning a return, they stated that they would like to make an average of £17,864.71 annually in Poland. Over a third of the sample invested or was planning to invest money in Poland. Regarding the introduction of the euro, 68% was opposed to it although the majority stated that it would not impact their frequency of travels toPoland (79%) or possibility of return (55%). The Polish migrants were highly mobile with 87% traveling to Poland at least once a year, including 32% who traveled three or more times per year. The Polish migrants reported having generally good access to health care (subjectively rated as 6.7 out of 10) with 79% having a family physician, 76% being able to access emergency health services, 70% being able to get a referral toa specialist when needed, and 70% feeling that their pharmaceutical coverage was adequate. Three quarters of the respondents (76%) never or rarely felt discriminated due to their Polish background. Overall, the findings from this study may be beneficial for policy makers and agencies in the United Kingdom and Poland, which are working with Polish immigrants and migrant workers.In Europe, one of the largest Polish diasporas is located in the United Kingdom, where it is estimated that over 650,000 Polish-born individuals currently reside. The continued growth of the population of Polish migrants in the United Kingdom highlights the need to keep this area of research up-to-date. Therefore, the research objectives of this studyare to examine the demographic characteristics, plans of return migration, opinion on the introduction of the euro in Poland, and access to health care services of Polish migrants living in United Kingdom. To answer these objectives, a cross-sectional survey of adult Polish immigrants and migrant workers residing in London and Edinburgh was undertaken. Overall, 119 respondents completed the questionnaire (76 from London and43 from Edinburgh). The study sample was mostly female (70%), young (63% under the age of 35 years), in a married or common-law relationship (54%), did not have children (54%) and did not have closest family in the United Kingdom (51%). They were highly educated with 55% having post-secondary degrees, living mostly in London. The respondents came from all sixteen Polish provinces with most originating from Małopolskie, Lubelskie, and Mazowieckie provinces. Over 60% of the sample moved to the United Kingdom post-Poland’s accession to the European Union in 2004, with a quarter coming within the last year. The most quoted reason for moving was employment and over 90% of the sample was working with common employment sectors being retail, food services, and hospitality and tourism. 36% of the respondents were planning to return back to Poland with most planning to do so within the next fouryears, while 33% were unsure about whether they would consider moving back. Among those individuals planning a return, they stated that they would like to make an average of £17,864.71 annually in Poland. Over a third of the sample invested or was planning to invest money in Poland. Regarding the introduction of the euro, 68% was opposed to it although the majority stated that it would not impact their frequency of travels toPoland (79%) or possibility of return (55%). The Polish migrants were highly mobile with 87% traveling to Poland at least once a year, including 32% who traveled three or more times per year. The Polish migrants reported having generally good access to health care (subjectively rated as 6.7 out of 10) with 79% having a family physician, 76% being able to access emergency health services, 70% being able to get a referral toa specialist when needed, and 70% feeling that their pharmaceutical coverage was adequate. Three quarters of the respondents (76%) never or rarely felt discriminated due to their Polish background. Overall, the findings from this study may be beneficial for policy makers and agencies in the United Kingdom and Poland, which are working with Polish immigrants and migrant workers