medical malpractice research papers

Medical Malpractice: An Empirical Examination of the Litigation Process

New data on medical malpractice claims against a single hospital where a direct measure of the quality of medical care is available are used to address 1) the specific question of the role of the negligence rule in the dispute settlement process in medical malpractice, and 2) the general question of how the process of negotiation and dispute resolution in medical malpractice operates with regard to both the behavior of the parties and the outcome of the process. We find that the quality of medical care is an extremely important determinant of deferdants' medical malpractice liability. More generally, we find that the data are consistent with a model where 1) the plaintiff is not well informed ex ante about the likelinood of negligence and 2) the ex ante expected value to the plaintiff of a suit is high relative to the costs of filing a suit and getting more information. Thus, suits are filed even where there is no concrete reason to believe there has been negligence, and virtually all suits are either dropped or settled based on the information gained after filing. We conclude that the filing of suits that appear, ex post, to be nuisance suits can be rational eguilibrium behavior, ex ante, where there is incomplete information about care quality.

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MARC RIS BibTeΧ

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Rand Journal of Economics , Vol. 22, Summer 1991, pp. 199-217.

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Medical Malpractice and Black-Box Medicine

I. Glenn Cohen et al., eds., Big Data, Health Law, and Bioethics (Cambridge University Press, 2018)

U of Michigan Public Law Research Paper No. 536

12 Pages Posted: 4 Feb 2017 Last revised: 30 Jul 2018

W. Nicholson Price II

University of Michigan Law School

Date Written: February 2, 2017

The explosive proliferation of health data has combined with the rapid development of machine-learning algorithms to enable a new form of medicine: black-box medicine. In this phenomenon, algorithms troll through tremendous databases of health data to find patterns that can be used to guide care, whether by predicting unknown patient risks, selecting the right drug, suggesting a new use of an old drug, or triaging patients to preserve health resources. These decisions differ in kind from previous data-based decisions because black-box medicine is, by its nature, opaque; that is, the bases for black-box decisions are unknown and unknowable. Black-box medicine raises a number of legal questions, ranging from how to shape incentives for its development to how to regulate its growth and quality. One key question is how black-box medicine will influence the medical malpractice liability of health-care providers. How should tort liability apply to providers who cannot know the mechanistic underpinnings of the treatment they recommend? Must they learn as much as they can about the way algorithms are developed and verified? Or can they rely on the assurances of the developer without more knowledge? And how can they obtain the informed consent of patients? This chapter explores the medical malpractice implications of black-box medicine. It briefly introduces the phenomenon and then considers how the tort system does, can, and should regulate the behavior of providers and health-care facilities using black-box medical techniques. It concludes that while providers and facilities are ill-suited to evaluate the substantive accuracy of black-box medical algorithms, they can and should be required to exercise due care to evaluate procedural quality — the expertise of the developer and the availability of independent external validation — when implementing black-box algorithms in a health-care facility or using them to care for patients.

Keywords: black-box medicine, precision medicine, medical malpractice, medical algorithms

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William Nicholson Price II (Contact Author)

University of michigan law school ( email ).

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Medical malpractice: treating the causes instead of the symptoms

2000, Medical care

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Medical Malpractice Lawsuit

When a patient is injured as a result of negligent care by a medical doctor, health care professional, or hospital, the circumstance is commonly referred to as “medical malpractice.” In medical malpractice cases, injuries can vary from minor to life-altering, and, if severe enough, can result in death.

Call (800) 995-1212 now for a free case review to see if you may be eligible for compensation from a medical malpractice lawsuit.

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Medical Malpractice Is Common

Medical malpractice occurs far too often. A recent report from Johns Hopkins Medicine estimates as many as 250,000 Americans die each year from preventable medical mistakes , making it the fourth-leading cause of death in the United States.

If you believe that you are a victim of medical malpractice, you may be able to file a medical malpractice lawsuit as a way to secure financial compensation for pain and suffering, medical expenses, life care costs, and lost work wages.

Sokolove Law is a personal injury law firm with experience across a broad range of practice areas, including medical malpractice. Submit the form to the right or request a free case review and we’ll let you know if we can represent you.

What Is a Medical Malpractice Lawsuit?

A medical malpractice lawsuit is typically filed shortly after a medical professional’s care resulted in a patient’s injury. These lawsuits will vary based on the type and severity of the injury, but all medical malpractice suits aim to provide injured patients with significant financial compensation.

In medical malpractice lawsuits, a medical provider or facility may have:

• Failed to provide an acceptable standard of care
• Acted with negligence, either through an omission or a direct negligent act
• Caused significant injury to the patient

In order for a patient to secure financial compensation for an injury caused by medical negligence, their legal team must prove that the injury was the result of medical malpractice, meeting the criteria noted above.

Our Past Medical Malpractice Settlements

According to the U.S. Department of Justice (DOJ), 93% of all medical malpractice cases are settled out-of-court . Settlements are often the preferred route, because they can save both the plaintiffs and the defendants time, resources, and money.

When a settlement is reached in a medical malpractice case, the injured victim and their legal team receive an agreed-upon amount of compensation from the offending doctor, medical professional, health care provider, and/or hospital.

A few of our many settlements for medical malpractice include:

• $9.67 Million for a child who suffered injuries during a delayed delivery
• $3.9 Million for a patient who received a delayed diagnosis for a herniated disc
• $3.25 Million for a patient who suffered a delayed lung cancer diagnosis
• $2.9 Million for a patient whose misdiagnosis caused his cancer to worsen
• $2.5 Million for a victim of medical malpractice in Boston
• $2.43 Million for a failure to diagnosis case
• $2.25 Million for a case involving an incorrect diagnosis
• $2 Million for a woman whose daughter passed away due to medical malpractice
• $1.75 Million for a woman whose doctors failed to diagnose her ovarian cancer
• $1.5 Million for a man in whose his lung cancer was missed in X-rays until it spread to stage 4

While there's never a guarantee of compensation in any case, we'll fight hard to get you everything you're entitled to.

Call (800) 995-1212 now to get started for free. Let us put our decades of experience to work for you.

Types of Medical Malpractice

There are several different types of medical malpractice, but the common denominator is that negligent medical care results in a significant injury to a patient. Through no fault of their own, medical malpractice victims are forced to experience dramatic physical and emotional challenges, potentially for the rest of their lives.

It’s worth noting that the type of medical malpractice and the severity of the injury can have drastic impacts on the victim’s claim to compensation. Below, we outline some of the more common types of medical malpractice, though this list is not exhaustive.

If you don't see a certain type of injury below that relates to your circumstance, let us know — we offer free, no-obligation legal consultations and may be able to help.

Birth and Pregnancy Injuries Malpractice

Birth injuries and pregnancy injuries are some of the more common types of medical malpractice. These injuries are caused by medical negligence and take place before, during, or shortly after the birth of a newborn, often resulting in significant injury to the child.

In a birth injury medical malpractice case, the baby’s brain and/or body is injured, resulting in injuries that can last a lifetime. As devastating as it is, around 7 of every 1,000 newborns will be injured at birth.

Some of the more common birth injuries include:

• Cerebral palsy
• Erb’s palsy
• Infant brain damage
• Injuries to the brachial plexus nerves

Other serious birth injuries can result in bleeding and/or lack of oxygen in the brain, facial nerve damage, and/or skull fracturing.

Failure to Diagnose Malpractice Lawsuits

Failure to diagnose conditions and failure to diagnose cancer are two of the more common types of medical malpractice lawsuits. When a doctor or medical practitioner fails to diagnose a serious medical condition, illness, or disease, it can prove catastrophic for the patient.

A doctor may fail to diagnose:

• Heart attack
• Pulmonary embolism

If a doctor fails to diagnose cancer, tumors may progress and spread undetected, and the patient may then miss their window of opportunity for life-extending therapies or surgeries.

During a surgical operation, a surgeon may make preventable mistakes that result in patient injury. Known as surgical errors , this type of medical malpractice is shockingly common.

Preventable surgical errors include:

• Wrong-site surgery (when surgery is done on the wrong part or side of the body, like removing the left lung when cancer was in the right lung instead)
• Wrong-patient surgery
• Damage to internal organs
• Surgical tools left inside of the body
• Improper management of post-operative complications
• Botched plastic surgery

According to the U.S. Department of Health and Human Services (HHS), 1 in every 112,000 surgeries will result in an error — a figure that does not include ER and ambulance operations, which produce more surgical errors.

Other Medical Malpractice Cases

While failure-to-diagnose, surgical, and birth-related medical malpractice are more common, there are many other types of medical malpractice as well, each of which can be equally catastrophic.

Some other medical malpractice cases include:

• Delayed diagnosis : A doctor diagnoses a disease or condition later than they otherwise should have
• Emergency room errors : An ER doctor makes a medical error in an emergency-room setting that results in significant injury to the patient
• Failure to treat: A doctor makes an accurate diagnosis, but does not prescribe adequate medical treatment
• Misdiagnosis: A doctor makes an incorrect diagnosis, resulting in improper treatment
• Prescription drug errors: A doctor prescribes the wrong medication or the right medication but in too high or too low a dosage

If you do not see the medical malpractice situation that injured you or your loved one, we can still determine if you have a case. Contact us today for a free consultation .

How to Prove Medical Malpractice

With over 45 years of experience handling medical malpractice cases, Sokolove Law has helped thousands of clients prove their stories and receive medical compensation.

In medical malpractice lawsuits against a doctor, hospital, or health care worker, our legal team generally works to prove the following:

• The doctor’s legal duty to provide standard of care to the patient
• The doctor’s breach of their legal duty to provide standard of care by failing to meet the standards of the medical profession
• The doctor’s breach of duty caused the patient’s injury
• The injury and its resulting damages can be addressed through the legal system

The term “standard of care” or “duty of care” refers to the type of care and treatment patients should normally expect from a medical professional. A doctor may violate the standard of care when they make a decision or an omission that a standard doctor would have most likely avoided.

By filling out a free legal case review , we can help you determine if you have a legal case for medical malpractice.

How Does a Medical Malpractice Lawsuit Work?

A medical malpractice lawsuit can be filed shortly after a patient is injured by a doctor or medical professional who fails to provide standard medical care. An injured patient can then file a medical malpractice lawsuit with the help of a medical malpractice law firm.

Lawsuits will then undergo the following phases:

• Discovery: During the discovery phase, both the injured party (plaintiff) and the defendants will request and gather information and evidence related to the case
• Expert Witnesses: During this phase, neutral expert medical witnesses may be called to testify on the merits of a medical malpractice claim; these experts can help both parties determine the standard of medical care and whether that standard of care was breached
• Settlement: Not all medical malpractice lawsuits end in a verdict or settlement, but the majority do; if the evidence presented during discovery and expert testimony is sufficient to prove a breach of medical care, then defendants will often work to cut their losses and settle the case out-of-court, and the defendant and plaintiff attorneys then negotiate a sum to be paid to the victim for their injury or injuries

While most medical malpractice lawsuits are settled before they go to court, some cases do reach trial. When this happens, a judge and jury will listen to the case and render a verdict based on the information presented.

Average Settlement for Medical Malpractice Lawsuits

Settlement amounts will vary in every circumstance and are based on the severity of the injury, the victim’s ability to work and earn wages, the cost of future or ongoing medical procedures, the extent of the medical professional’s negligence, and a host of other factors.

In a report published by Medscape, the average settlement amount for a medical malpractice lawsuit is around $425,000 . This figure reflects the national average, and it’s important to note that settlement amounts will vary based on the individual factors of your case, including the state you live in.

Surprisingly, many states actually have medical malpractice damage caps that limit the amount of compensation a plaintiff can receive from economic damages (which can be calculated from measurable losses, like medical expenses or lost wages) and/or non-economic damages (for losses you can’t put a price tag on, like pain and suffering).

For instance, Massachusetts has a non-economic damage cap of $500,000 but no cap on economic damages, while some states have no cap on medical malpractice cases, like both Rhode Island and New Hampshire .

What Is the Statute of Limitations on Medical Malpractice?

When a doctor, medical professional, or hospital commits a mistake that results in an injury to a patient, the injured patient has only a limited amount of time to file a medical malpractice lawsuit. The specific amount of time that a victim has to file a suit is called the statute of limitations.

Statutes of limitations vary by state and type of case, but very rarely do they exceed a period of 2-7 years.

A victim’s lawsuit must fall within statutes of limitations. Once this limit has passed, they can no longer file a claim. Don’t let the time limit pass — reach out to us today for a free case evaluation .

Sokolove Law and Medical Malpractice Cases

Medical malpractice occurs far too often. Unsuspecting patients have their lives completely upended when they are injured as a result of a medical expert’s negligence. Injured patients leave the hospital feeling confused and upset, searching for answers.

Sokolove Law has been fighting side-by-side with victims like these for more than 45 years. While the roots of our practice may be in Boston, Massachusetts and later New Hampshire and Rhode Island, Sokolove Law is a national law firm serving clients in all 50 states .

We believe every person — no matter their background — should have the right to pursue justice through the legal system. Our attorneys only get paid if your case results in compensation , so there are no financial barriers to taking action.

If you or someone you love has been injured due to medical malpractice, we want to help. Beginning the legal process with Sokolove Law is the first step in advocating for you or your loved one’s rights and getting the justice you deserve.

Medical Malpractice Lawsuit FAQs

What are some examples of medical malpractice or negligence.

Medical malpractice (or negligence) takes many different forms but almost always involves harm done to a patient on behalf of a doctor or medical professional. Some examples of medical malpractice include misdiagnosis, surgery on the wrong area of the body, improperly prescribing drugs, and failure to treat a certain condition properly.

An example of medical malpractice may be a doctor who misdiagnoses a patient with pneumonia when, in fact, the patient has lung cancer. As a result of the misdiagnosis, the patient’s cancer treatment is delayed and they lose precious time that could have been spent combating the disease.

What should you do if you suspect medical malpractice?

If you suspect medical malpractice, your first move should be protecting your health and getting the proper care that you need.

After contacting another doctor, you should retrieve your medical records from the facility where you believe the malpractice occurred. If you suspect malpractice, be sure to monitor your health closely by taking daily notes or writing in a journal any symptoms you experience.

Finally, reach out to a medical malpractice law firm . An experienced and qualified personal injury attorney can help you figure out your next step forward.

How many years do you have to sue for medical malpractice?

The amount of time that a victim has to file a lawsuit is determined by a given state’s statute of limitations. These laws differ from state to state and are determined by the type of case a victim files, such as a personal injury claim versus a wrongful death claim.

Statutes of limitations typically range between 2-7 years, though 2-3 years is much more common. Once the statute of limitations passes, a victim can no longer file a lawsuit. If you suspect medical malpractice in your case, reach out to us today for a free case evaluation .

In a medical malpractice lawsuit, are you suing the doctor or the hospital?

In figuring out who to sue in a medical malpractice lawsuit, the determining factor is often the doctor’s employment status. In most cases, doctors operate as independent contractors, which can help medical facilities, such as hospitals, avoid legal trouble from medical malpractice.

In some cases, however, doctors are full-time employees of a hospital. In these circumstances, a victim may sue the hospital for their injury.

How long do medical malpractice claims take?

How long a medical malpractice case takes to settle or go to trial is largely determined by the complexity of the injury and the strength of the evidence presented during the discovery phase. Cases that are especially complex can take several years to reach a resolution.

By contrast, cases that are relatively straightforward — such as when a doctor mistakenly operates on the wrong area of a patient’s body — can take much less time to reach a resolution.

How much does it cost to sue for medical malpractice?

The act of hiring a medical malpractice attorney rarely costs anything upfront, and that’s because most lawyers practicing in this area work on a contingency-fee-basis. When an attorney is hired on a contingency-fee-basis, it means the victim pays nothing unless your case successfully reaches a settlement or verdict.

Only at the conclusion of a successful medical malpractice lawsuit will the victim’s legal team accept a portion of the compensation. If the lawsuit is unsuccessful, the medical malpractice lawyer does not collect any legal fees.

Managing Attorney, Sokolove Law

• Legal Editor
• Fact-Checked

Ricky A. LeBlanc is the Managing Attorney at Sokolove Law. As Managing Attorney, Ricky is responsible for all communications with prospective clients and, along with his team of paralegals and case managers, review all potential cases.

• Bal, B. Sonny. “An Introduction to Medical Malpractice in the United States.” Clinical Orthopaedics and Related Research. 2008 Nov 26. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628513/ . Accessed on November 5, 2023.
• Expert Institute. “Medical Malpractice Payout Reports for 2018.” Retrieved from https://www.expertinstitute.com/resources/insights/medical-malpractice-payout-report-for-2018/ . Accessed on November 5, 2023.
• Expert Institute. “The Current State of State Damage Caps.” Retrieved from https://www.expertinstitute.com/resources/insights/state-state-damage-caps/ . Accessed on November 5, 2023.
• Johns Hopkins Medicine. “Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S.” 2016 May 15. Retrieved from https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us . Accessed on November 5, 2023.
• LeverageRx. “2019 Medical Malpractice Payout Report.” Retrieved from https://www.leveragerx.com/malpractice-insurance/2019-medical-malpractice-report/ . Accessed on November 5, 2023.
• Medscape. “Malpractice: When to Settle a Suit and When to Fight.” Retrieved from https://www.medscape.com/viewarticle/811323_3 . Accessed on November 5, 2023.
• Medscape. “Should You Settle or Go to Trial?” Retrieved from https://www.medscape.com/courses/section/880448 . Accessed on November 5, 2023.
• U.S. Department of Health and Human Services. “Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery.” Retrieved from https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery . Accessed on November 5, 2023.
• U.S. Department of Justice. “Medical Malpractice Insurance Claims in Seven States.” Retrieved from https://www.bjs.gov/content/pub/pdf/mmicss04.pdf . Accessed on November 5, 2023.

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The Emergence of Mpox: Epidemiology and Current Therapeutic Options

Samriddhi ranjan.

1 College of Public Health, George Mason University, 4400 University Drive Fairfax, Fairfax, VA 22030 USA

Kanupriya Vashishth

2 Advance Cardiac Centre Department of Cardiology, PGIMER, Chandigarh, 160012 India

3 NGO Praeventio, Tartu, Estonia

Hardeep Singh Tuli

4 Department of Biotechnology, Maharishi Markandeshwar Engineering College, Maharishi Markandeshwar (Deemed to Be University), Mullana-Ambala, Haryana, 133207 India

Associated Data

This document includes citations for all the data that were analysed throughout the literature review.

The world recently witnessed the emergence of new epidemic outbreaks like COVID-19 and mpox. The 2022 outbreak of mpox amid COVID-19 presents an intricate situation and requires strategies to combat the status quo. Some of the challenges to controlling an epidemic include present knowledge of the disease, available treatment options, appropriate health infrastructures facilities, current scientific methods, operations concepts, availability of technical staff, financial funds, and lastly international policies to control an epidemic state. These insufficiencies often hinder the control of disease spread and jeopardize the health of countless people. Also, disease outbreaks often put a huge burden on the developing economies. These countries are the worst affected and are immensely dependent on assistance provided from the larger economies to control such outbreaks. The first case of mpox was reported in the 1970s and several outbreaks were detected thereafter in the endemic areas eventually leading to the recent outbreak. Approximately, more than 80,000 individuals were infected, and 110 countries were affected by this outbreak. Yet, no definite vaccines and drugs are available to date. The lack of human clinical trials affected thousands of individuals in availing definite disease management. This paper focuses on the epidemiology of mpox, scientific concepts, and treatment options including future treatment modalities for mpox.

Introduction

Amidst the COVID-19 pandemic, another public health concern emerged as a potential threat to afflict people globally, i.e. an abrupt increase in the incidence of mpox (monkeypox) cases. Indeed, starting from mid-May 2022, cases of human mpox have significantly risen in several non-endemic countries worldwide, leading to the declaration of the ongoing outbreak of mpox as a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) in July 2022 [ 1 , 2 ]. Mpox disease is caused by the mpox virus (MPXV), a double-stranded DNA virus from the Orthopoxvirus genus, belonging to the Poxviridae family [ 2 , 3 ]. The same genus includes the variola virus, a known causative agent of smallpox [ 2 ]. Genetically, MPXV is identified with two types of clads. Clad I, also known as Congo Basin clad, is mostly clustered in the Central-South Cameroon region till DRC. Infections from this clad are more severe with case fatality rates (CRF) > 10%. Clad II also referred to as West African clad, commonly distributed in western Cameroon to the Sierra Leon area, is further divided into sub-clad groups as IIa and IIb (also now referred to as clad III) having a CRF < 1% [ 4 , 5 ]. Overall reported human case fatality rates (CFRs) range between 3.6 and 10.6% in the endemic regions [ 2 ]. In the current 2022 outbreak, clad IIb was predominant [ 6 , 7 ]. To date, the exact animal reservoir for the mpox virus (MPXV) has remained unknown. However, few native African rodents (Gambian giant rats) and squirrels are suspected to be natural reservoirs of the virus. Common species which were frequently infected with MPXV are squirrels, Gambian giant rats, strip mice, dormice, and primates [ 8 ].

Emergence of Mpox

The first outbreak of mpox was reported in 1958 in a group of 10 captive monkeys at the Statens Seruminstitut, Copehengan, Denmark, and Centre d’Enseignement et de Recherches de Medecine aeronautique, Paris. No human infection was reported in individuals who were in close contact with infected monkeys. Subsequently, the mpox outbreak occurred for the first time in humans between 1970 to 1971 [ 9 ]. The first case was reported in a 9-month-old boy residing in a remote village of the Democratic Republic of Congo (DRC), admitted to a local hospital suspected of smallpox infection. Samples from infected individuals were sent to the WHO Smallpox Reference Center, Moscow, revealing mpox infections in virus isolates [ 10 ]. When inspected from family, monkeys were part of the diet, and their skins were also processed in this area. However, no other cases including secondary infections were reported in the community. Nonetheless, seven more cases were reported during this time period [ 9 ]. The World Health Organization in 1967 took the initiative to collaborate with laboratories to conduct cooperative studies. This was to conduct serological surveys, identify mpox outbreaks, and determine the natural foci of the virus. However, these surveys failed to state any major findings and concluded mpox is not a widespread disease and can exist only in the local environment [ 9 ]. Ever since, there has been a subsequent upsurge of mpox cases, mostly recorded in the DRC province. Approximately, 80% of the cases were reported in this region from the years 1970–1997 [ 11 ]. For the past five decades, DRC is the most affected country with mpox; no other country had reported an mpox outbreak to such an extent [ 12 ].

The initial mpox outbreak that was reported in DRC mostly affected children below 10 years of age. A slight male predominance was observed in the systemic review conducted by Beer and Rao [ 11 ]. Most of the initial outbreaks occurred among individuals living in small rural areas or residing close to humid evergreen tropical forests or individuals commonly involved with bushmeat hunting [ 11 ]. Geographically, the spread of infection from 1970 to 2003 concentrated in the Central and Western parts of Africa (Table 1). Countries which frequently reported infections were Cameroon, the Central African Republic, Gabon, Sierra Leone, Liberia, Nigeria, and Cote d’Ivoire, yet greater outbreaks were mostly detected in DRC [ 13 ]. An active surveillance programme was carried out by WHO between the years 1981 to 1986 reporting total confirmed cases of 338 and 33 deaths, an almost 20 times rise in the reported case after the surveillance [ 10 , 11 ]. A slight drop in the incidence of disease was observed between the period of 1993–1995. But soon after, DRC witnessed a major outbreak from 1996–1997 [ 13 ]. A total of 511 cases were recorded with a surge in secondary transmission rates of up to 78% and a fatality rate between 1 and 5% [ 10 , 13 ].

In 2003, the mpox outbreak occurred for the first time in the USA, outside the African continent. The index case was a 3-year-old girl, bitten by an infected prairie dog, imported from Ghana along with other African rodents to the USA [ 14 ]. A total of 71 cases were reported, including both suspected and laboratory-confirmed cases, as per the CDC report [ 15 ]. During the period of 2005, mpox was registered for the first time in the dry savannah region of Sudan. Overall, 40 cases both suspected and confirmed were recorded. In this outbreak, a change in the genomic structure of MPXV was observed as compared to the MPXV traditionally reported in DRC suggesting the adaptability of MPVX in dry regions from humid evergreen tropical forests [ 10 ]. In the year 2018, mpox travelled for the first time to the UK and was reported in the European continent. Only two cases were registered, in individuals, which had a travel history to Nigeria [ 16 ]. Nevertheless, with the advent of 2022, the world saw a major outbreak of mpox (Table ​ (Table1 1 ).

Decade-wise spread of mpox across different countries between 1970 and 2020 9,10

Mpox Outbreak 2022

Mpox is endemic in Central and West Africa, where hundreds of cases were detected annually for many years, acquired mostly from wild animals and most rarely from infected humans [ 1 , 3 ], which results in a sporadic spillover of cases in humans as observed in the MPVX endemic regions [ 5 ]. However, in the 2022 outbreak of mpox, most of the cases were reported in non-endemic countries like N. America, S. America, and Europe (Fig.  1 ) [ 17 ]. Although the origin of the 2022 outbreak is still unknown, it is highly likely that the initial infection has been imported from an endemic country, allowing the circulation of the virus through close physical contacts among humans [ 1 , 18 ]. For the first time, mpox was documented with transmission chains in countries which had no immediate contact with Central or Western Africa [ 19 , 20 ]. This suggests a probability of undetected MPXV circulating in the local population in the outbreak-hit regions causing disease transmission in humans [ 17 ]. Being a DNA virus, mpox is more stable in nature and may have possibly evolved as a potent virus causing infections in humans in the due course of time [ 17 ]. Daniel et al. reported 6–12 times higher mutation rates in mpox as previously estimated [ 6 ]. Human to human transmissibility of mpox has also evolved in these decades [ 21 , 22 ]. Vertical infection of mpox has been also reported. Pregnant mothers infected with mpox had miscarriages during the first trimester of pregnancy [ 6 ]. Perinatally acquired mpox infection was registered in a 9-day year old neonate as well [ 23 ]. Transmissibility of infection within the family especially from parents to children have also been stated to increase [ 20 , 22 ]. The degree of transmissibility of the diseases, popularly known as R 0 , reported in the 1980 for mpox was 0.83. However, in the 2022 outbreak, the R 0 reported was 1.1–2.4 [ 21 , 24 ]. Pan et al. suggested the increase in the R 0 is due to decreased immunity of individuals due to the absence of smallpox immunization and high contact rates of infection in the MSM community [ 6 ].

Countries reporting mpox historically vs countries reporting an mpox outbreak as recorded in an early March 2023 report by CDC 19

As per the WHO, till 17 March 2023, the total confirmed cases for mpox were 86,601, with 1265 probable cases reported with 112 deaths. Globally, 110 countries were affected by mpox so far (Fig.  2 ) [ 20 ]. Approximately 34.7% of cases were reported in America, the worst affected country [ 20 ]. Majority of the infection occurred through household contacts (43%) and by sexual encounters (43%) [ 20 , 22 ]. Commonly affected individuals were young males who were not vaccinated against smallpox and have had sex with men. There was a slight male predisposition, with the median age reported as 34 years (IQR: 29–41). Around, 98% of individuals who were infected were either gay or bisexual, among which 41% of the people were HIV infected [ 4 ].

Mpox number of cases and deaths recorded in early March 2023 across the continent as per the report by CDC 19

On 23 July 2022, mpox was declared a public health emergency by the Public Health Emergency of International Concern (PHEIC), depicting a risk of international spread, along with significant international coordination to control the disease [ 25 ].

Clinical presentation of this disease includes three distinct phases, i.e. incubation, prodrome, and rash [ 2 ]. The incubation period can last for 3 to 20 days with the median being 7 days followed by the prodrome phase that is characterized by lethargy, myalgia, headache, fever, and lymphadenopathy which may last up to 5 days (Fig.  3 ) [ 2 , 4 , 18 ]. Lymphadenopathy is one of the critical features of the progression of the disease and often reported before the development of skin lesions [ 18 ]. Fever is usually followed by multiple papular, ulcerative, and vesiculopustular skin lesions [ 4 ], which progress from macules to papules, vesicles, pustules, crusts, and lastly scab, presenting for up to 4 weeks [ 2 , 18 ]. In 95% of the cases, skin lesions appears [ 4 ]. Common anatomical sites for skin lesions were anogenital with approximately 73% of cases followed by trunk, arms or legs, face, and eventually palms and soles, only accounting for 10% of the cases. Lesions developed contain infectious virus particles, through which the infection can be transmitted directly with human contacts [ 2 ]. Secondary complications include pneumonia, encephalitis, keratitis, gastroenteritis, sepsis, and secondary bacterial infections, affecting mostly patients with a previous diagnosis of HIV infection [ 2 , 4 , 5 ].

Common features reported in mpox infection 4

Current Treatment Modalities and Prevention

The strategy for the prevention and treatment of mpox is very similar to the treatment of Orthomyxovirus infection [ 26 ]. The 2022 outbreak revealed the urgency to control the spread of mpox as it has caused a potential threat in many countries [ 27 ]. Presently, there is no definitive cure for mpox infection, mild symptoms are manageable, and further complications can be avoided in patients with mpox with the help of supportive care [ 28 , 29 ]. Studies have depicted that patients with mild symptoms recover without any treatment [ 30 – 32 ]. Treatment options available for smallpox are also effective in the treatment of mpox, as the clinical presentation of mpox and smallpox is very similar. These include the vaccinia vaccine, vaccinia immune globulin (IVG), and antiviral agents such as cidofovir, tecovirimat, and brincidofovir [ 32 ]. Furthermore, CDC recommends the use of the potential treatment options should be done depending upon the severity of the cases and for serious emergency cases, as the current drugs pose severe adverse effects, and their therapeutic efficacy is still uncertain [ 33 ]. Antiviral drugs are a choice of treatment in immunocompromised patients, in patients with complicated lesions, in pregnant women infected with mpox, in breast-feeding women, and in the paediatric population [ 34 ]. Tecovirimat is the first line of action antiviral recommended for the treatment of smallpox; it works by inhibiting the viral envelope protein, thereby blocking the final steps of virus maturation and release from infected cells, inhibiting the spread. As per the CDC guidelines, emergency access use of tecovirimat is allowed for compassionate use, for the treatment of Orthopoxvirus infections, such as mpox [ 35 , 36 ]. Cidofovir and its oral analogue brincidofovir are commonly approved drugs for the treatment of smallpox; both act by inhibiting viral DNA polymerase. Different studies have evaluated the effect of brincidofovir against Orthopoxvirus infections [ 37 ]. Studies done by Lanier et al. and others on the effect of cidofovir and brincidofovir have been evaluated for mpox with some success [ 34 , 37 ]. As per the recommended guidelines by CDC, preexposure smallpox vaccination has been advised for veterinarians, monkeypox contacts, healthcare workers caring for mpox patients, researchers, and field investigators [ 38 ]. Prior immunization with the smallpox vaccine has demonstrated some proven protective effects against mpox due to the cross-protective immunity provided by the smallpox vaccine. Furthermore, the severity of clinical manifestations is also reduced [ 39 ]. Currently, three available smallpox vaccines with the US national stockpile, i.e. JYNNEOSTM, ACAM2000, have been licenced (2007) for smallpox, the most recent being Aventis Pasteur Smallpox Vaccine (APSV) which could be potentially used for mpox on a case-to-case basis, under an investigational new drug (IND) protocol. JYNNEOSTM, a third-generation and live viral vaccine, is produced from the modified vaccinia Ankara-Bavarian Nordic [ 40 – 42 ]. Licenced in 2019, JYNNEOSTM is an attenuated non-replicating orthopoxvirus. It is now indicated for both smallpox and mpox prevention for adults. Further, ACAM2000, a second-generation vaccine constituted of live vaccinia virus, under the emergency access ACAM2000 is allowed for mpox during the outbreak. Researchers have demonstrated that these vaccines can be used as pre- and post-treatment options, i.e. either in preventing the infection and the disease or in ameliorating the infection and disease [ 34 , 43 , 44 ]. Studies have demonstrated that pregnant women, children less than 8 years of age, and immunocompromised patients should be given antiviral treatment than vaccination. These vaccines, although approved, have shown some local and systematic side effects such as fever, muscle pain, vaccinia, abdominal and back pain, fatigue, headache, lymphadenopathy, etc. [ 42 – 44 ]. Researchers have also highlighted the need for maintaining appropriate social barriers such as avoiding close contact with affected individuals, avoiding contact with skin lesions of individuals infected with MPXV, etc. [ 44 – 46 ]. Vaccinia immune globulin intravenous (VIGIV) is a choice of treatment in case of severe infection with mpox, though there is a paucity of data about its effectiveness in treating mpox. VIGIV is also under SNS and can be administered under investigational new drugs held by CDC [ 29 , 30 , 47 – 49 ]. Therefore, the treatment options and the repurposing of vaccines need to be considered on a case-to-case basis depending on the severity of cases and the immune state of patients [ 50 ] (Fig. ​ (Fig.4 4 ).

A Symptoms and B mechanism of action of mpox antiviral therapy: cidofovir, brincidofovir, vaccinia immune globulin, and tecovirimat [ 50 ] 

Key Fundamental Findings of the Narrative Review

Some major key findings related to mpox are as follows: mpox was solely endemic to the region of DRC [ 11 ]. There has been a slow and steady increase in mpox cases which has adapted itself to develop into the current outbreak. Secondly, the 1996–1997 DRC outbreak highlighted the increase in secondary transmission rates of mpox, potentially getting adapted to spread in the human population [ 13 ]. Thirdly, the MPXV had adapted to thrive itself from the humid evergreen regions to the dry savannah region of Sudan, as observed in the 2005 outbreak, thus further demonstrating its environmental adaptability to flourish [ 10 ]. Lastly, international travel and commerce have given a wider chance for the disease to spread as reported in the 2003 and 2018 outbreaks of mpox in the USA and the UK [ 14 , 16 ]. All these above factors have led to the 2022 outbreak of mpox, affecting every continent across the globe (Fig.  5 ).

Global spread of mpox in 2023 outbreak 19

Most of the consistent outbreak guidelines available from WHO or CDC only account for people with a high risk of exposure; these guidelines are based on the best available evidence which is based upon risk–benefit analysis and other factors [ 51 ]. Available drugs for the treatment of choice are also limited and lack evidence-based studies in humans [ 29 , 30 , 48 ]. This depicts an extensive need to increase the sustainable funding option to enhance our understanding of the development of new drugs and vaccines to curtail the spread of mpox.

Implication in Future Research

The environmental, behavioural, and social reasons behind the 2022 mpox outbreak remain unknown to date [ 1 ]. A deeper understanding of mpox genetics and biochemistry is essential to control its outbreak. It is currently unclear how mpox is closely related and linked to the viral strain that is primarily found in western Africa, as well as the potential routes of rapid transmission. To further understand the immune defence mechanisms against MPXV, more research is needed on the human systemic and mucosal immune responses. As DNA viruses are more adept to correct mutations; therefore, it is unlikely that the mpox virus will suddenly change during human transmission [ 24 , 52 ]. It is yet unknown, whether vaccinations and earlier infections have given the population immunity. Additionally, exploratory studies are required to pinpoint the precise mpox virus reservoir, understand how the virus spreads naturally, and determine the causes of the present increase in cases across several nations. Currently, no potent drugs are available and limited evidence-based studies are being conducted for the treatment of mpox [ 29 ]. Most of the available choices of treatment are discussed in this paper (Fig.  6 ). Therefore, it becomes essential to investigate the domain of natural products with antiviral properties. This provides alternative treatment options, to prevent human to human spread of infection and restrict virus amplification in the host organisms. There is a recent increased interest among the scientific community to look into the numerous bioactivities of structurally unrelated natural compounds [ 53 , 54 ]. Plant-derived polyphenol resveratrol has beeb shown to significantly suppress replication of MPXV affecting probably the viral DNA synthesis and inducing a comparable effect to the well-characterized Orthopoxvirus inhibitor, i.e. cytosine-1-β- d -arabinofuranoside (AraC) [ 55 ]. Due to the pleiotropic action of natural compounds and lack of systemic toxicity, plant-derived agents may represent target compounds to be explored in future clinical trials to enrich the drug arsenal against Orthopoxvirus infections. Parallel to this, early detection of infected patients who are potentially capable of transmitting the infection is also crucial, pointing to the need for improved diagnosis (particularly in atypical clinical presentations and asymptomatic cases), and better availability of molecular tests. Besides, such continual efforts of preclinical scientists and pharmaceutical companies, availability of health infrastructures, and medical staff are of critical importance—a situation still aggravated by the ongoing COVID-19 pandemic. A high-risk patient population is possibly in danger of mpox nosocomial transmission and deserves more attention. Therefore, it is crucial to administer the proper supportive care [ 24 ]. Consequently, it is necessary to improve genomic sequencing capabilities to identify the mpox viral clade(s). The primary necessities are to combat the spread of mpox while dealing with the ongoing COVID-19 pandemic and to include suitable and timely information campaigns for people at risk. It is challenging to create an evidence-based classification of drug safety and effectiveness having a brief history of mpox. Further studies on various animal models, which may affect medication exposure, are also encouraged. The focus of larger research should be on identifying the patients who are most at risk for consequences from mpox infection as well as the best timing for initiating and completing antiviral therapy.

Different treatment modalities in mpox

The emergence of new diseases is one of the incessant threats which mankind can face. Persistent interference between the environment and humans creates an opportunity for new infections to evolve. Over 75% of the pathogens, which are newly emerging, are zoonotic in nature [ 56 ]. Several diseases like HIV/AIDS, Nipah, SARS, and Ebola including mpox have recently appeared. International travel and commerce and human behaviour often help disease to spread [ 56 ]. With the first emergence of mpox in 1958, little is still known about its reservoir host and vector of the disease. Despite repeated outbreaks of mpox over the past years, it has failed to gather scientific attention. There is a lack of understanding of mpox transmission dynamics and disease evolution. In the areas endemic to mpox, regular disease surveillance is lacking. This also includes the need to promote funding for capacity building required for surveillance of the disease, research activities, and testing facilities [ 17 , 57 ]. The role of central bodies like the World Health Organization plays a major role in controlling such outbreaks. However, non-compliance to guidelines and regulations by health agencies like WHO severely impacts the control measures [ 25 ]. Boosting vaccine development and effective drug development is essential to prevent future outbreaks. In addition, new plant-derived products could be further developed and can be promoted as they potentially have lesser side effects for mpox treatment.

Abbreviations

Author Contribution

SR, KV, and KS: conceptualization and writing; HST: editing and proofreading. All authors reviewed the manuscript.

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The authors declare no competing interests.

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