Nexus between monkeypox and obesity: improved precautions and vigilance for obese patients

The multi-country outbreak of monkeypox (Mpox) was proclaimed a public health emergency of international concern on July 23, 2022, by the WHO Director-General1. In the middle of May 2023, 87429 cases were confirmed worldwide, with 140 deaths from more than 110 countries. On May 10, 2023, WHO announced multi-country Mpox outbreak is not a global public health emergency in the fifth International Health Regulations (2005) (WHO, 2023). However, further Mpox waves and outbreaks might appear, and the committee suggested being concerned about new significant cases. Though little is known about the relationship between disease severity and its determinants, the illness of Mpox has been made worse by several comorbidities (acquired immunodeficiency syndrome, diabetes, and lymphoproliferative disorders). Obesity is one of the leading causes of death and is associated with various illnesses. According to the most recent data on obesity, there are around 1.3 million fatalities caused by obesity worldwide each year, which has increased 3× globally in recent years2. In the European Region, males (63%) and females (54%) are affected by this epidemic. Human monkeypox, also known as Mpox, is an uncommon zoonotic disease caused by an Mpox virus (MPXV) from the family Poxviridae with an enveloped 190 kb double-stranded DNA genome3. The former Congo Basin (Central Africa) is now classified as Clade One (I) and West Africa as Clade Two (II), where Clade II is made up of the subclades IIa and IIb (mostly spreading-B.1 lineage-1945 sequences) (https://nextstrain.org/monkeypox/mpxv)(https://mpox.genspectrum.org/explore). Clinical symptoms of confirmed MPXV patients include fever, chills, exhaustion, headaches, and muscle pains4. After 1–3 days of Mpox infection, the onset of fever and lymphadenopathy rash was observed, which typically affects the hands, feet, chest, face, and mouth, as well as the penis, testicles, labia, and vagina, as well as the anus5. The incubation period of this self-limited disease is 3–17 days. Close physical contact, skin-to-skin contact with an infected person with rash, contact with their saliva, upper respiratory secretions (snot and mucus), and anus, rectum, or vagina are all ways MPXV can be transmitted. Oral, anal, or vaginal sex, as well as touching the genitals (penis, testicles, labia, and vagina), are also risk factors. Interacting with contaminated clothing, bedding, towels, fetish gear, or sex toys has a relatively low transmission risk6. The main objective of this article is to investigate the possibility of a link between the prevalence of obesity and the number of Mpox cases and fatalities globally. This study gathered the essential Mpox-related data from the “Our World in Data” website (https://ourworldindata.org/explorers/monkeypox) from May 1, 2022 to April 30, 2023. This data included the total number of new cases and fatalities from 103 different nations. In our analysis, we also gathered and used information on the prevalence of obesity (https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight). The relationship between cases/deaths and obesity was assessed using a linear regression analysis with cases/deaths as the dependent variable and the obesity rate as the independent variable. Among the top 10 countries with the most Mpox cases, the USA reported the most (30154 cases), whereas Canada the lowest (1484 instances). By obesity rate, the USA also exhibited the highest cases (36.20%) among top cases countries, with Peru showing the lowest (19.47%) (Supplemental Table ST1, Supplemental Digital Content 1, https://links.lww.com/IJSGH/A23). It is also revealed that the average total number of Mpox cases in the top 10 and the world increased by 0.05% and 0.06%, respectively, if the obesity rate rises by 1% (Supplemental Table ST2, Supplemental Digital Content 1, https://links.lww.com/IJSGH/A23). In the top 10 countries and globally, the model explained 35.4% and 7.74% of the total variation, respectively. Pearson correlation coefficient and scatter plot showed a perfect positive linear relationship (r = 0.596 and r = 0.278) between total cases and the obesity rate of the top 10 countries and world Mpox cases (Supplemental Table ST2, Supplemental Digital Content 1, https://links.lww.com/IJSGH/A23 and Fig. 1). The majority of Mpox deaths (42), as well as obesity (36.20%), also occur in the USA. Among the top 10 countries with the highest death rates, Argentina (2) has the fewest Mpox deaths in the percentages of obese people (28.30%) (Supplemental Table ST1, Supplemental Digital Content 1, https://links.lww.com/IJSGH/A23).Figure 1: Scatter plot with regression line between total cases and deaths of Mpox with obesity rate.The average number of deaths in Mpox increases by 0.41 times for every 1% increase in the obesity rate in the top 10 deaths countries. The model explained 34.26% of the total variation (Supplemental Table ST2). Pearson correlation coefficient and scatter plot showed a positive linear relationship (r = 0.585) between total deaths and the obesity rate of the top 10 Mpox deaths countries (Supplemental Table ST2, Supplemental Digital Content 1, https://links.lww.com/IJSGH/A23 and Fig. 1). This is the first study to explore the association between Mpox and obese patients. Our findings indicate a substantial association between obesity and MPXV cases, with the top countries with the prevalence of obese individuals affecting relatively more people, despite the lack of research-based evidence about Mpox and obesity. According to WHO statistics, the Americas and Europe had the highest percentage of obese adults, and these 2 continents also suffered the worst effects of Mpox rather than others. One needs to monitor their health, and blood lipid levels, get guidance from a nutritionist, partake in enough physical activity, and manage their diet to handle the significant problem of obesity. Two doses of the JYNNEOS MPXV vaccine are used to prevent this infection, despite the longevity of vaccination action yet unclear7. Some nations have policies or are creating them to provide vaccines to people who may be at risk, including laboratory staff, quick reaction teams, and health care professionals8. The primary preventative method for Mpox involves increasing public knowledge of risk factors and teaching individuals about the steps they may take to lessen virus exposure. According to this data, obese patients may need to take more care and adhere to recommended practices to safeguard themselves against MPXV infection. Although this study has a few limitations, however, it indicates the potential link between obese patients and Mpox. After 1 year, the WHO proclaimed to withdraw this global concern, but further new cases might happen, and obese patients might be concerned rather than others. Ethical approval The present study includes printed and published information; therefore, formal ethical clearance not applicable for this study. Acknowledgments The authors are grateful to the Advanced Molecular Lab, President Abdul Hamid Medical College and Hospital. Authors also acknowledge KTH Royal Institute, Sweden. Sources of funding Nil. Author contributions M.N.H.: analysis, review, and editing. P.B.: manuscript writing, review, and editing. M.A.I.: original article writing, review, and editing. Conflict of interest disclosures The authors declare that they have no financial conflict of interestwith regards to the content of this report. Research registration unique identifying number (UIN) Not applicable. Guarantor Md. Aminul Islam.

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