Discussion

Due to the persisting prevalence of monkeypox, the number of scientific publications in this field has continued to rise, particularly in 2022. The importance of evaluating the quality of these publications and extracting useful information from them for future research cannot be overlooked. In the current studies, 1646 publications about monkeypox indexed in the WoS Core Collection database were analyzed. Three research areas were represented in the published literature: virology, immunology, and infectious diseases. The most frequently used keyword, “monkeypox” was closely related to “orthopoxvirus” and “smallpox.” The United States has made the most outstanding contributions to this vital field.

Monkeypox is a rare infectious disease, first discovered in a laboratory monkey in 1958.Reference Mitjà, Ogoina and Titanji ¹⁴ The first recorded human case was in 1970 in Zaire.¹⁵MPV occurred mainly in African countries before 2003. Since the outbreak of monkeypox in the United States in 2003, cases have emerged in many other countries outside AfricaReference Martín-Delgado, Martín Sánchez and Martínez-Sellés ¹⁶ and have continued to spread globally, predominantly in Europe and North America. The spike in the number of infectious cases may be related to a mutation making MPV more transmissible. WHO declared monkeypox a PHEIC in July 2022, indicating that global solidarity is needed to address its rapid spread. According to the case reports to date, the outbreak of monkeypox has been associated with close intimate contact, primarily involving men who have sex with men. In addition to the aforementioned direct contact form of transmission, airborne transmission is also a way by which the virus spreads.

The monkeypox epidemic is still raging throughout the world. This rapid global spread has heightened researchers’ vigilance and led to the development of numerous effective strategies for combating the epidemic. With the highest number of published articles and citations, the Journal of Virology has become the most popular publication, demonstrating its great advantages.

Monkeypox is caused by the MPV. Both the MPV and smallpox virus belong to the orthopoxvirus family, and their typical clinical manifestations are similar.Reference Harris ^{2 ,} Reference Kozlov ^{3 ,} Reference Bayer-Garner ^{17 ,} Reference Simpson, Heymann and Brown ¹⁸ Therefore, as the top 10 most frequently used keywords, “monkeypox” and “orthopoxvirus” were closely associated with “smallpox”. In addition, many people are extremely concerned due to the outbreak of monkeypox and the lack of effective prevention and treatment methods. Therefore, “outbreak” and “smallpox vaccine” were another 2 top 10 keywords.

Most articles on monkeypox published in 2022 were written by American scholars. This is likely because the pandemic is mainly spreading in Europe and North America, particularly the United States, which has become one of the countries with the highest monkeypox infection rate worldwide.Reference Khan, Akbar and Yahiro ¹⁹ The United States reported its first case of monkeypox on May 7, 2022, and by August 9, 2022, nearly 9500 confirmed cases had been reported. At the same time, on August 4, the United States government declared monkeypox a public health emergency.Reference Khan, Akbar and Yahiro ¹⁹ In addition, the United States has a robust information and data management system.

With the in-depth study of monkeypox, more clinical studies have been carried out in other countries.Reference Rao, Schulte and Chen ^{20 ,} Reference Mileto, Riva and Cutrera ²¹ Current research focuses primarily on understanding the epidemiology and diagnosis of monkeypox, studying changes at the organ and cell levels, and exploring potential pathogenesis and treatment methods. For the diagnostic method of monkeypox, besides determining monkeypox-specific DNA sequences, AI-based detection is a valid method to identify this disease at the early stage, and AI-based diagnostic methods may be appropriate for mass screening.Reference Sitaula and Shahi ²² Currently, the treatment for most patients is symptomatic, and there is no antiviral drug approved for monkeypox.Reference Adler, Gould and Hine ^{7 ,} Reference Del Rio and Malani ²³ Three antivirals—tecovirimat, cidofovir, and brincidofovir—have been shown to be effective against monkeypox infection.Reference Matias, Koshy and Nagami ^{24 ,} Reference Grosenbach, Honeychurch and Rose ²⁵ These antivirals, approved to treat smallpox, are expected to be potential options for treating monkeypox as well. However, none of these antivirals has been evaluated in randomized trials. Tecovirimat is the first choice for the treatment of monkeypox, and it has been approved by the European Medicines Agency (EMA) for monkeypox but not yet by the FDA.Reference Sherwat, Brooks and Birnkrant ²⁶ Cidofovir has been shown to be effective against monkeypox in animal models, but its dose-dependent nephrotoxicity restricts its use in the clinic.Reference Stittelaar, Neyts and Naesens ²⁷ As an analogue of cidofovir, brincidofovir has decreased nephrotoxicity. However, it has the risk of derangement in liver function.Reference Adler, Gould and Hine ⁷ Consequently, effective treatment will undoubtedly become one of the primary concerns of future researchers. In addition, there are 2 main vaccines (the JYNNEOS and ACAM2000 vaccines) that can presently be used to prevent monkeypox, both of which have been proven to be 85% effective.Reference Rizk, Lippi and Henry ^{28 ,} Reference Rao, Petersen and Whitehill ²⁹ However, the supply of vaccines is severely limited at the moment, so further research and development of vaccines will also be a focus of future research. Finally, beyond vaccination, a comprehensive strategy to prevent monkeypox should be applied, including maintaining personal hygiene, avoiding contact with infected animals, controlling health-care environments, education and awareness, and early diagnosis and treatment.

In this study, the WoS Core Collection database was searched for publications on monkeypox, and VOSviewer was applied to conduct a quantitative analysis of the relevant literature to gain an objective and comprehensive understanding of the epidemic. However, there are some limitations in this research. First, only using the WoS Core Collection database to screen the literature may have caused some publications, which they might be included in other databases, to be excluded from our analysis. In addition, “grey” literature may hold significance in research, but this study mainly focused on publications that are widely recognized in academia; therefore, the “grey” literature, such as WHO’s situation reports, will be included for more comprehensive analysis in a future study. Second, as time goes on, more articles may be published, and the number of articles included based on the search terms may be varied. In future reports, research results will be updated according to the latest number of articles, thereby improving the reliability of the study. Finally, the studies included were analyzed based on the citations rather than other evaluation methods, and thus, the collected literature was of variable quality. Impact Factor, CiteScore, Eigen Factor, and the h-index are significant indicators for evaluating the quality of literature. Therefore, future research may utilize evaluation criteria that include these indicators to control for the impact of the variable quality of literature on conclusions.