Although mpox has been detected in paediatric populations in central and west Africa for decades, evidence synthesis on paediatric, maternal, and congenital mpox, and the use of vaccines and therapeutics in these groups, is lacking. A systematic review is therefore indicated to set the research agenda. We conducted a systematic review and meta-analysis, searching articles in Embase, Global Health, MEDLINE, CINAHL, Web of Science, Scopus, SciELO, and WHO databases from inception to April 17, 2023. We included studies reporting primary data on at least one case of confirmed, suspected, or probable paediatric, maternal, or congenital mpox in humans or the use of third-generation smallpox or mpox vaccines, targeted antivirals, or immune therapies in at least one case in our population of interest. We included clinical trials and observational studies in humans and excluded reviews, commentaries, and grey literature. A pooled estimate of the paediatric case fatality ratio was obtained using random-effects meta-analysis. This study is registered with PROSPERO (CRD420223336648). Of the 61 studies, 53 reported paediatric outcomes (n=2123 cases), seven reported maternal or congenital outcomes (n=32 cases), two reported vaccine safety (n=28 recipients), and three reported transmission during breastfeeding (n=4 cases). While a subset of seven observational studies (21 children and 12 pregnant individuals) reported uneventful treatment with tecovirimat, there were no randomised trials reporting safety or efficacy for any therapeutic agent. Among children, the commonest clinical features included rash (86 [100%] of 86), fever (63 [73%] of 86), and lymphadenopathy (40 [47%] of 86). Among pregnant individuals, rash was reported in 23 (100%) of 23; fever and lymphadenopathy were less common (six [26%] and three [13%] of 23, respectively). Most paediatric complications (12 [60%] of 20) arose from secondary bacterial infections. The pooled paediatric case fatality ratio was 11% (95% CI 4–20), =75%. Data from 12 pregnancies showed half resulted in fetal death. Research on vaccine and immune globulin safety remains scarce for children and absent for pregnant individuals. Our review highlights critical knowledge gaps in the epidemiology, prevention, and treatment of mpox in children and pregnant individuals, especially those residing in endemic countries. Increased funding, international collaboration, and equitable research is needed to inform mpox control strategies tailored for at-risk communities in endemic countries. None. For the French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.

中文翻译：

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儿科、孕产妇和先天性 MPOX：系统评价和荟萃分析

尽管几十年来在中非和西非的儿科人群中发现了 MPOX，但缺乏关于儿科、孕产妇和先天性 MPOX 以及这些群体中疫苗和治疗方法使用的证据综合。因此，需要进行系统回顾来制定研究议程。我们进行了系统回顾和荟萃分析，检索了 Embase、Global Health、MEDLINE、CINAHL、Web of Science、Scopus、SciELO 和 WHO 数据库中从成立到 2023 年 4 月 17 日的文章。我们纳入了至少报告主要数据的研究1 例人类确诊、疑似或可能的儿科、孕产妇或先天性 MPOX 病例，或在我们感兴趣的人群中至少有 1 例使用了第三代天花或 MPOX 疫苗、靶向抗病毒药物或免疫疗法。我们纳入了人类临床试验和观察性研究，排除了评论、评论和灰色文献。使用随机效应荟萃分析获得了儿科病死率的汇总估计值。本研究已在 PROSPERO 注册（CRD420223336648）。在 61 项研究中，53 项报告了儿科结局（n=2123 例），7 项报告了孕产妇或先天性结局（n=32 例），2 项报告了疫苗安全性（n=28 名接受者），3 项报告了母乳喂养期间的传播（n=4例）。虽然七项观察性研究的一部分（21 名儿童和 12 名孕妇）报告了替考维马的治疗效果平稳，但没有随机试验报告任何治疗药物的安全性或有效性。在儿童中，最常见的临床特征包括皮疹（86 例中的 86 例 [100%]）、发热（86 例中的 63 例 [73%]）和淋巴结肿大（86 例中的 40 例 [47%]）。在 23 名孕妇中，有 23 名（100%）报告出现皮疹；发热和淋巴结肿大较少见（23 例中分别有 6 例 [26%] 和 3 例 [13%]）。大多数儿科并发症（20 例中有 12 例 [60%]）由继发性细菌感染引起。汇总儿科病死率为 11% (95% CI 4-20)，=75%。 12 次妊娠的数据显示，其中一半导致胎儿死亡。针对儿童和孕妇的疫苗和免疫球蛋白安全性研究仍然很少。我们的综述强调了儿童和孕妇（尤其是居住在流行国家的儿童和孕妇）MPOX 的流行病学、预防和治疗方面的关键知识差距。需要增加资金、国际合作和公平研究，以便为流行国家高危社区制定针对性的 MPOX 控制策略提供信息。没有任何。有关摘要的法语、西班牙语和葡萄牙语翻译，请参阅补充材料部分。