---
title: "Asymptomatic Monkeypox Virus (MPXV) Prevalence in Nonendemic Regions: 2022–2024 Meta-analysis"
id: "cdc-emerging-infectious-diseases-journal-2-meta-analysis-of-asymptomatic-monkeypox-virus-prevalence-in-nonendemic-regions"
canonical_url: "https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-2-meta-analysis-of-asymptomatic-monkeypox-virus-prevalence-in-nonendemic-regions"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "CDC Emerging Infectious Diseases Journal"
source_url: "https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article"
published_at: "2026-09-16T04:00:00.000Z"
evidence_level: "Agency Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Asymptomatic Monkeypox Virus (MPXV) Prevalence in Nonendemic Regions: 2022–2024 Meta-analysis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-2-meta-analysis-of-asymptomatic-monkeypox-virus-prevalence-in-nonendemic-regions
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** CDC Emerging Infectious Diseases Journal
- **Source URL:** [Original Journal Publication](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article)
- **Published At:** 2026-09-16T04:00:00.000Z
- **Evidence Rating:** Agency Feed
## Executive GIST (TL;DR)
- The authors conducted a meta-analysis of peer-reviewed studies published from May 12, 2022, through September 13, 2024, to estimate pooled prevalence of **asymptomatic** monkeypox virus (**MPXV**) detections in nonendemic regions. - The literature search used PubMed as the primary database and included additional citations found in screened articles; the review was not prospectively registered. - Inclusion required studies outside sub-Saharan Africa that performed PCR testing on adults (>18 years) and explicitly identified persons as asymptomatic (no lesions or symptomatic signs); sample types included pharyngeal, anorectal, urethral swabs, urine, or blood. - Data extracted from each included study included study design, recruitment dates, country, number of asymptomatic MPXV detections, and total tested. - Prevalence was calculated as positive asymptomatic detections divided by total tested; a funnel plot assessed bias and random-effects logistic regression estimated the pooled effect with 95% prediction intervals (PIs). - The final pooled prevalence estimate of **asymptomatic MPXV detections** was 1.0% with a 95% prediction interval of 0.1%–11.2% from a random-effects analysis. - Results did not vary substantially by geographic region or study design according to the analysis reported. - The authors note that detection of viral genetic material by PCR does not necessarily indicate infectiousness; infectivity and transmission potential from truly asymptomatic persons were not evaluated in this meta-analysis. - A prior meta-analysis that included earlier reports estimated a higher pooled prevalence (10.2%), but most of those studies preceded the 2022 global outbreak and included noncomparable settings, limiting generalizability. - The authors emphasize that MPXV continues to circulate globally and that viral dynamics enabling persistence, including the role of asymptomatic infections in transmission, require further study.
## Clinical Analysis & Structured Key Points
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[EID Journal](https://wwwnc.cdc.gov/eid/) 2. [Volume 32](https://wwwnc.cdc.gov/eid/early-release) 3. [Early Release](https://wwwnc.cdc.gov/eid/early-release#issue-1346) 4. [Main Article](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article) * [Facebook](https://www.facebook.com/sharer/sharer.php?u=%2Feid%2Farticle%2F32%2F10%2F26-0305_article "Share to Facebook") * [Twitter](http://twitter.com/share?url=%2Feid%2Farticle%2F32%2F10%2F26-0305_article&text= "Share to Twitter") * [LinkedIn](https://www.linkedin.com/shareArticle?url=%2Feid%2Farticle%2F32%2F10%2F26-0305_article&title= "Share to LinkedIn") * [Syndicate](https://tools.cdc.gov/medialibrary/index.aspx#/sharecontent//eid/article/32/10/26-0305_article "Embed this Page") [ Emerging Infectious Disease journal ISSN: 1080-6059 ](https://wwwnc.cdc.gov/eid/) _Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released._ #### Volume 32, Number 10—October 2026 ##### _Research_ ### Meta-analysis of Asymptomatic Monkeypox Virus Prevalence in Nonendemic Regions, 2022–2024 On This Page [Methods](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article) * * * [Results](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article) * * * [Discussion](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article) * * * [Suggested Citation](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article) Figures [Figure 1](https://wwwnc.cdc.gov/eid/article/32/10/26-0305-f1) * * * [Figure 2](https://wwwnc.cdc.gov/eid/article/32/10/26-0305-f2) Tables [Table 1](https://wwwnc.cdc.gov/eid/article/32/10/26-0305-t1) * * * [Table 2](https://wwwnc.cdc.gov/eid/article/32/10/26-0305-t2) Downloads [Appendix ](https://wwwnc.cdc.gov/eid/article/32/10/26-0305-app1.pdf) * * * [RIS [TXT - 2 KB] ](https://wwwnc.cdc.gov/eid/article/32/10/26-0305.ris) Article Metrics [Metric Details](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article) Related Articles [Monkeypox Virus, Sierra Leone, June 2025](https://wwwnc.cdc.gov/eid/article/32/10/25-1697_article) * * * [Monkeypox Virus Surveillance in Wastewater](https://wwwnc.cdc.gov/eid/article/32/13/26-0414_article) * * * [_Orthopoxvirus_ Antibodies in Feral Mammals, Nigeria](https://wwwnc.cdc.gov/eid/article/32/5/25-1565_article) * * * [More articles on monkeypox, mpox](https://wwwnc.cdc.gov/eid/spotlight/mpox) Kelsey J. MacCuish, Robert Snyder, Kelly A. Johnson, Edwin Chojolan, Awa Keinde, Kathleen Jacobson, and Kayla Saadeh[![Comments to Author](https://wwwnc.cdc.gov/eid/content/images/icon/email.gif)](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#comment) Author affiliation: California Department of Public Health Office of Sexually Transmitted Infections and Hepatitis C Virus, Richmond, California, USA (K.J. MacCuish, R. Snyder, K.A. Johnson, E. Chojolan, A. Keinde, K. Jacobson, K. Saadeh); University of California, San Francisco School of Medicine, San Francisco, California, USA (K.A. Johnson) [Suggested citation for this article](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#suggestedcitation) ### Abstract In this meta-analysis, we performed a literature search for articles relating to asymptomatic monkeypox virus (MPXV) detections published worldwide during May 12, 2022–September 13, 2024. The primary outcome was to determine the pooled prevalence of asymptomatic MPXV detections. We conducted a random-effects analysis that yielded a final pooled prevalence of 1.0% (95% prediction interval 0.1%–11.2%). Results did not substantially differ by geographic region or study design. Although those findings are reassuring, we did not evaluate infectivity or transmission potential among asymptomatic persons. MPXV continues to circulate globally; the viral dynamics that enable its persistence remain poorly understood and merit further study. Clade IIb of human monkeypox virus (MPXV), which causes mpox, an infectious disease in the same family as smallpox, began spreading globally in 2022 and prompted international public health concern ([_1_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r1 "1")). MPXV can be transmitted through close or intimate contact between humans, through infected animals, or through fomites ([_1_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r1 "1")). In the United States, most MPXV infections are spread person-to-person through sexual contact, primarily among gay, bisexual, and other men who have sex with men (GBMSM) ([_1_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r1 "1")). The emergence of the disease in the United States and Europe, where clinical and epidemiologic resources are more abundant than sub-Saharan Africa, has improved our understanding of the clinical manifestations and epidemiologic characteristics of MPXV. It is now understood that MPXV can be transmitted in 1–4 days before a person has onset of symptoms of infection ([_1_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r1 "1")). However, whether persons who remain asymptomatic throughout the course of infection can transmit MPXV to others is much less clear. This uncertainty arises partly because persons need to have lesions to be clinically tested for MPXV in the United States. The prevalence of asymptomatic MPXV infection in the ongoing global outbreak also is unknown and could have important implications for public health efforts. A previous systematic review and meta-analysis of the prevalence of asymptomatic MPXV detections estimated a pooled prevalence of 10.2% (95% CI 2.5%–17.9%) but only included reports available through September 2022 ([_2_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r2 "2")). Because most studies in that meta-analysis preceded the 2022 global MPXV outbreak and the analysis also included a report from an outbreak that began in a primate sanctuary in Cameroon, the results may not be generalizable to the ongoing outbreak that primarily affects GBMSM ([_2_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r2 "2")). The absence of asymptomatic MPXV detections in study populations has been noted in numerous reports ([_3_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r3 "3")–[ _8_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r8 "8")). For example, a retrospective study noted that only 0.2% of patients tested through PCR were asymptomatic. However, that study was conducted in the summer and fall of 2022, the peak of the global outbreak, when transmission was more widespread in the GBMSM community ([_9_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r9 "9")). In contrast, 2 studies that assessed the prevalence of asymptomatic MPXV detections among GBMSM in France and Belgium retrospectively screened anorectal, urine, and oropharyngeal samples and found higher prevalences of asymptomatic detections (5.5% in France and 1.3% in Belgium), although a notable methodologic limitation of those studies is that detection of viral genetic material does not necessarily mean that a person is infectious, whereas a negative test result indicates that infectiousness is highly unlikely ([_10_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r10 "10"),[_11_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r11 "11")). Because overlooking asymptomatic viral infections, if highly prevalent, could hinder disease control and prevention, we assessed the prevalence of asymptomatic MPXV detections worldwide through a meta-analysis of peer-reviewed articles published during May 12, 2022–September 13, 2024. ### Methods ##### Search Strategy and Selection Criteria We searched PubMed for relevant articles by using the search terms (asymptomatic OR non-lesion OR no lesion* OR without lesion* OR without cutaneous lesion* OR undetected OR unrecognized OR proctitis OR undiagnosed OR no symptom*) AND (monkeypox OR mpox OR MPXV OR MPX OR monkey pox OR monkeypox virus OR MPV). Because PubMed contains relevant biomedical literature related to MPXV and because of resource constraints and the substantial overlap between PubMed, Web of Science, and Embase, we opted for using PubMed as our primary database. We found additional relevant articles through citations from screened studies. We limited results to publication dates during May 12, 2022–September 13, 2024, to yield results relevant to the ongoing outbreak. ##### Data Extraction and Management Figure 1 ![Preferred Reporting Standard of Systematic Reviews and Meta-Analysis flowchart for studies published during May 12, 2022–September 13, 2024, that were included in a meta-analysis of asymptomatic monkeypox virus detections in nonendemic regions.](https://wwwnc.cdc.gov/eid/images/26-0305-F1-tn.jpg) [Figure 1](https://wwwnc.cdc.gov/eid/article/32/10/26-0305-f1 "Figure 1"). Preferred Reporting Standard of Systematic Reviews and Meta-Analysis flowchart for studies published during May 12, 2022–September 13, 2024, that were included in a meta-analysis of asymptomatic monkeypox virus detections in... The primary outcome was determination of the pooled prevalence of asymptomatic MPXV detections among persons tested for MPXV. We used the Preferred Reporting Standard of Systematic Reviews and Meta-Analysis (PRISMA) checklist to evaluate the searched articles ([Figure 1](https://wwwnc.cdc.gov/eid/article/32/10/26-0305-f1)). We did not prospectively register the review protocol. The first author began by screening and removing studies whose titles did not indicate asymptomatic MPXV detections; she also briefly reviewed abstracts of excluded articles. She then screened the abstracts for inclusion and exclusion criteria, after which 2 other authors independently reviewed the remaining full-text articles for inclusion. If discordance about whether to include an article occurred, we consulted a third co-author to determine whether the article met eligibility criteria. ##### Inclusion and Exclusion Criteria Studies about asymptomatic MPXV detections published during May 12, 2022–September 13, 2024, were eligible for inclusion. We followed the PICO (population, intervention, comparison, outcome) framework to synthesize our research question. We searched for articles that assessed individual adults (population) who tested positive for MPXV by PCR. PCR testing for asymptomatic persons enrolled in those studies was conducted by using pharyngeal, anorectal, urethral swabs, urine, or blood. We compared those asymptomatic persons who tested positive for MPXV to those who tested negative for MPXV (comparison). We used the following inclusion and exclusion criteria and completed the JBI (formerly Joanna Briggs Institute) critical appraisal checklist for prevalence studies to determine whether studies should be included in the meta-analysis. The study must have been conducted during May 12, 2022–September 13, 2024; taken place outside of sub-Saharan Africa (in nonendemic regions for MPXV); been primary research (not a review of already published studies); must have had a population of >1 person; been conducted on the individual patient level (e.g., not an ecologic study or a study that does not provide counts of individual characteristics); researched people >18 years of age (e.g., any sex, sexual orientation, or race/ethnicity); researched transmission between humans only; not selectively sampled on MPXV infection (e.g., the study did not only include persons with MPXV); performed PCR testing to determine the presence of MPXV infection; and included persons who displayed no physical symptoms of MPXV as determined by explicitly stating that persons were asymptomatic, undetected, clinically inapparent, did not experience lesions or rashes, or a combination of these descriptions. Any mention of symptomology excluded a person from being asymptomatic or (if it did not otherwise include asymptomatic MPXV) the entire article from inclusion. We initially considered vaccination status as inclusion criteria but ultimately did not include the criteria because very few studies accounted for vaccination status. We then excerpted the following from each included article: author (or authors), study design (cross-sectional, prospective cohort, retrospective cohort, mixed cohort), publication date, study recruitment dates, country where the study participants were recruited, number of asymptomatic MPXV patients in the study population, and total number of persons who were tested for MPXV in the study population. ##### Data Analysis We calculated the prevalence of asymptomatic MPXV detections as the cumulative number of asymptomatic MPXV detections divided by the total number of study participants tested for MPXV. We first constructed a funnel plot of the included research studies and statistically tested for biases and then estimated the pooled effect by using random effects estimates and their associated 95% prediction intervals (PIs) ([_12_](https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article#r12 "12")). We built logistic regression models to calculate random effects estimates, which assume that included studies e
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