Background The current literature shows increasing concerns about potential seminal transmission of monkeypox virus (MPV). Accordingly, we aimed to understand better the potential presence of MPV in the seminal uids and others specimens obtained from monkeypox (MPX) cases.Methods On June 26, 2022, a systematic search of the literature was conducted across PubMed, Scopus, Web of Science, EMBASE, ScienceDirect, ProQuest, EBSCOHost-Academic Search Complete, and Google Scholar to nd articles that examine the presence of MPV in seminal uid of con rmed cases . The search was updated on August 12 to include newly published articles. The prevalence of MPV DNA presence in the seminal uid and other specimens was pooled in a meta-analysis and results were presented as effect sizes and their corresponding 95% con dence intervals (CI). The quality of included articles was assessed using the National Institute of Health tool.Results Eight articles (including 585 MPX-con rmed patients) were included. Only four studies were eligible for a meta-analysis, and the individual positivity rate of MPV DNA in semen specimens ranged from 61.11% to as high as 90.62%, while the pooled rate was 78% (95% CI: 62-93%; I2=61.93%) among 91 examined patients. Moreover, the pooled positive rate of MPV DNA was the highest in rectal samples (100%; 95%CI: 94-100%), followed by urinary (31%; 95%CI: 1-61%), nasopharyngeal (28%; 95%CI: 24-32%), and blood/plasma (8%; 95%CI: 6-10%) samples, respectively. Furthermore, two articles also investigated the infectivity of MPV particles detected in seminal specimens by testing their replication competence. Culturing MPV was successful in one out of three patients included in these studies. Also, based on available evidence, the positivity of MPV in semen specimens can be observed early and up to 19 days after symptoms onset.Conclusions MPV is highly prevalent in seminal specimens of MPX cases, further corroborating the role of sexual transmission of the disease. However, further evidence is still needed to shed more light on the replication competence of these particles.

(1) Background: The monkeypox virus (MPV) is a double-stranded DNA virus belonging to the Poxviridae family, Chordopoxvirinae subfamily, and Orthopoxvirus genus. It was called monkeypox because it was first discovered in monkeys, in a Danish laboratory, in 1958. However, the actual reservoir for MPV is still unknown. (2) Methods and Results: We have reviewed the existing literature on the options for Monkeypox virus. There are three available vaccines for orthopoxviruses—ACAM2000, JYNNEOS, and LC16—with the first being a replicating vaccine and the latter being non- or minimally replicating. (3) Conclusions: Smallpox vaccinations previously provided coincidental immunity to MPV. ACAM2000 (a live-attenuated replicating vaccine) and JYNNEOS (a live-attenuated, nonreplicating vaccine) are two US FDA-approved vaccines that can prevent monkeypox. However, ACAM2000 may cause serious side effects, including cardiac problems, whereas JYNNEOS is associated with fewer complications. The recent outbreaks across the globe have once again highlighted the need for constant monitoring and the development of novel prophylactic and therapeutic modalities. Based on available data, there is still a need to develop an effective and safe new generation of vaccines specific for monkeypox that are killed or developed into a mRNA vaccine before monkeypox is declared a pandemic.

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Olokizumab (OKZ) is a novel IL-6 inhibitor that directly targets IL-6 rather than its receptor. We aim to evaluate the efficacy and safety of OKZ for patients with rheumatoid arthritis (RA) and to investigate the optimal treatment regimen. A systematic review, pairwise, and network meta-analysis synthesizing randomized controlled trials (RCTs) from WOS, CENTRAL, SCOPUS, EMBASE, and PubMed until August 31, 2022. We used the risk ratio (RR) and mean difference (MD) for dichotomous and continuous outcomes, respectively, presented with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022358082. Five RCTs with 2277 patients were included. OKZ significantly improved the American College of Rheumatology criteria (ACR) 20 (RR: 1.97 with 95% CI [1.49, 2.58], P = 0.00001), ACR50 (RR: 3.83 with 95% CI [2.13, 6.87], P = 0.00001), ACR70 (RR: 3.83 with 95% CI [2.13, 6.87], P = 0.00001), disease activity score 28 based on C-reactive protein (DAS28-CRP) (RR: 3.91 with 95% CI [2.65, 5.79], P = 0.00001), clinical disease activity index (CDAI) (RR: 2.80 with 95% CI [1.43, 5.48], P = 0.003), and health assessment questionnaire disability index (HAQ-DI) (MD: − 0.28 with 95% CI [− 0.38, − 0.18], P = 0.00001) after 12 weeks, compared to placebo. However, OKZ was also associated with a higher incidence of any adverse events (AEs) (RR: 1.15 with 95% CI [1.06, 1.25], P = 0.0005) and AEs leading to drug discontinuation (RR: 1.86 with 95% CI [1.05, 3.29], P = 0.03). OKZ is effective and with acceptable safety profile when administrated with methotrexate in patients with RA not adequately controlled by tumor necrosis factor inhibitors; however, more large-scale RCTs are still required to investigate the optimal dosing, long-term effects, and comparative efficacy versus established biological DMARDs. Key Points• OKZ is effective especially with methotrexate in RA patients.