tetano
Editor, Senior Moderator
Am J Epidemiol
. 2024 Aug 14:kwae284.
doi: 10.1093/aje/kwae284. Online ahead of print. Caveats Regarding the Test-Negative Design to Study Mpox (monkeypox) Risk Factors and Vaccine Effectiveness
Isaac Núñez[SUP] 1 2 [/SUP]
Affiliations
The test-negative design (TND) has been commonly used to study vaccine effectiveness (notably regarding COVID-19 and influenza vaccines) and has been recently proposed as a valid design to study causal risk factors of diseases during an outbreak. In April 2022, mpox (previously monkeypox) led to a worldwide outbreak that resulted in an international public health emergency. The TND could be used to study vaccine effectiveness and risk factors of mpox using epidemiologic databases, and a few studies have already done so. However, several issues prevent such study design from being valid for this end. Problems stem from stigma surrounding mpox, which impacts a person's decision to look for healthcare. This poses a challenge to the "similar healthcare seeking behaviour" assumption that is central for test negative studies. Further limitations include the differential diagnoses of mpox, which have notable differences from mpox that may be easily detected by clinicians or patients but are unlikely to be included in epidemiologic databases or electronic health records. Herein I discuss caveats regarding the use of the TND in the context of the mpox outbreak, as well as potential steps that may allow it to be used effectively.
Keywords: monkeypox; mpox; outbreak; test-negative design.
. 2024 Aug 14:kwae284.
doi: 10.1093/aje/kwae284. Online ahead of print. Caveats Regarding the Test-Negative Design to Study Mpox (monkeypox) Risk Factors and Vaccine Effectiveness
Isaac Núñez[SUP] 1 2 [/SUP]
Affiliations
- PMID: 39142690
- DOI: 10.1093/aje/kwae284
The test-negative design (TND) has been commonly used to study vaccine effectiveness (notably regarding COVID-19 and influenza vaccines) and has been recently proposed as a valid design to study causal risk factors of diseases during an outbreak. In April 2022, mpox (previously monkeypox) led to a worldwide outbreak that resulted in an international public health emergency. The TND could be used to study vaccine effectiveness and risk factors of mpox using epidemiologic databases, and a few studies have already done so. However, several issues prevent such study design from being valid for this end. Problems stem from stigma surrounding mpox, which impacts a person's decision to look for healthcare. This poses a challenge to the "similar healthcare seeking behaviour" assumption that is central for test negative studies. Further limitations include the differential diagnoses of mpox, which have notable differences from mpox that may be easily detected by clinicians or patients but are unlikely to be included in epidemiologic databases or electronic health records. Herein I discuss caveats regarding the use of the TND in the context of the mpox outbreak, as well as potential steps that may allow it to be used effectively.
Keywords: monkeypox; mpox; outbreak; test-negative design.