Mapping the Intellectual Landscape: A Bibliometric Analysis of Monkeypox Literature

Mapping the Intellectual Landscape: A Bibliometric Analysis of Monkeypox Literature | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Mapping the Intellectual Landscape: A Bibliometric Analysis of Monkeypox Literature Sudip Bhattacharya, Alok Singh, Akanksha Singh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7601560/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Monkeypox, a viral zoonotic disease caused by the monkeypox virus, has garnered increasing global attention due to its recent outbreaks beyond traditionally endemic regions. First identified in laboratory monkeys in 1958, the virus primarily spreads through rodents and can infect humans via direct contact with infected animals or through human-to-human transmission. Since the first human case in 1970 in the Democratic Republic of the Congo (DRC), over 19,000 cases have been reported, primarily in Central and West Africa, with the DRC accounting for about 70% of global cases. The disease has a varying case fatality rate (CFR) depending on the strain, with the Congo Basin strain being more lethal (up to 10%) compared to the West African strain (1–3%). The recent global spread of monkeypox has led to significant research efforts aimed at understanding the virus and developing effective control strategies. This study conducted a comprehensive bibliometric analysis of monkeypox literature from 2022 to 2024, using data from the SCOPUS database. The analysis identified a rapid increase in publications during this period, reflecting the global scientific community's response to the monkeypox outbreaks. The United States led in both the number of publications and citations, followed by China and India, with notable contributions from institutions like the Centers for Disease Control and Prevention (CDC) and Harvard Medical School. Key journals such as the "Journal of Medical Virology" and "Emerging Infectious Diseases" were identified as major sources of monkeypox research. The study also highlighted significant international collaborations, particularly between the USA and the UK, and between Saudi Arabia and Pakistan. Keyword analysis revealed a focus on terms like "monkeypox virus," "vaccination," and "HIV infection," indicating key areas of interest in the research community. However, the analysis is limited by its focus on English-language publications and the specific timeframe of 2022 to 2024. Future research should consider a broader range of document types and languages, as well as a more extended temporal analysis, to provide a more comprehensive understanding of global research trends on monkeypox. Infectious Diseases monkey pox zoonotic disease infectious disease Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Monkeypox is a viral zoonotic disease caused by the monkeypox virus, which belongs to the same family of viruses as smallpox.( 1 ) It was first discovered in 1958 among laboratory monkeys, hence the name, although it is primarily spread through rodents and other animals. ( 2 ) Human cases were first recorded in the Democratic Republic of the Congo in 1970, and since then, outbreaks have been reported in various parts of Central and West Africa, with occasional cases linked to travel or imported animals. ( 3 ) The virus is transmitted to humans through direct contact with an infected animal's blood, bodily fluids, or skin lesions. Human-to-human transmission can also occur through respiratory droplets, close physical contact, or contaminated materials like bedding. ( 4 ) The symptoms of monkeypox are similar to, but milder than, those of smallpox, including fever, headache, muscle aches, and a characteristic rash that often starts on the face and spreads to other parts of the body. While monkeypox is generally less severe than smallpox, it can be serious, particularly in children or individuals with weakened immune systems.( 5 ) Public health measures, including vaccination and isolation of cases, are important in controlling outbreaks. Recent years have seen increased global attention to monkeypox due to its spread beyond endemic regions, highlighting the need for vigilant monitoring and response to prevent further transmission.( 6 ) The burden of monkeypox disease is particularly evident in Central and West Africa, where the disease is endemic. Since its discovery in 1970, over 19,000 cases have been reported in these regions, with the Democratic Republic of the Congo (DRC) being the most affected, accounting for approximately 70% of global cases. The case fatality rate (CFR) of monkeypox varies significantly depending on the strain, with the Congo Basin strain having a higher CFR of up to 10%, compared to the West African strain, which has a CFR of around 1–3%. ( 7 ) The disease disproportionately affects rural and impoverished communities, where access to healthcare is limited, leading to delays in diagnosis and treatment. This contributes to higher morbidity and mortality rates. During outbreaks, healthcare systems in these regions can become overwhelmed, with significant economic impacts. For instance, the 2017 outbreak in Nigeria resulted in over 200 confirmed cases, leading to substantial public health expenditures and economic disruption.( 6 ) Furthermore, monkeypox outbreaks can lead to disruptions in trade and agriculture, particularly in areas dependent on livestock and wildlife. For example, during the 2003 outbreak in the United States, linked to the importation of infected rodents from Africa, the cost of managing the outbreak, including public health interventions and animal quarantines, was estimated to be in the millions of dollars. The outbreak also led to increased regulatory scrutiny and trade restrictions, impacting international commerce.( 8 ) In recent years, the global burden of monkeypox has gained more attention due to its spread beyond Africa, with cases reported in Europe, the Americas, and Asia. The World Health Organization (WHO) has noted a significant increase in the number of cases since 2016, highlighting the need for better surveillance, vaccination, and response strategies to mitigate the disease's impact both in endemic regions and globally. ( 9 ) Aim The aim of this study is to conduct a comprehensive bibliometric analysis of the scientific literature on monkeypox published in the SCOPUS database during the period from 2022 to 2024. This analysis seeks to identify trends in research output, key contributing authors, institutions, and countries, as well as the most influential publications and thematic areas of focus. By examining citation patterns, collaboration networks, and the evolution of research topics, this study aims to provide insights into the global research landscape on monkeypox, highlighting areas of significant scientific interest and identifying potential gaps in the current knowledge base. The findings of this analysis will inform future research directions and public health strategies, particularly in the context of the recent resurgence of monkeypox and its spread beyond traditionally endemic regions. 1. Materials and Methods Bibliometric data were obtained from the Scopus database, which is known for its reliability in indexing and abstracting, to analyze publishing trends and patterns related to Monkeypox. The search was conducted using the following queries in the Article, title, abstract, and keyword fields within the Scopus core collection. ( TITLE-ABS-KEY ( monkeypox ) OR TITLE-ABS-KEY ( "monkeypox virus" ) OR TITLE-ABS-KEY ( mpxv ) ) AND PUBYEAR > 2021 AND PUBYEAR < 2025 AND ( LIMIT-TO ( DOCTYPE , "ar" ) OR LIMIT-TO ( DOCTYPE , "re" ) ) AND ( LIMIT-TO ( PUBSTAGE , "final" ) ) AND ( LIMIT-TO ( SRCTYPE , "j" ) ) AND ( LIMIT-TO ( LANGUAGE , "English" ) ) The query was further refined by publication years (2022 to 2024) and document types (article or review article ). Letters, Notes, Editorial, Erratum, Short survey, Conference paper, and Data paper were excluded. Documents published only in English and in the final stage were included in this study. Finally, the 2966 records (articles = 2381 and review articles = 585) were imported and downloaded in CSV format formats on 24 th Aug 2024. A bibliometric analysis was performed using Biblioshiny, a free, web-based interface compatible with the R operating system(10), VOS viewer, a tool for bibliometric analysis and visualization(11) and MS Excel. The primary data is detailed in Table 1. This study is based on a thorough dataset encompassing materials from 2020 to August 24, 2024, specifically for analyzing Monkeypox. The dataset includes 2,966 documents from 994 pertinent sources, indicating substantial research efforts in this domain. 2. Results In 2022, 740 publications on Monkeypox were documented, averaging 9.6 citations annually. In 2023, the number of publications surged to 1,550, more than twice the previous year's total, with an average of 3.7 citations per year. From January 2024 to August 24, 2024, 676 publications were recorded, averaging 1 citation annually. This indicates significant global research interest in Monkeypox. 3. Most Productive Countries and Organizations The countries leading in monkeypox research are those that have published the most articles in the field. Table 2 highlights the top 10 countries and organizations globally that have contributed to Monkeypox literature, each with over 100 publications from 2022 to August 24, 2024. Only three countries have produced more than 300 publications. The United States tops the list with 851 publications, 6612 citations, and an average of 11.90 citations per publication. China follows with 383 publications, 2586 citations, and an average of 7.60 citations, while India has 385 publications, 1365 citations, and an average of 6.20 citations. Although the UK ranks fourth in terms of publication numbers, it holds the second-highest citation count. Among the top 10 organizations, the Centers for Disease Control and Prevention leads with 78 publications in the Scopus database, followed by Harvard Medical School with 51 documents, King Saud University with 49 documents, and the Chinese Academy of Sciences with 42 documents. 4. Influential Research Journals Table 3 highlights the leading ten research journals publishing literature on Monkeypox. Among these, the top four journals contributed over 50 publications, with two journals exceeding 70 publications each. The Journal of Medical Virology, based in the United States, with an impact factor of 6.8, stands out as the most prolific, generating 106 publications. Following closely is the Emerging Infectious Diseases journal from the U.S., with an impact factor of 7.2, ranks 10th among 132 infectious disease journals and 4th among open-access journals, contributing 73 publications. The journal Vaccines from Switzerland, with an impact factor of 5.2, published 69 articles. Of the top 10 journals, the majority are from the USA (4) and Switzerland (3), with one each from the United Kingdom, Sweden, and Switzerland. 5. Authorship Analysis A total of 159 authors contributed to the Monkeypox-related articles analyzed. Out of 2,966 articles, 244 were authored by prolific researchers, representing 5.3% of the total publications. Sah, R. from Tribhuvan University Teaching Hospital in Kathmandu, Nepal, was the most prolific contributor, with 42 papers (Fig. 1 ). The top-cited article was authored by Thornhill J.P. et al., published on August 25, 2022, titled 'Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. 6. Word Cloud of Authors Keywords Figure 2 displays the top 50 author keywords in a word cloud, with the size of each keyword corresponding to its frequency. Notably, 'monkeypox' and 'human' are the most prominent terms, while other frequently used keywords include 'monkeypox virus,' 'male,' 'vaccination,' 'adult,' 'epidemic,' and 'HIV infection,' all of which were common in monkeypox research from 2022 to 2024. Keywords such as 'monkeypox' and 'human' appear larger in the word cloud, signifying their higher usage, whereas the remaining keywords have smaller dimensions, indicating their relatively lower frequency. Additionally, the less frequently used keywords are represented with minimal prominence in the word cloud, reflecting their insignificant occurrence rates. 7. Highly Cited Articles Table 4 presents the ten most frequently cited articles on Monkeypox, with all of them notably published in 2022. Two articles were published in The Lancet Infectious Disease, and the remaining eight were published in different journals. Half of the articles got over 400 citations. The article entitled “Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022” by “Thornhill J.P. et al.” published in (10), (12)got the highest number of citations (1234). The article at the bottom of the list, "Community transmission of monkeypox in the United Kingdom, April to May 2022“ by Vivancos, Roberto et al., received 256 citations.(13) 8. Three-Factor Analyses of Major Aspects of the Data The relationship among countries (left), keywords (middle), and authors' affiliated organizations (right) is depicted in Fig. 3 using a three-factor analysis. The analysis reveals that five countries (USA, China, Italy, Spain, and Germany) have predominantly contributed to Monkeypox literature, focusing on fourteen key terms (Monkeypox, mpox, monkeypox virus, HIV, Orthopox virus, outbreak, epidemiology, tecovirimat, vaccination, mpxv, mpox, vaccine, COVID-19, and public health). These countries and keywords are closely associated with five major organizations: Sun Yat-sen University (China), Centers for Disease Control and Prevention (USA), National Institute of Infectious Diseases Lazzaro Spallanzani (Italy), and Institute of Tropical Medicine (Belgium). 9. Active Funding Agencies Out of 2996 articles analyzed, 1992 (67.5%) received support from 159 funding agencies, while 1004 (33.5%) were not funded. The National Natural Science Foundation of China was the top funder, supporting 164 of the funded articles. 10. Co-author and Keyword Co-occurrence The co-author map was configured to include documents authored by at least ten individuals as a selection criterion, resulting in 34 authors meeting the requirement. VOSviewer then created a co-author map comprising 15 items with a link strength of 104 and organized into four clusters. For the author keyword co-occurrence map, the threshold was set to a minimum of 25 keyword occurrences. Out of 4,468 keywords, 41 met this criterion and were included. The resulting VOSviewer map displays 41 items across six clusters with a total link strength of 1,325. Figures 4 and 5 illustrate the co-author and keyword co-occurrence maps, respectively. 11. Country Collaboration Map on COVID-19 Literature Table 5 and Fig. 6 illustrate global collaboration on Monkeypox research. A total of 2,136 international partnerships are recorded, with the highest single collaboration count being 57. The United States and the United Kingdom lead with 57 collaborations, followed by Saudi Arabia and Pakistan with 56, and the USA and India with 37. India and Saudi Arabia have 46 collaborations, while the USA and Canada share 41. Other countries listed in the table have fewer than 40 collaborations. Discussion The bibliometric analysis of monkeypox literature from 2022 to 2024 reveals several important trends and patterns that reflect the global scientific community's response to the recent monkeypox outbreaks. A significant finding is the rapid increase in publications during this period, with the number of studies rising from 740 in 2022 to 1,550 in 2023. This more than two-fold increase likely stems from the global spread of monkeypox, particularly as cases were reported in non-endemic regions for the first time. The urgency to understand the virus, its transmission, and potential treatments likely drove researchers worldwide to focus their efforts on this emerging health threat. Interestingly, despite the surge in publications, the average number of citations per article decreased from 9.6 in 2022 to 3.7 in 2023 and further to 1.0 in 2024. This decline can be attributed to the fact that older publications naturally accumulate more citations over time, while more recent publications have had less time to be cited. Additionally, as the volume of literature expanded, the attention of the research community may have been spread across a wider array of studies, leading to fewer citations per individual article. Geographically, the United States emerged as the leader in both the number of publications (851) and total citations (6,612). This dominance can be linked to the robust research infrastructure in the U.S., which includes significant funding for infectious disease research and strong international collaborations. The prominence of U.S.-based institutions like the Centers for Disease Control and Prevention (CDC) and Harvard Medical School further underscores the country's leading role in this area of research. Meanwhile, China and India also contributed substantially, although their publications had lower average citation counts, possibly due to language barriers, fewer international collaborations, or different research dissemination practices. In terms of journal contributions, the "Journal of Medical Virology" and "Emerging Infectious Diseases" were the most prolific sources of monkeypox literature. These journals, known for their focus on virology and infectious diseases, were likely chosen by researchers for their high impact factors and broad readership, ensuring that their findings reached a wide audience. The preference for these journals indicates the critical importance of disseminating monkeypox research in highly regarded, specialized publications. The analysis also highlighted the contributions of individual authors and the impact of specific papers. Notably, R. Sah from Tribhuvan University was identified as the most prolific author, while the most highly cited paper, by Thornhill J.P. et al., focused on monkeypox virus infection across 16 countries and was published in the prestigious "New England Journal of Medicine." This paper's high citation count reflects its relevance during the early stages of the global outbreak, emphasizing the importance of international collaboration in producing influential research. Keyword analysis revealed that terms such as "monkeypox virus," "vaccination," and "HIV infection" were frequently used, indicating that these were key areas of focus. The connection between monkeypox and HIV suggests a particular interest in studying the disease's impact on immunocompromised populations. This focus on vaccination and public health further underscores the urgent need to develop effective prevention strategies and manage public health responses to monkeypox. The country collaboration map revealed extensive international cooperation, particularly between the USA and the UK, and between Saudi Arabia and Pakistan. These collaborations are likely driven by the global nature of the outbreak and the need to share data and resources effectively. The strong partnership between the USA and India reflects strategic collaborations in global health initiatives, particularly in managing large at-risk populations. In summary, the findings of this bibliometric analysis highlight the intense research focus on monkeypox following the global outbreaks, with a significant contribution from leading countries and institutions. The results emphasize the importance of international collaboration and the role of research in informing public health strategies to combat emerging infectious diseases. These trends demonstrate the scientific community's rapid response to the challenges posed by monkeypox and underline the critical need for continued research and global cooperation. The bibliometric analysis of monkeypox literature from 2022 to 2024, while comprehensive, is subject to several limitations that should be acknowledged. First, the analysis is confined to articles and review articles published in English and indexed in the SCOPUS database. This exclusion of non-English publications and other document types like conference papers and editorials may have resulted in an incomplete picture of the global research landscape, potentially overlooking important contributions from non-English-speaking countries or emerging research areas presented in conferences. Additionally, the study's reliance on citation counts as a measure of impact might not fully capture the influence of newer publications or those in less-cited but highly specialized journals. Another limitation is the focus on the period from 2022 to 2024, which, while relevant due to the recent outbreaks, may not reflect long-term research trends or historical context. The analysis might also be biased by the sudden surge in publications following the outbreak, which could skew the understanding of the overall research development and the depth of studies conducted before this period. For future research, it would be valuable to expand the analysis to include non-English literature and a broader range of document types to gain a more holistic understanding of the global research efforts on monkeypox. Longitudinal studies that track research trends over a more extended period could also provide insights into how the focus and impact of monkeypox research evolve over time. Additionally, qualitative assessments of research quality, such as peer-review rigor or real-world impact on public health policies, could complement citation-based metrics, offering a more nuanced evaluation of the literature's significance. Exploring interdisciplinary research that integrates insights from virology, public health, sociology, and economics could also be crucial in addressing the multifaceted challenges posed by monkeypox, especially as the disease continues to spread beyond traditional endemic regions. 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Plot\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7601560/v1/b421e630a7e9f78a86a530a2.png"},{"id":91512555,"identity":"238afb30-bd06-4ed9-b3fc-467dbebfcfc7","added_by":"auto","created_at":"2025-09-17 08:53:59","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":124664,"visible":true,"origin":"","legend":"\u003cp\u003eCo-author Map\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7601560/v1/45d77f4d3655902c49cef381.png"},{"id":91512526,"identity":"6df35aeb-79be-4c5a-93dc-d6558ce3090a","added_by":"auto","created_at":"2025-09-17 08:53:58","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":318157,"visible":true,"origin":"","legend":"\u003cp\u003eKeyword Co-occurrence Map\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7601560/v1/5bd25ac3badf97bf40157280.png"},{"id":91512578,"identity":"03fe28d2-df7a-4ed3-89cf-822f6b2d9fae","added_by":"auto","created_at":"2025-09-17 08:54:00","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":291057,"visible":true,"origin":"","legend":"\u003cp\u003eCountry Collaboration Map\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7601560/v1/901dbd7a570a332d12db3ae6.png"},{"id":91513439,"identity":"96b5c3c9-dc3e-4ac4-9eca-bd233feb4ec1","added_by":"auto","created_at":"2025-09-17 09:02:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1803707,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7601560/v1/001e7bbf-21c8-4601-84c9-c279563a2115.pdf"},{"id":91512547,"identity":"a51fb9fb-31d4-4354-980f-c3c7d77efefc","added_by":"auto","created_at":"2025-09-17 08:53:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":506513,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7601560/v1/6032115c5879936685256e1b.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eMapping the Intellectual Landscape: A Bibliometric Analysis of Monkeypox Literature\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMonkeypox is a viral zoonotic disease caused by the monkeypox virus, which belongs to the same family of viruses as smallpox.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) It was first discovered in 1958 among laboratory monkeys, hence the name, although it is primarily spread through rodents and other animals. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Human cases were first recorded in the Democratic Republic of the Congo in 1970, and since then, outbreaks have been reported in various parts of Central and West Africa, with occasional cases linked to travel or imported animals. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) The virus is transmitted to humans through direct contact with an infected animal's blood, bodily fluids, or skin lesions. Human-to-human transmission can also occur through respiratory droplets, close physical contact, or contaminated materials like bedding. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) The symptoms of monkeypox are similar to, but milder than, those of smallpox, including fever, headache, muscle aches, and a characteristic rash that often starts on the face and spreads to other parts of the body. While monkeypox is generally less severe than smallpox, it can be serious, particularly in children or individuals with weakened immune systems.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Public health measures, including vaccination and isolation of cases, are important in controlling outbreaks. Recent years have seen increased global attention to monkeypox due to its spread beyond endemic regions, highlighting the need for vigilant monitoring and response to prevent further transmission.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) The burden of monkeypox disease is particularly evident in Central and West Africa, where the disease is endemic. Since its discovery in 1970, over 19,000 cases have been reported in these regions, with the Democratic Republic of the Congo (DRC) being the most affected, accounting for approximately 70% of global cases. The case fatality rate (CFR) of monkeypox varies significantly depending on the strain, with the Congo Basin strain having a higher CFR of up to 10%, compared to the West African strain, which has a CFR of around 1\u0026ndash;3%. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) The disease disproportionately affects rural and impoverished communities, where access to healthcare is limited, leading to delays in diagnosis and treatment. This contributes to higher morbidity and mortality rates. During outbreaks, healthcare systems in these regions can become overwhelmed, with significant economic impacts. For instance, the 2017 outbreak in Nigeria resulted in over 200 confirmed cases, leading to substantial public health expenditures and economic disruption.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Furthermore, monkeypox outbreaks can lead to disruptions in trade and agriculture, particularly in areas dependent on livestock and wildlife. For example, during the 2003 outbreak in the United States, linked to the importation of infected rodents from Africa, the cost of managing the outbreak, including public health interventions and animal quarantines, was estimated to be in the millions of dollars. The outbreak also led to increased regulatory scrutiny and trade restrictions, impacting international commerce.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIn recent years, the global burden of monkeypox has gained more attention due to its spread beyond Africa, with cases reported in Europe, the Americas, and Asia. The World Health Organization (WHO) has noted a significant increase in the number of cases since 2016, highlighting the need for better surveillance, vaccination, and response strategies to mitigate the disease's impact both in endemic regions and globally. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003cp\u003eThe aim of this study is to conduct a comprehensive bibliometric analysis of the scientific literature on monkeypox published in the SCOPUS database during the period from 2022 to 2024. This analysis seeks to identify trends in research output, key contributing authors, institutions, and countries, as well as the most influential publications and thematic areas of focus. By examining citation patterns, collaboration networks, and the evolution of research topics, this study aims to provide insights into the global research landscape on monkeypox, highlighting areas of significant scientific interest and identifying potential gaps in the current knowledge base. The findings of this analysis will inform future research directions and public health strategies, particularly in the context of the recent resurgence of monkeypox and its spread beyond traditionally endemic regions.\u003c/p\u003e\u003c/p\u003e"},{"header":"1. Materials and Methods","content":"\u003cp\u003eBibliometric data were obtained from the Scopus database, which is known for its reliability in indexing and abstracting, to analyze publishing trends and patterns related to Monkeypox. The search was conducted using the following queries in the Article, title, abstract, and keyword fields within the Scopus core collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e( TITLE-ABS-KEY ( monkeypox ) OR TITLE-ABS-KEY ( \"monkeypox virus\" ) OR TITLE-ABS-KEY ( mpxv ) ) AND PUBYEAR \u0026gt; 2021 AND PUBYEAR \u0026lt; 2025 AND ( LIMIT-TO ( DOCTYPE , \"ar\" ) OR LIMIT-TO ( DOCTYPE , \"re\" ) ) AND ( LIMIT-TO ( PUBSTAGE , \"final\" ) ) AND ( LIMIT-TO ( SRCTYPE , \"j\" ) ) AND ( LIMIT-TO ( LANGUAGE , \"English\" ) )\u003c/p\u003e\n\u003cp\u003eThe query was further refined by publication years \u0026nbsp;(2022 to 2024) and document types (article or review article ). Letters, Notes, Editorial, Erratum, Short survey, Conference paper, and Data paper were excluded. Documents published only in English and in the final stage were included in this study. Finally, the 2966 records (articles = 2381 and review articles = 585) were imported and downloaded in CSV format formats on 24\u003csup\u003eth\u003c/sup\u003e Aug 2024.\u003c/p\u003e\n\u003cp\u003eA bibliometric analysis was performed using Biblioshiny, a free, web-based interface compatible with the R operating system(10), VOS viewer, a tool for bibliometric analysis and visualization(11) and \u0026nbsp;MS Excel. The primary data is detailed in Table 1. This study is based on a thorough dataset encompassing materials from 2020 to August 24, 2024, specifically for analyzing Monkeypox. The dataset includes 2,966 documents from 994 pertinent sources, indicating substantial research efforts in this domain.\u003c/p\u003e"},{"header":"2. Results","content":"\u003cp\u003eIn 2022, 740 publications on Monkeypox were documented, averaging 9.6 citations annually. In 2023, the number of publications surged to 1,550, more than twice the previous year's total, with an average of 3.7 citations per year. From January 2024 to August 24, 2024, 676 publications were recorded, averaging 1 citation annually. This indicates significant global research interest in Monkeypox.\u003c/p\u003e"},{"header":"3. Most Productive Countries and Organizations","content":"\u003cp\u003eThe countries leading in monkeypox research are those that have published the most articles in the field. Table 2 highlights the top 10 countries and organizations globally that have contributed to Monkeypox literature, each with over 100 publications from 2022 to August 24, 2024. Only three countries have produced more than 300 publications. The United States tops the list with 851 publications, 6612 citations, and an average of 11.90 citations per publication. China follows with 383 publications, 2586 citations, and an average of 7.60 citations, while India has 385 publications, 1365 citations, and an average of 6.20 citations. Although the UK ranks fourth in terms of publication numbers, it holds the second-highest citation count. Among the top 10 organizations, the Centers for Disease Control and Prevention leads with 78 publications in the Scopus database, followed by Harvard Medical School with 51 documents, King Saud University with 49 documents, and the Chinese Academy of Sciences with 42 documents.\u003c/p\u003e"},{"header":"4. Influential Research Journals","content":"\u003cp\u003eTable 3 highlights the leading ten research journals publishing literature on Monkeypox. Among these, the top four journals contributed over 50 publications, with two journals exceeding 70 publications each. The Journal of Medical Virology, based in the United States, with an impact factor of 6.8, stands out as the most prolific, generating 106 publications. Following closely is the Emerging Infectious Diseases journal from the U.S., with an impact factor of 7.2, ranks 10th among 132 infectious disease journals and 4th among open-access journals, contributing 73 publications. The journal Vaccines from Switzerland, with an impact factor of 5.2, published 69 articles. Of the top 10 journals, the majority are from the USA (4) and Switzerland (3), with one each from the United Kingdom, Sweden, and Switzerland.\u003c/p\u003e"},{"header":"5. Authorship Analysis","content":"\u003cp\u003eA total of 159 authors contributed to the Monkeypox-related articles analyzed. Out of 2,966 articles, 244 were authored by prolific researchers, representing 5.3% of the total publications. Sah, R. from Tribhuvan University Teaching Hospital in Kathmandu, Nepal, was the most prolific contributor, with 42 papers (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The top-cited article was authored by Thornhill J.P. et al., published on August 25, 2022, titled 'Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022.\u003c/p\u003e"},{"header":"6. Word Cloud of Authors Keywords","content":"\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e displays the top 50 author keywords in a word cloud, with the size of each keyword corresponding to its frequency. Notably, 'monkeypox' and 'human' are the most prominent terms, while other frequently used keywords include 'monkeypox virus,' 'male,' 'vaccination,' 'adult,' 'epidemic,' and 'HIV infection,' all of which were common in monkeypox research from 2022 to 2024. Keywords such as 'monkeypox' and 'human' appear larger in the word cloud, signifying their higher usage, whereas the remaining keywords have smaller dimensions, indicating their relatively lower frequency. Additionally, the less frequently used keywords are represented with minimal prominence in the word cloud, reflecting their insignificant occurrence rates.\u003c/p\u003e"},{"header":"7. Highly Cited Articles","content":"\u003cp\u003eTable 4 presents the ten most frequently cited articles on Monkeypox, with all of them notably published in 2022. Two articles were published in The Lancet Infectious Disease, and the remaining eight were published in different journals. Half of the articles got over 400 citations. The article entitled “Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022” by “Thornhill J.P. et al.” published in \u0026nbsp;(10), (12)got the highest number of citations (1234). The article at the bottom of the list, \"Community transmission of monkeypox in the United Kingdom, April to May 2022“ by Vivancos, Roberto et al., received 256 citations.(13)\u0026nbsp;\u003c/p\u003e"},{"header":"8. Three-Factor Analyses of Major Aspects of the Data","content":"\u003cp\u003eThe relationship among countries (left), keywords (middle), and authors' affiliated organizations (right) is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e using a three-factor analysis. The analysis reveals that five countries (USA, China, Italy, Spain, and Germany) have predominantly contributed to Monkeypox literature, focusing on fourteen key terms (Monkeypox, mpox, monkeypox virus, HIV, Orthopox virus, outbreak, epidemiology, tecovirimat, vaccination, mpxv, mpox, vaccine, COVID-19, and public health). These countries and keywords are closely associated with five major organizations: Sun Yat-sen University (China), Centers for Disease Control and Prevention (USA), National Institute of Infectious Diseases Lazzaro Spallanzani (Italy), and Institute of Tropical Medicine (Belgium).\u003c/p\u003e"},{"header":"9. Active Funding Agencies","content":"\u003cp\u003eOut of 2996 articles analyzed, 1992 (67.5%) received support from 159 funding agencies, while 1004 (33.5%) were not funded. The National Natural Science Foundation of China was the top funder, supporting 164 of the funded articles.\u003c/p\u003e"},{"header":"10. Co-author and Keyword Co-occurrence","content":"\u003cp\u003eThe co-author map was configured to include documents authored by at least ten individuals as a selection criterion, resulting in 34 authors meeting the requirement. VOSviewer then created a co-author map comprising 15 items with a link strength of 104 and organized into four clusters. For the author keyword co-occurrence map, the threshold was set to a minimum of 25 keyword occurrences. Out of 4,468 keywords, 41 met this criterion and were included. The resulting VOSviewer map displays 41 items across six clusters with a total link strength of 1,325. Figures\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e illustrate the co-author and keyword co-occurrence maps, respectively.\u003c/p\u003e"},{"header":"11. Country Collaboration Map on COVID-19 Literature","content":"\u003cp\u003eTable\u0026nbsp;5 and Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e illustrate global collaboration on Monkeypox research. A total of 2,136 international partnerships are recorded, with the highest single collaboration count being 57. The United States and the United Kingdom lead with 57 collaborations, followed by Saudi Arabia and Pakistan with 56, and the USA and India with 37. India and Saudi Arabia have 46 collaborations, while the USA and Canada share 41. Other countries listed in the table have fewer than 40 collaborations.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe bibliometric analysis of monkeypox literature from 2022 to 2024 reveals several important trends and patterns that reflect the global scientific community's response to the recent monkeypox outbreaks. A significant finding is the rapid increase in publications during this period, with the number of studies rising from 740 in 2022 to 1,550 in 2023. This more than two-fold increase likely stems from the global spread of monkeypox, particularly as cases were reported in non-endemic regions for the first time. The urgency to understand the virus, its transmission, and potential treatments likely drove researchers worldwide to focus their efforts on this emerging health threat.\u003c/p\u003e\u003cp\u003eInterestingly, despite the surge in publications, the average number of citations per article decreased from 9.6 in 2022 to 3.7 in 2023 and further to 1.0 in 2024. This decline can be attributed to the fact that older publications naturally accumulate more citations over time, while more recent publications have had less time to be cited. Additionally, as the volume of literature expanded, the attention of the research community may have been spread across a wider array of studies, leading to fewer citations per individual article. Geographically, the United States emerged as the leader in both the number of publications (851) and total citations (6,612). This dominance can be linked to the robust research infrastructure in the U.S., which includes significant funding for infectious disease research and strong international collaborations. The prominence of U.S.-based institutions like the Centers for Disease Control and Prevention (CDC) and Harvard Medical School further underscores the country's leading role in this area of research. Meanwhile, China and India also contributed substantially, although their publications had lower average citation counts, possibly due to language barriers, fewer international collaborations, or different research dissemination practices. In terms of journal contributions, the \"Journal of Medical Virology\" and \"Emerging Infectious Diseases\" were the most prolific sources of monkeypox literature. These journals, known for their focus on virology and infectious diseases, were likely chosen by researchers for their high impact factors and broad readership, ensuring that their findings reached a wide audience. The preference for these journals indicates the critical importance of disseminating monkeypox research in highly regarded, specialized publications.\u003c/p\u003e\u003cp\u003eThe analysis also highlighted the contributions of individual authors and the impact of specific papers. Notably, R. Sah from Tribhuvan University was identified as the most prolific author, while the most highly cited paper, by Thornhill J.P. et al., focused on monkeypox virus infection across 16 countries and was published in the prestigious \"New England Journal of Medicine.\" This paper's high citation count reflects its relevance during the early stages of the global outbreak, emphasizing the importance of international collaboration in producing influential research. Keyword analysis revealed that terms such as \"monkeypox virus,\" \"vaccination,\" and \"HIV infection\" were frequently used, indicating that these were key areas of focus. The connection between monkeypox and HIV suggests a particular interest in studying the disease's impact on immunocompromised populations. This focus on vaccination and public health further underscores the urgent need to develop effective prevention strategies and manage public health responses to monkeypox. The country collaboration map revealed extensive international cooperation, particularly between the USA and the UK, and between Saudi Arabia and Pakistan. These collaborations are likely driven by the global nature of the outbreak and the need to share data and resources effectively. The strong partnership between the USA and India reflects strategic collaborations in global health initiatives, particularly in managing large at-risk populations.\u003c/p\u003e\u003cp\u003eIn summary, the findings of this bibliometric analysis highlight the intense research focus on monkeypox following the global outbreaks, with a significant contribution from leading countries and institutions. The results emphasize the importance of international collaboration and the role of research in informing public health strategies to combat emerging infectious diseases. These trends demonstrate the scientific community's rapid response to the challenges posed by monkeypox and underline the critical need for continued research and global cooperation. The bibliometric analysis of monkeypox literature from 2022 to 2024, while comprehensive, is subject to several limitations that should be acknowledged. First, the analysis is confined to articles and review articles published in English and indexed in the SCOPUS database. This exclusion of non-English publications and other document types like conference papers and editorials may have resulted in an incomplete picture of the global research landscape, potentially overlooking important contributions from non-English-speaking countries or emerging research areas presented in conferences. Additionally, the study's reliance on citation counts as a measure of impact might not fully capture the influence of newer publications or those in less-cited but highly specialized journals. Another limitation is the focus on the period from 2022 to 2024, which, while relevant due to the recent outbreaks, may not reflect long-term research trends or historical context. The analysis might also be biased by the sudden surge in publications following the outbreak, which could skew the understanding of the overall research development and the depth of studies conducted before this period.\u003c/p\u003e\u003cp\u003eFor future research, it would be valuable to expand the analysis to include non-English literature and a broader range of document types to gain a more holistic understanding of the global research efforts on monkeypox. Longitudinal studies that track research trends over a more extended period could also provide insights into how the focus and impact of monkeypox research evolve over time. Additionally, qualitative assessments of research quality, such as peer-review rigor or real-world impact on public health policies, could complement citation-based metrics, offering a more nuanced evaluation of the literature's significance. Exploring interdisciplinary research that integrates insights from virology, public health, sociology, and economics could also be crucial in addressing the multifaceted challenges posed by monkeypox, especially as the disease continues to spread beyond traditional endemic regions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUpadhayay S, Arthur R, Soni D, Yadav P, Navik US, Singh R et al (2022) Monkeypox infection: The past, present, and future. Int Immunopharmacol. ;113\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaragoz A, Tombuloglu H, Alsaeed M, Tombuloglu G, AlRubaish AA, Mahmoud A et al (2023) Monkeypox (mpox) virus: Classification, origin, transmission, genome organization, antiviral drugs, and molecular diagnosis. J Infect Public Health 16(4):531\u0026ndash;541\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbout Mpox | Mpox | Poxvirus | CDC [Internet]. [cited 2024 Aug 26]. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/35760647/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/35760647/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"monkey pox, zoonotic disease, infectious disease","lastPublishedDoi":"10.21203/rs.3.rs-7601560/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7601560/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMonkeypox, a viral zoonotic disease caused by the monkeypox virus, has garnered increasing global attention due to its recent outbreaks beyond traditionally endemic regions. First identified in laboratory monkeys in 1958, the virus primarily spreads through rodents and can infect humans via direct contact with infected animals or through human-to-human transmission. Since the first human case in 1970 in the Democratic Republic of the Congo (DRC), over 19,000 cases have been reported, primarily in Central and West Africa, with the DRC accounting for about 70% of global cases. The disease has a varying case fatality rate (CFR) depending on the strain, with the Congo Basin strain being more lethal (up to 10%) compared to the West African strain (1\u0026ndash;3%). The recent global spread of monkeypox has led to significant research efforts aimed at understanding the virus and developing effective control strategies. This study conducted a comprehensive bibliometric analysis of monkeypox literature from 2022 to 2024, using data from the SCOPUS database. The analysis identified a rapid increase in publications during this period, reflecting the global scientific community's response to the monkeypox outbreaks. The United States led in both the number of publications and citations, followed by China and India, with notable contributions from institutions like the Centers for Disease Control and Prevention (CDC) and Harvard Medical School. Key journals such as the \"Journal of Medical Virology\" and \"Emerging Infectious Diseases\" were identified as major sources of monkeypox research. The study also highlighted significant international collaborations, particularly between the USA and the UK, and between Saudi Arabia and Pakistan. Keyword analysis revealed a focus on terms like \"monkeypox virus,\" \"vaccination,\" and \"HIV infection,\" indicating key areas of interest in the research community. However, the analysis is limited by its focus on English-language publications and the specific timeframe of 2022 to 2024. Future research should consider a broader range of document types and languages, as well as a more extended temporal analysis, to provide a more comprehensive understanding of global research trends on monkeypox.\u003c/p\u003e","manuscriptTitle":"Mapping the Intellectual Landscape: A Bibliometric Analysis of Monkeypox Literature","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 08:53:29","doi":"10.21203/rs.3.rs-7601560/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"290d1acd-34a3-4104-a8d7-58b75f97ab9e","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54638550,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2025-09-17T08:53:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 08:53:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7601560","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7601560","identity":"rs-7601560","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}