To discuss the validity and limitations of using the test-negative design (TND) for studying mpox risk factors and vaccine efficacy during the outbreak, with a focus on specific challenges.
Key Findings:
Stigma surrounding mpox affects individuals' decisions to seek healthcare, violating the assumption of similar healthcare-seeking behavior in TND.
Differential diagnoses of mpox may lead to selection bias, as not all relevant cases are included in epidemiological databases.
Testing policies vary by country, introducing further selection bias in TND studies, which may skew results.
Interpretation:
The TND may not be a valid design for studying mpox due to inherent biases and limitations specific to the disease's outbreak context, necessitating consideration of alternative study designs.
Limitations:
Stigma affecting healthcare-seeking behavior.
Differential diagnoses not included in databases.
Variability in testing policies across different regions, which may impact data reliability.
Conclusion:
While the TND has potential for studying mpox, careful consideration of its limitations is necessary to ensure valid results, and alternative methods should be explored.
