2022 年 4 月至 6 月 16 个国家人类感染猴痘病毒。

Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022.

机构信息

From the Blizard Institute and the SHARE Collaborative, Queen Mary University of London, and the Department of Infection and Immunity, Barts Health NHS Trust (J.P.T., V.A., C.M.O.), the Department of Genitourinary Medicine and Infectious Disease, Guys and St. Thomas' NHS Trust (A.N.), the Department of Sexual Health, Homerton University Hospital (I.R.), and the Clinical Infection Unit, St. George's University Hospitals NHS Foundation Trust (M.S.H.) - all in London; the Department of Medicine, Division of Infectious Diseases (S.B., L.B.H., M.B.K.), the J.D. MacLean Centre for Tropical Diseases (S.B.), the Research Institute of the McGill University Health Centre (S.B., M.B.K.), and the Chronic Viral Illness Service, Department of Medicine (M.B.K.), McGill University Health Centre, Montreal, and the Department of Medicine, University Health Network, University of Toronto (S.W.), the Division of Infectious Diseases and the MAP Centre for Urban Health Solutions, St. Michael's Hospital (D.T.), and the Department of Medicine, University of Toronto (D.T.), Toronto - all in Canada; University Hospital Bonn, Department of Medicine I, Bonn (J.R., C.B.), the Department of Infectious Diseases, St. Joseph Hospital, Berlin (P.M.), Medizinisches Versorgungszentrum (MVZ) München am Goetheplatz, Munich (S. Noe), and the Infektionsmedizinisches Centrum Hamburg (ICH) Study Center, Hamburg MVZ ICH Stadmitte, Hamburg (C.H.) - all in Germany; the National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome (A.A., F.M.), the Division of Infectious Disease, Luigi Sacco Hospital, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco (D.M.), and the Department of Infectious and Tropical Diseases, IRCCS-Ospedale San Raffaele (S. Nozza), Milan, the Clinic of Infectious Diseases, University of Modena, Modena (C.M.), and the Infectious Diseases Division, Department of Medical Sciences, Azienda Ospedale Universita, Padua (A.C.) - all in Italy; the Department of Infectious Diseases, Sorbonne University, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital (R.P., V.P.), and the Department of Infectious Diseases, Saint Louis Lariboisière Hospital, AP-HP, University of Paris Cité (C.P.), Paris, and the Department of Prevention and Community Health, Créteil Intercommunal Hospital, Créteil (C.P.) - all in France; the HIV Cure Research Center, Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University and Ghent University Hospital, Ghent (L.V.), and the HIV/STI Clinic, Institute of Tropical Medicine, Antwerp (E.F.) - both in Belgium; the Sackler Faculty of Medicine, Tel Aviv University, and the Israel Department of Infectious Diseases and Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (M.Y.); the Department of Dermatology, University Hospital La Paz, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Investigación Hospital Universitario La Paz (E.S.), and CIBERINFEC, Instituto de Salud Carlos III (J.L.B.), Madrid, and the Infectious Diseases Service, Hospital Clinic-IDIBAPS (Instituto de Investigaciones Biomédicas August Pi i Sunyer), University of Barcelona, Barcelona (J.L.B.) - all in Spain; Hospital de Curry Cabral-Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (F.M.M.); Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (A.G.); the Department of Infectious Diseases, University Hospital of Copenhagen, Hvidovre, Denmark (A.-B.E.H.); the Condesa Specialized Clinic, Mexico City (J.I.L.); the François-Xavier Bagnoud Center for Health and Human Rights at Harvard University, Boston (K.M.); and the Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland (J.N.).

出版信息

N Engl J Med. 2022 Aug 25;387(8):679-691. doi: 10.1056/NEJMoa2207323. Epub 2022 Jul 21.

DOI:10.1056/NEJMoa2207323

PMID:35866746

Abstract

BACKGROUND

Before April 2022, monkeypox virus infection in humans was seldom reported outside African regions where it is endemic. Currently, cases are occurring worldwide. Transmission, risk factors, clinical presentation, and outcomes of infection are poorly defined.

METHODS

We formed an international collaborative group of clinicians who contributed to an international case series to describe the presentation, clinical course, and outcomes of polymerase-chain-reaction-confirmed monkeypox virus infections.

RESULTS

We report 528 infections diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries. Overall, 98% of the persons with infection were gay or bisexual men, 75% were White, and 41% had human immunodeficiency virus infection; the median age was 38 years. Transmission was suspected to have occurred through sexual activity in 95% of the persons with infection. In this case series, 95% of the persons presented with a rash (with 64% having ≤10 lesions), 73% had anogenital lesions, and 41% had mucosal lesions (with 54 having a single genital lesion). Common systemic features preceding the rash included fever (62%), lethargy (41%), myalgia (31%), and headache (27%); lymphadenopathy was also common (reported in 56%). Concomitant sexually transmitted infections were reported in 109 of 377 persons (29%) who were tested. Among the 23 persons with a clear exposure history, the median incubation period was 7 days (range, 3 to 20). Monkeypox virus DNA was detected in 29 of the 32 persons in whom seminal fluid was analyzed. Antiviral treatment was given to 5% of the persons overall, and 70 (13%) were hospitalized; the reasons for hospitalization were pain management, mostly for severe anorectal pain (21 persons); soft-tissue superinfection (18); pharyngitis limiting oral intake (5); eye lesions (2); acute kidney injury (2); myocarditis (2); and infection-control purposes (13). No deaths were reported.

CONCLUSIONS

In this case series, monkeypox manifested with a variety of dermatologic and systemic clinical findings. The simultaneous identification of cases outside areas where monkeypox has traditionally been endemic highlights the need for rapid identification and diagnosis of cases to contain further community spread.

摘要

背景

在 2022 年 4 月之前，人类感染猴痘病毒的情况很少在该病毒流行的非洲地区以外的地区报告。目前，猴痘病例正在全球范围内发生。其传播途径、危险因素、临床表现和转归仍不清楚。

方法

我们组建了一个国际临床医生合作小组，该小组对一项国际病例系列研究做出了贡献，以描述聚合酶链反应确诊的猴痘病毒感染的临床表现、临床病程和结局。

结果

我们报告了 2022 年 4 月 27 日至 6 月 24 日在 16 个国家的 43 个地点诊断的 528 例感染。总体而言，98%的感染者为男同性恋或双性恋者，75%为白人，41%有人免疫缺陷病毒感染；中位年龄为 38 岁。95%的感染者怀疑是通过性行为传播的。在本病例系列研究中，95%的感染者出现皮疹（64%有≤10 个皮损），73%有生殖器皮损，41%有黏膜皮损（54%有单一生殖器皮损）。皮疹出现前常见的全身症状包括发热（62%）、乏力（41%）、肌痛（31%）和头痛（27%）；淋巴结病也很常见（277 例中有 109 例报告）。在接受检测的 377 名中有合并性传播感染的患者中，有 109 例（29%）报告。在 23 例有明确接触史的患者中，潜伏期中位数为 7 天（范围为 3~20 天）。在 32 名分析了精液的患者中，有 29 名检测到猴痘病毒 DNA。总的来说，给予 5%的患者抗病毒治疗，70 例（13%）住院；住院的原因是疼痛管理，主要是严重的肛门直肠疼痛（21 例）；软组织继发感染（18 例）；咽痛限制口服摄入（5 例）；眼部病变（2 例）；急性肾损伤（2 例）；心肌炎（2 例）；感染控制目的（13 例）。没有报告死亡。