Sexually Transmitted Diseases Clinic, Dermatology Department, Hospital Clinic, Barcelona, Spain.
Centro Sandoval, Dermatology Department, Hospital Clínico San Carlos, Madrid, Spain.
Br J Dermatol. 2022 Nov;187(5):765-772. doi: 10.1111/bjd.21790. Epub 2022 Aug 20.
Since May 2022, a new outbreak of monkeypox has been reported in several countries, including Spain. The clinical and epidemiological characteristics of the cases in this outbreak may differ from those in earlier reports.
To document the clinical and epidemiological characteristics of cases of monkeypox in the current outbreak.
We conducted a prospective cross-sectional study in multiple medical facilities in Spain to describe the cases of monkeypox in the 2022 outbreak.
In total, 185 patients were included. Most cases started with primarily localized homogeneous papules, not pustules, in the probable area of inoculation, which could be cutaneous or mucous, including single lesions. Generalized small pustules appeared later in some of them. Heterogeneous lesions occurred during this generalized phase. All patients had systemic symptoms. Less common lesions included mucosal ulcers (including pharyngeal ulcers and proctitis) and monkeypox whitlows. Four patients were hospitalized, none died. Smallpox vaccination and well-controlled HIV disease were not associated with markers of severity. Contact during sex is the most likely mechanism of transmission. In this outbreak, cases have been described in men who have sex with men and are strongly associated with high-risk sexual behaviours. Seventy-six per cent of the patients had other sexually transmitted diseases upon screening.
The clinical findings in this outbreak differ from previous findings and highly suggest contact transmission and initiation at the entry site. The characterization of the epidemiology of this outbreak has implications for control. What is already known about this topic? Monkeypox eruption is described as consisting of pustules. The roles of HIV and previous smallpox vaccination in the prognosis are unknown. The transmission route was initially described as respiratory droplets and was later suggested to be via sexual contact. What does this study add? Initial lesions at the probable inoculation area were homogeneous and papular (pseudopustules). Generalized small pustules appeared later in some of them. Heterogeneous lesions occurred during this generalized phase. All patients had systemic symptoms. Less common signs included mucosal ulcers (including pharyngeal ulcers and proctitis) and monkeypox whitlows. Well-controlled HIV and previous smallpox vaccination were not associated with severity. No patient died. The data support the hypothesis of transmission via contact during sex. Although this might change, the outbreak is currently limited mostly to men who have sex with men, with high-risk factors for sexually transmitted diseases.
自 2022 年 5 月以来，包括西班牙在内的多个国家报告了新一轮猴痘疫情。此次疫情的病例临床表现和流行病学特征可能与以往报告有所不同。
记录当前猴痘疫情中病例的临床和流行病学特征。
我们在西班牙的多家医疗机构开展了一项前瞻性横断面研究，以描述 2022 年猴痘疫情中的病例。
共纳入 185 例患者。大多数病例最初在可能的接种部位出现单一皮损，表现为局限性、均匀一致的丘疹，而非脓疱，皮损可为皮肤或黏膜，有些患者随后出现全身性小脓疱。在全身性播散阶段出现了不同形态的皮损。所有患者均有全身症状。黏膜溃疡（包括咽峡炎和直肠炎）和猴痘脓性指头炎等少见皮损也有发生。4 例患者住院，无死亡病例。天花疫苗接种和控制良好的 HIV 疾病与严重程度标志物无关。性接触是最可能的传播途径。此次疫情中，已在男男性行为者中描述了病例，且与高风险性行为强烈相关。筛查发现 76%的患者同时患有其他性传播疾病。
此次疫情中的临床表现与以往不同，强烈提示接触传播和原发感染部位。此次疫情的流行病学特征描述对控制工作具有重要意义。
猴痘皮损表现为脓疱。HIV 感染和既往天花疫苗接种对预后的影响尚不清楚。传播途径最初描述为呼吸道飞沫传播，随后提示为性接触传播。
原发皮损位于可能的接种部位，呈均匀一致的丘疹样（假性脓疱）。有些患者随后出现全身性小脓疱。在全身性播散阶段出现了不同形态的皮损。所有患者均有全身症状。黏膜溃疡（包括咽峡炎和直肠炎）和猴痘脓性指头炎等少见皮损也有发生。控制良好的 HIV 和既往天花疫苗接种与严重程度无关。无死亡病例。数据支持通过性接触传播的假设。虽然这可能会发生变化，但疫情目前主要局限于男男性行为者，他们存在性传播疾病的高风险因素。
