County of San Diego, Emergency Medical Services Office, Public Safety Group - San Diego County Fire, San Diego, California, USA.
Department of Emergency Medicine and Public Health, University of California Irvine, Orange, California, USA.
Prehosp Disaster Med. 2022 Oct;37(5):687-692. doi: 10.1017/S1049023X22001121. Epub 2022 Aug 4.
Monkeypox 2022 exhibits unprecedented human-to-human transmission and presents with different clinical features than those observed in prior outbreaks. Previously endemic only to West and Central Africa, the monkeypox virus spread rapidly world-wide following confirmation of a case in the United Kingdom on May 7, 2022 of an individual that had traveled to Nigeria. Detection of cases with no travel history confirms on-going community spread. Emergency Medical Services (EMS) professionals will likely encounter patients suspected or confirmed to have monkeypox, previously a rare disease and therefore unfamiliar to most clinicians. Consequently, it is critical for EMS medical directors to immediately implement policies and procedures for EMS teams - including emergency medical dispatchers - to identify potential monkeypox cases. These must include direction on actions EMS professionals should take to protect themselves and others from virus transmission. Monkeypox 2022 may manifest more subtly than it has historically. Presentations include a subclinical prodrome and less dramatic skin lesions - potentially limited to genital or anal body regions - which can be easily confused with dermatologic manifestations of common sexually transmitted infections (STIs). While most readily spread by close contact with infectious skin lesions on a patient, it is also transmissible from fomites, such as bed sheets. Additionally, droplet transmission can occur, and the virus can be spread by aerosolization under certain conditions. The long incubation period could have profound negative consequences on EMS staffing if clinicians are exposed to monkeypox. This report summarizes crucial information needed for EMS professionals to understand and manage the monkeypox 2022 outbreak. It presents an innovative Identify-Isolate-Inform (3I) Tool for use by EMS policymakers, educators, and clinicians on the frontlines who may encounter monkeypox patients. Patients are identified as potentially exposed or infected after an initial assessment of risk factors with associated signs and symptoms. Prehospital workers must immediately don personal protective equipment (PPE) and isolate infectious patients. Also, EMS professionals must report exposures to their agency infection control officer and alert health authorities for non-transported patients. Prehospital professionals play a crucial role in emerging and re-emerging infectious disease mitigation. The monkeypox 2022 3I Tool includes knowledge essential for all clinicians, plus specific information to guide critical actions in the prehospital environment.
猴痘 2022 年的人际传播前所未有，其临床特征与以往疫情中的观察结果不同。猴痘病毒以前仅在西非和中非流行，2022 年 5 月 7 日英国确认一名曾前往尼日利亚的旅行者感染该病毒后，迅速在全球范围内传播。发现无旅行史的病例证实了持续的社区传播。紧急医疗服务（EMS）专业人员可能会遇到疑似或确诊患有猴痘的患者，以前这种疾病很少见，因此大多数临床医生都不熟悉。因此，EMS 医疗主任必须立即为 EMS 团队（包括紧急医疗调度员）制定政策和程序，以识别潜在的猴痘病例。这些政策和程序必须包括指导 EMS 专业人员为保护自己和他人免受病毒传播而应采取的行动。猴痘 2022 年的表现可能比以往更为微妙。其表现包括亚临床前驱期和不太明显的皮肤损伤——可能仅限于生殖器或肛门区域——这很容易与常见性传播感染（STI）的皮肤表现混淆。虽然它最容易通过与患者感染性皮肤损伤密切接触传播，但也可以通过床罩等媒介物传播。此外，飞沫传播也可能发生，并且在某些条件下，病毒可以通过气溶胶化传播。如果临床医生接触到猴痘，较长的潜伏期可能对 EMS 人员配备产生深远的负面影响。本报告总结了 EMS 专业人员理解和管理 2022 年猴痘疫情所需的关键信息。它提出了一种创新的识别-隔离-通知（3I）工具，供可能遇到猴痘患者的 EMS 政策制定者、教育者和临床医生使用。在对相关体征和症状进行初始风险因素评估后，患者被确定为可能暴露或感染。院前工作人员必须立即穿戴个人防护设备（PPE）并隔离感染患者。此外，EMS 专业人员必须向其机构感染控制官员报告暴露情况，并通知卫生当局非转运患者。院前专业人员在新发和再发传染病的缓解中发挥着至关重要的作用。猴痘 2022 年的 3I 工具包括所有临床医生必备的知识，以及指导院前环境中关键行动的具体信息。
