Najeeb Abdurrahman, Eltalkhawy Youssef M, Reda Omnia
Tropical Medicine Department, Faculty of Medicine, Alexandria University, Egypt.
Division of Infection and Hematopoiesis, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Japan.
J Taibah Univ Med Sci. 2023 Feb;18(1):137-139. doi: 10.1016/j.jtumed.2022.08.001. Epub 2022 Aug 26.
Since 1958 witnessed the detection of Monkeypox virus in monkeys, no human infection was encountered until 1970. Afterwards, zoonotic transmission was the rule near African rainforests, mainly in DRC. Most cases occurred in children who weren't immunized against smallpox. Since 2003 and the first human infection in the USA, research was accelerated. Two clades were identified with different virulence, demographic distribution and transmissibility. The mean age of infection increased with waning smallpox vaccine immunity. Mild febrile prodrome can precede lymphadenopathy, which doesn't occur in smallpox. Homogenous crops of lesions appear in stages until scabs fall and contagiosity ends. However, since May outbreak, cases started to appear in non-endemic areas, human transmission increased and was linked to close sexual contact especially in MSM community. Lesions were found mainly perioral, at genitals and perianal. Newer system for nomenclature was suggested in which there are 3 viral clades and the responsible clade for the outbreak is clade 3 (lineage B.1). About 50 mutations were detected compared with the strains isolated 4 years ago. Gene loss and APOBEC3 may be related to accelerated mutation rate which may accelerate human transmission. Previous mistakes in failure to allocate available vaccines to control the disease in previously endemic areas should be avoided and rapid ring vaccination of potential contacts and those at risk should be a priority. Case isolation, contact isolation or tracing for an incubation period, standard measures for airborne infections and safe sex should be implanted in the light of the current uncertainty.
自1958年在猴子身上检测到猴痘病毒以来，直到1970年才出现人类感染病例。此后，在非洲雨林附近，主要是在刚果民主共和国，人畜共患传播成为常态。大多数病例发生在未接种天花疫苗的儿童身上。自2003年美国出现首例人类感染病例以来，研究加速进行。已识别出两个具有不同毒力、人口统计学分布和传播性的进化枝。随着天花疫苗免疫力的下降，感染的平均年龄有所增加。轻微的发热前驱症状可能先于淋巴结病出现，而天花不会出现这种情况。皮疹分批出现，直到结痂脱落且传染性结束。然而，自5月疫情爆发以来，病例开始在非流行地区出现，人际传播增加，且与密切的性接触有关，尤其是在男男性行为者群体中。皮疹主要出现在口周、生殖器和肛周。有人提出了新的命名系统，其中有3个病毒进化枝，此次疫情的责任进化枝是进化枝3（谱系B.1）。与4年前分离的毒株相比，检测到约50处突变。基因缺失和载脂蛋白B编辑酶催化多肽样3可能与突变率加快有关，这可能会加速人际传播。应避免以往在未能分配可用疫苗以控制以前流行地区疾病方面的错误，对潜在接触者和高危人群进行快速环状疫苗接种应成为优先事项。鉴于目前的不确定性，应实施病例隔离以及对潜伏期进行接触隔离或追踪、空气传播感染的标准措施和安全性行为。
