Department of Infection and Immunity, Blizard Institute and SHARE Collaborative, Queen Mary University of London, Barts Health NHS Trust, London, UK.
Infectious Diseases Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre Louis Epidemiology and Public Health Institute, Sorbonne University, INSERM 1136, Paris, France.
Lancet. 2022 Dec 3;400(10367):1953-1965. doi: 10.1016/S0140-6736(22)02187-0. Epub 2022 Nov 17.
Between May and November, 2022, global outbreaks of human monkeypox virus infection have been reported in more than 78 000 people worldwide, predominantly in men who have sex with men. We describe the epidemiological and clinical characteristics of monkeypox virus infection in cisgender (cis) and transgender (trans) women and non-binary individuals assigned female sex at birth to improve identification and understanding of risk factors.
International collaborators in geographical locations with high numbers of diagnoses of monkeypox virus infection were approached and invited to contribute data on women and non-binary individuals with confirmed monkeypox virus infection. Contributing centres completed deidentified structured case-report spreadsheets, adapted and developed by participating clinicians, to include variables of interest relevant to women and non-binary individuals assigned female at birth. We describe the epidemiology and clinical course observed in the reported infections.
Collaborators reported data for a total of 136 individuals with monkeypox virus infection who presented between May 11 and Oct 4, 2022, across 15 countries. Overall median age was 34 years (IQR 28-40; range 19-84). The cohort comprised 62 trans women, 69 cis women, and five non-binary individuals (who were, because of small numbers, grouped with cis women to form a category of people assigned female at birth for the purpose of comparison). 121 (89%) of 136 individuals reported sex with men. 37 (27%) of all individuals were living with HIV, with a higher proportion among trans women (31 [50%] of 62) than among cis women and non-binary individuals (six [8%] of 74). Sexual transmission was suspected in 55 (89%) trans women (with the remainder having an unknown route of transmission) and 45 (61%) cis women and non-binary individuals; non-sexual routes of transmission (including household and occupational exposures) were reported only in cis women and non-binary individuals. 25 (34%) of 74 cis women and non-binary individuals submitted to the case series were initially misdiagnosed. Overall, among individuals with available data, rash was described in 124 (93%) of 134 individuals and described as anogenital in 95 (74%) of 129 and as vesiculopustular in 105 (87%) of 121. Median number of lesions was ten (IQR 5-24; range 1-200). Mucosal lesions involving the vagina, anus, or oropharynx or eye occurred in 65 (55%) of 119 individuals with available data. Vaginal and anal sex were associated with lesions at those sites. Monkeypox virus DNA was detected by PCR from vaginal swab samples in all 14 samples tested. 17 (13%) individuals were hospitalised, predominantly for bacterial superinfection of lesions and pain management. 33 (24%) individuals were treated with tecovirimat and six (4%) received post-exposure vaccinations. No deaths were reported.
The clinical features of monkeypox in women and non-binary individuals were similar to those described in men, including the presence of anal and genital lesions with prominent mucosal involvement. Anatomically, anogenital lesions were reflective of sexual practices: vulvovaginal lesions predominated in cis women and non-binary individuals and anorectal features predominated in trans women. The prevalence of HIV co-infection in the cohort was high.
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2022 年 5 月至 11 月期间，全球报告了超过 78000 例人类猴痘病毒感染病例，主要发生在与男性发生性关系的男性中。我们描述了顺性别（cis）和跨性别（trans）女性以及出生时被指定为女性的非二元个体中猴痘病毒感染的流行病学和临床特征，以提高对风险因素的识别和理解。
我们联系了在猴痘病毒感染诊断数量较高的地理位置的国际合作者，并邀请他们提供确诊猴痘病毒感染的女性和非二元个体的数据。参与中心使用由参与临床医生制定和开发的经过适应性调整的匿名结构化病例报告电子表格，包括与出生时被指定为女性的女性和非二元个体相关的感兴趣的变量。我们描述了报告感染中观察到的流行病学和临床过程。
合作者报告了在 2022 年 5 月 11 日至 10 月 4 日期间，来自 15 个国家的总共 136 例猴痘病毒感染患者的数据。总体中位数年龄为 34 岁（IQR 28-40；范围 19-84）。该队列包括 62 名跨性别女性、69 名 cis 女性和 5 名非二元个体（由于数量较少，为了比较，将他们与 cis 女性归为一组，出生时被指定为女性的人）。121 名（89%）136 名患者报告与男性发生性行为。37 名（27%）的个体患有艾滋病毒，跨性别女性的比例更高（62 名中的 31[50%]），而 cis 女性和非二元个体的比例较低（74 名中的 6[8%]）。怀疑性传播在 55 名（89%）跨性别女性（其余的传播途径未知）和 45 名（61%）cis 女性和非二元个体中传播；仅在 cis 女性和非二元个体中报告了非性传播途径（包括家庭和职业接触）。在提交给病例系列的 74 名 cis 女性和非二元个体中，有 25 名（34%）最初被误诊。总体而言，在有可用数据的个体中，134 名中有 124 名（93%）描述了皮疹，129 名中有 95 名（74%）描述为生殖器皮疹，121 名中有 105 名（87%）描述为疱疹性脓疱病。中位数病变数为 10（IQR 5-24；范围 1-200）。阴道、肛门或口咽或眼部有黏膜病变的发生在 119 名有可用数据的个体中占 65 名（55%）。阴道和肛门性行为与这些部位的病变有关。从所有 14 个阴道拭子样本中通过 PCR 检测到猴痘病毒 DNA。17 名（13%）个体住院，主要是为了治疗病变的细菌合并感染和疼痛管理。33 名（24%）个体接受了特考韦瑞治疗，6 名（4%）接受了暴露后疫苗接种。没有报告死亡。
女性和非二元个体中猴痘的临床特征与男性中描述的特征相似，包括存在伴有明显黏膜受累的肛门和生殖器病变。解剖学上，生殖器病变反映了性行为：阴道病变在 cis 女性和非二元个体中更为常见，而肛门特征在跨性别女性中更为常见。该队列中艾滋病毒合并感染的患病率很高。
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