Cologne Public Health Department, Cologne, Germany.
Institute for Hygiene, University Hospital Münster, Münster, Germany.
Infection. 2023 Oct;51(5):1369-1381. doi: 10.1007/s15010-023-01997-x. Epub 2023 Feb 14.
The worldwide mpox outbreak starting in May 2022 marks the occurrence of another previously atypical infectious disease in Europe. This study's objective was to present a comprehensive overview based on the gathered data and to illustrate the approach of the Cologne Health Department to contain the mpox outbreak.
In this retrospective observational study, 368 individuals reported to the Cologne Health Department as PCR-positive for mpox were included. Data were collected in structured telephone interviews and digitally processed.
The first mpox case in Cologne was recorded on May 24, 2022. The local outbreak lasted approximately 4 months and reached its peak in July. The last reported case in Cologne occurred on September 17. Transmissions mostly occurred through sexual contacts (67.4%) or other close physical contacts (4.6%) between men, but also through fomites, in the context of events or occasionally in the work environment. In 21.5% of cases, no route of infection could be determined. The mean incubation period was 8.2 days. Clinically, mpox infections usually presented with skin and/or mucosal lesions accompanied by general symptoms. In 74.8% of cases, a prodromal stage was absent. Initially, the rash often had an unspecific appearance, but in the further clinical course, it usually passed through the typical stages. Most infections resolved spontaneously under home care. In 3.5% of cases, however, inpatient hospitalisation was required. Infected persons with a previous smallpox vaccination had 0.43 times the odds of unvaccinated persons to be affected by lesions in 3 or more body regions and 0.30 times the odds to develop lesions in all 5 body regions. Previous vaccination statistically reduced the total duration of symptoms by 2.0 days.
The mpox outbreak 2022 in Cologne primarily affected men who have sex with men and have reported recent sexual encounters. The observed average incubation period was shorter than initially assumed. Mucosal involvement and associated symptoms occur in a relevant number of cases and can lead to more severe clinical courses. Previous smallpox vaccination was statistically significantly associated with milder courses of mpox. In the case of an unclear rash or symptoms suggesting mucosal involvement, mpox should be considered as a differential diagnosis. An equally rapid and well-orchestrated public health response are crucial for infection control.
2022 年 5 月开始的全球猴痘疫情标志着欧洲又发生了一种以前非典型的传染病。本研究的目的是基于收集的数据提供全面概述，并说明科隆卫生部门控制猴痘疫情的方法。
在这项回顾性观察研究中，纳入了向科隆卫生部门报告的 368 名 PCR 检测猴痘阳性的个体。数据通过结构化电话访谈收集并进行数字处理。
科隆首例猴痘病例于 2022 年 5 月 24 日记录。当地疫情持续了大约 4 个月，7 月达到高峰。科隆最后一例报告病例发生在 9 月 17 日。传播主要通过男性之间的性接触（67.4%）或其他密切的身体接触（4.6%），也通过接触污染物，在活动或偶尔在工作环境中发生。在 21.5%的病例中，无法确定感染途径。潜伏期平均为 8.2 天。临床上，猴痘感染通常表现为皮肤和/或粘膜损伤，并伴有全身症状。74.8%的病例没有前驱期。最初，皮疹通常表现为非特异性外观，但在进一步的临床过程中，它通常会通过典型阶段。大多数感染在家庭护理下自行缓解。然而，3.5%的病例需要住院治疗。与未接种疫苗的人相比，既往接种过天花疫苗的感染者发生 3 个或更多身体区域病变的几率为 0.43 倍，发生所有 5 个身体区域病变的几率为 0.30 倍。既往接种可使症状总持续时间平均缩短 2.0 天。
2022 年科隆的猴痘疫情主要影响男男性行为者，并报告了最近的性接触。观察到的平均潜伏期比最初假设的要短。在大量病例中存在粘膜受累和相关症状，这可能导致更严重的临床病程。既往接种天花疫苗与猴痘的轻度病程有统计学显著相关性。在皮疹不明确或有粘膜受累症状时，应考虑猴痘作为鉴别诊断。快速、协调良好的公共卫生应对对于感染控制至关重要。
