MMWR Morb Mortal Wkly Rep. 2024 Oct 10;73(40):903-905. doi: 10.15585/mmwr.mm7340a3.
The antiviral drug tecovirimat* has been used extensively to treat U.S. mpox cases since the start of a global outbreak in 2022. Mutations in the mpox viral protein target (F13 or VP37) that occur during treatment can result in resistance to tecovirimat (1,2). CDC and public health partners have conducted genetic surveillance of monkeypox virus (MPXV) for F13 mutations through sequencing and monitoring of public databases. MPXV F13 mutations associated with resistance have been reported since 2022, typically among severely immunocompromised mpox patients who required prolonged courses of tecovirimat (3-5). A majority of patients with infections caused by MPXV with resistant mutations had a history of tecovirimat treatment; however, spread of tecovirimat-resistant MPXV was reported in California during late 2022 to early 2023 among persons with no previous tecovirimat treatment (3). This report describes a second, unrelated cluster of tecovirimat-resistant MPXV among 18 persons with no previous history of tecovirimat treatment in multiple states.
抗病毒药物特考韦瑞（tecovirimat*）自 2022 年全球猴痘疫情爆发以来，被广泛用于治疗美国的猴痘病例。在治疗过程中，猴痘病毒蛋白靶标（F13 或 VP37）发生的突变可导致对特考韦瑞的耐药性（1,2）。美国疾病控制与预防中心（CDC）和公共卫生合作伙伴通过测序和监测公共数据库，对猴痘病毒（MPXV）的 F13 突变进行了遗传监测。自 2022 年以来，一直有报告称与耐药性相关的 MPXV F13 突变，这些突变通常发生在严重免疫功能低下的猴痘患者中，这些患者需要长期使用特考韦瑞治疗（3-5）。大多数具有耐药突变的 MPXV 感染患者都有特考韦瑞治疗史；然而，2022 年底至 2023 年初，加利福尼亚州报告了无特考韦瑞治疗史的人群中存在特考韦瑞耐药的 MPXV 传播（3）。本报告描述了在多个州，18 名无特考韦瑞治疗史的患者中发生的第二起与之前无关的特考韦瑞耐药 MPXV 聚集性病例。
