Pesonel Elise, Laouénan Cédric, Guiraud Laetitia, Bourner Josephine, Hoffmann Isabelle, Molino Diana, Tardivon Coralie, Bachelet Delphine, Mentré France, Amstutz Alain, Merson Laura, Rojek Amanda, Cervantes Gonzalez Minerva, Antinori Andrea, Castagna Antonella, Nozza Silvia, Pourcher Valérie, Libois Agnès, Dunning Jake, Tacconelli Evelina, Hites Maya, De La Calle Prieto Fernando, Horby Peter, Yazdanpanah Yazdan, Calmy Alexandra, Lescure François-Xavier, Olliaro Piero
International Severe Acute Respiratory and Emerging Infection Consortium-Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom.
Department of Epidemiology Biostatistics and Clinical Research, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, Hôpital Bichat, Paris, France.
Clin Infect Dis. 2025 Jun 4;80(5):1060-1073. doi: 10.1093/cid/ciae657.
The global mpox outbreak that started in May 2022 was caused by a novel clade IIb variant of the mpox virus (Orthopoxvirus monkeypox, MPXV). It differed from the traditional Western and Central Africa disease in transmission patterns and clinical presentation.
To address the need for detailed clinical and virologic data, we conducted an observational cohort study (MOSAIC) during May 2022-July 2023 in individuals with confirmed MPXV infection enrolled in 6 European countries. Case management decisions were left to the attending physician. Participants were monitored for up to 6 months for clinical signs/symptoms and clinical and virologic outcomes through hospital visits, phone interviews, and self-administered questionnaires. Outcomes included time to lesion resolution, clinical status, and virus clearance.
The 518 participants not receiving any specific treatment ("untreated") were diagnosed a median 5 days from symptom onset; 90% were managed as outpatients. Lesions were mostly cutaneous (88%) and perigenital (74%). By day 14 from the first polymerase chain reaction (PCR)-positive sample, 39% had resolved lesions. Time to 95% unculturable virus was longest in cutaneous lesions (52 days). A putative systemic antiviral was available for 57 participants, 44% as inpatients; 34% and 58% had resolved lesions by day 14 from the first PCR-positive sample and from treatment start, respectively. Time to 95% unculturable virus was 60 days in skin and oropharynx. No death or recrudescence occurred by day 180.
MOSAIC provides comprehensive insights into the clinical and virologic characteristics of mpox caused by the clade IIb variant. The study forms the basis of clinical characterization for ongoing mpox outbreaks.
始于2022年5月的全球猴痘疫情由猴痘病毒（正痘病毒属猴痘病毒，MPXV）的一种新型IIb分支变种引起。它在传播模式和临床表现上与传统的西非和中非疾病有所不同。
为满足对详细临床和病毒学数据的需求，我们于2022年5月至2023年7月在6个欧洲国家对确诊感染MPXV的个体进行了一项观察性队列研究（MOSAIC）。病例管理决策由主治医生做出。通过医院就诊、电话访谈和自行填写问卷，对参与者进行长达6个月的临床体征/症状以及临床和病毒学结局监测。结局包括皮损消退时间、临床状况和病毒清除情况。
518名未接受任何特定治疗（“未治疗”）的参与者从症状出现到确诊的中位时间为5天；90%作为门诊患者处理。皮损大多为皮肤型（88%）和生殖器周围型（74%）。从首个聚合酶链反应（PCR）阳性样本起14天时，39%的患者皮损已消退。皮肤型皮损中病毒达到95%不可培养状态的时间最长（52天）。57名参与者可使用一种假定的全身性抗病毒药物，44%为住院患者；从首个PCR阳性样本起14天以及从治疗开始起，分别有34%和58%的患者皮损已消退。皮肤和口咽部病毒达到95%不可培养状态的时间为60天。至180天时未发生死亡或复发情况。
MOSAIC研究全面深入地揭示了由IIb分支变种引起的猴痘的临床和病毒学特征。该研究构成了当前猴痘疫情临床特征描述的基础。
