《猴痘诊疗指南（2022年版）》解读

doi:10.19871/j.cnki.xfcrbzz.2022.03.003

摘要/Abstract

摘要： 猴痘是由猴痘病毒引起的人畜共患传染病,主要表现为发热、剧烈头痛、淋巴结肿大、皮疹等。该病主要流行于非洲的西部和中部。2022年5月以来,全球非流行国家暴发了猴痘疫情,且存在社区传播。猴痘大部分临床过程呈自限性,少数出现严重并发症,甚至危及生命。为提高临床早期识别和规范诊疗能力,国家卫生健康委员会制定了《猴痘诊疗指南（2022年版）》。本文结合相关研究进展对指南进行解读,内容覆盖了猴痘的病原学、流行病学、临床表现、实验室检查、诊断和鉴别诊断、治疗及医疗机构内感染预防与控制等,以提高临床医师对猴痘的认识。

关键词: 猴痘, 猴痘病毒, 诊断, 治疗, 指南解读

Abstract: Monkeypox is a zoonotic infectious disease caused by monkeypox virus, which mainly manifests as fever, Severe headache, lymphadenopathy, and rash. The disease were mainly prevalent in western and central Africa. Since May 2022, monkeypox outbreaks have occurred in non-endemic countries around the world, and there is community transmission. Most clinical processes of monkeypox are self-limiting, and rarely have serious complications, even to life-threatening. In order to improve the ability of early clinical identification and standardized diagnosis and treatment, the National Health Commission of the People's Republic of China issued the Guidelines for diagnosis and treatment of monkeypox (2022 Edition). This paper reviews the relevant research process of monkeypox, and interprets the guidelines. The course covered the etiology, epidemiology, clinical manifestations, laboratory examination, diagnosis and differential diagnosis, treatment, prevention and control of infection in medical institutions of monkeypox and etc, in order to improve the clinicians' understanding of monkeypox.

Key words: Monkeypox, Monkeypox virus, Diagnosis, Treatment, Guide interpretation

王长泰, 刘林娜, 赵令斋, 张复春. 《猴痘诊疗指南（2022年版）》解读[J]. 新发传染病电子杂志, 2022, 7(3): 12-17.

Wang Changtai, Liu Linna, Zhao Lingzhai, Zhang Fuchun. Interpretation of Guidelines for diagnosis and treatment of monkeypox (2022 Edition)[J]. Electronic Journal of Emerging Infectious Diseases, 2022, 7(3): 12-17.

参考文献

[1] MCCOLLUM AM, DAMON IK.Human monkeypox[J]. Clin Infect Dis, 2014,58(2):260-267.
[2] WORLD HEALTH ORGANIZATION.Multi-country monkeypox outbreak: situation update[EB/OL].[2022-06-27].https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396.
[3] EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL.Monkeypox multi-country outbreak [EB/OL].[2022-07-28]. https://www.ecdc.europa.eu/en/monkeypox-outbreak.
[4] CENTERS FOR DISEASE CONTROL AND PREVENTION.2022 Monkeypox Outbreak Global Map[EB/OL]. [2022-07-25]. https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html.
[5] 中华人民共和国国家卫生健康委员会.猴痘诊疗指南(2022年版)[EB/OL].[2022-06-10]. http://www.nhc.gov.cn/yzygj/s7653p/202206/d687b12fe8b84bbfaede2c7a5ca596ec.shtml.
[6] WORLD HEALTH ORGANIZATION. Second meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country outbreak of monkeypox[EB/OL].[2022-07-23]. https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-
[7] MCFADDEN G.Poxvirus tropism[J]. Nat Rev Microbiol, 2005,3(3):201-213.
[8] BABKIN IV, BABKINA IN, TIKUNOVA NV.An Update of Orthopoxvirus Molecular Evolution[J]. Viruses, 2022, 14(2):388.
[9] BAUER DJ, STVINCENT L, KEMPE CH, et al.Prophylactic treatment of small pox contacts with n-methylisatin beta-thiosemicarbazone (compound 33t57, marboran)[J]. Lancet, 1963, 2(7306):494-496.
[10] QUARLERI J, DELPINO MV, GALVAN V.Monkeypox: considerations for the understanding and containment of the current outbreak in non-endemic countries[J]. Geroscience, 2022:1-9.
[11] SHCHELKUNOV SN, TOTMENIN AV, BABKIN IV, et al.Human monkeypox and smallpox viruses: genomic comparison[J]. FEBS Lett, 2001,509(1):66-70.
[12] YINKA-OGUNLEYE A, ARUNA O, DALHAT M, et al.Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report[J]. Lancet Infect Dis, 2019,19(8):872-879.
[13] SADEUH-MBA SA, YONGA MG, ELS M, et al.Monkeypox virus phylogenetic similarities between a human case detected in Cameroon in 2018 and the 2017-2018 outbreak in Nigeria[J]. Infect Genet Evol, 2019, 69:8-11.
[14] BUNGE EM, HOET B, CHEN L, et al.The changing epidemiology of human monkeypox-A potential threat? A systematic review[J]. PLoS Negl Trop Dis, 2022, 16(2): e10141.
[15] ISIDRO J, BORGES V, PINTO M, et al. First draft genome sequence of monkeypox virus associated with the suspected multi-country outbreak, May2022 (confirmed case in Portugal)[EB/OL]. [2022-05-20]. https://virological.org/t/first-draft-genome-sequence-of-monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal/799.
[16] ISIDRO J, BORGES V, PINTO M, et al.Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of monkeypox virus[J]. Nat Med, 2022.
[17] MAULDIN MR, MCCOLLUM AM, NAKAZAWA YJ, et al.Exportation of Monkeypox Virus From the African Continent[J]. J Infect Dis, 2022,225(8):1367-1376.
[18] WALLAU GL, MACIEL-DE-FREITAS R, SCHMIDT-CHANASIT J. An unfolding monkeypox outbreak in Europe and beyond[J]. Mil Med Res, 2022,9(1):31.
[19] CANN JA, JAHRLING PB, HENSLEY LE, et al.Comparative Pathology of Smallpox and Monkeypox in Man and Macaques[J]. J Comp Pathol, 2013, 148(1):6-21.
[20] AMBROSE CT.Osler and the infected letter[J]. Emerg Infect Dis, 2005, 11(5):689-693.
[21] LADNYJ ID, ZIEGLER P, KIMA E.A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo[J]. Bull World Health Organ, 1972, 46(5):593-597.
[22] SKLENOVSKA N, VAN RANST M.Emergence of Monkeypox as the Most Important Orthopoxvirus Infection in Humans[J]. Front Public Health, 2018,6:241.
[23] DI GIULIO DB, ECKBURG PB.Human monkeypox: an emerging zoonosis[J]. Lancet Infect Dis, 2004,4(1):15-25.
[24] WORLD HEALTH ORGANIZATION. Meeting of the International Health Regulations (2005) Emergency Committee regarding the multi-country monkeypox outbreak[EB/OL].[ 2022-06-23]. https://www.who.int/news/item/25-06-2022-meeting-of-the-international-health-regulations-(2005)-emergency-committee--regarding-the-multi-country-monkeypox-outbreak.
[25] ALAKUNLE E, MOENS U, NCHINDA G, et al.Monkeypox Virus in Nigeria: Infection Biology, Epidemiology, and Evolution[J]. Viruses, 2020, 12(11):1257.
[26] KISALU NK, MOKILI JL.Toward Understanding the Outcomes of Monkeypox Infection in Human Pregnancy[J]. J Infect Dis, 2017, 216(7):795-797.
[27] THORNHILL JP, BARKATI S, WALMSLEY S, et al.Monkeypox Virus Infection in Humans across 16 Countries-April-June 2022[J]. N Engl J Med, 2022, 387(8):1-14.
[28] BRAGAZZI NL, KONG JD, MAHROUM N, et al.Epidemiological trends and clinical features of the ongoing monkeypox epidemic: a preliminary pooled data analysis and literature review[J]. J Med Virol, 2022.
[29] MIURA F, VAN EWIJK CE, BACKER JA, et al.Estimated incubation period for monkeypox cases confirmed in the Netherlands, May 2022[J]. Euro Surveill, 2022, 27(24):2200448.
[30] AL-TAWFIQ JA, BARRY M, MEMISH ZA.International outbreaks of Monkeypox virus infection with no established travel: A public health concern with significant knowledge gap[J]. Travel Med Infect Dis, 2022, 49:102364.
[31] DOSHI RH, ALFONSO VH, MORIER D, et al.Monkeypox Rash Severity and Animal Exposures in the Democratic Republic of the Congo[J]. Ecohealth, 2020, 17(1):64-73.
[32] BEER EM, RAO VB.A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy[J]. PLoS Negl Trop Dis, 2019, 13(10): e7791.
[33] [BROWN K, LEGGAT PA.Human Monkeypox: Current State of Knowledge and Implications for the Future[J]. Trop Med Infect Dis, 2016, 1(1):8.
[34] JEEEK Z, SZCZENIOWSKI M, PALUKU KM, et al.Human Monkeypox: Clinical Features of 282 Patients[J]. J Infect Dis, 1987, 156(2):293-298.
[35] HUHN GD, BAUER AM, YORITA K, et al.Clinical characteristics of human monkeypox, and risk factors for severe disease[J]. Clin Infect Dis, 2005,41(12):1742-1751.
[36] ADLER H, GOULD S, HINE P, et al.Clinical features and management of human monkeypox: a retrospective observational study in the UK[J]. Lancet Infect Dis, 2022, 22(8):1153-1162.
[37] STAGLES MJ, WATSON AA, BOYD JF, et al.The histopathology and electron microscopy of a human monkeypox lesion[J]. Trans R Soc Trop Med Hyg, 1985,79(2):192-202.
[38] 中国疾病预防控制中心. 猴痘防控技术指南(2022年版)[S]. 2022-06-06.
[39] WORLD HEALTH ORGANIZATION.Multi-country monkeypox outbreak in non-endemic countries[EB/OL].[2022-05-21].https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385.
[40] GROSENBACH DW, HONEYCHURCH K, ROSE EA, et al.Oral Tecovirimat for the Treatment of Smallpox[J]. N Engl J Med, 2018, 379(1):44-53.
[41] CHITTICK G, MORRISON M, BRUNDAGE T, et al.Short-term clinical safety profile of brincidofovir: A favorable benefit-risk proposition in the treatment of smallpox[J]. Antiviral Res, 2017,143:269-277.
[42] FINE PE, JEZEK Z, GRAB B, et al.The transmission potential of monkeypox virus in human populations[J]. Int J Epidemiol, 1988,17(3):643-650.
[43] CENTERS FOR DISEASE CONTROL AND PREVENTION. Monkeypox and Smallpox Vaccine Guidance[EB/OL].[2022-06-02]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html.