Attachind monkey acne is starting to spread, will it rame the world like a new coronal virus ｜ Western Medicine Frontier

Open -column

Every day, in every corner of the world, doctors and medical researchers are making important decisions. These decisions deeply affect the patients and the families behind them. These decisions must rely on the most reliable medical knowledge, evidence and practice at present. From 1836 to the present, Wolters Kluwer has been committed to serving global medical professionals. Today, Weiko and "Return to Pu" have a column to introduce readers to the latest medical frontiers and best practices from the top medical community and medical experts. I hope that every patient can benefit from the best medical knowledge and evidence. I hope that every doctor can do medicine like top experts.

Return to Park-Weiko column, give you the best medical knowledge and evidence

The outbreak of the monkey acne epidemic has swept more of non -monkey acne countries or regions, and has obvious interpersonal communication channels. Sexual contact dissemination has also become an important way of spreading, and it shows a rapid spread. This atypical epidemic situation is this time. The outbreak sounded the alarm for the global public health system. Will it ravage like a new crown virus?

Written article | Wang Huifang (Fifth Medical Center of the General Hospital of the PLA)

Monkey acne virus is close relatives of smallpox and acne virus, all of which belong to the Department of Acne Virus. Since the elimination of smallpox in the 1980s, monkey acne virus has become the most affected acne virus that has the greatest impact on public health, mainly in the central and western regions of Africa. However, starting from May 7, 2022, many countries outside Africa have reported the case of monkey acne. The World Health Organization (WHO) showed that this time on May 21st, people have passed on people, which belongs to "atypical typical". Phenomenon. According to the latest US CDC data, as of July 15, at least 1814 suspected or confirmed cases in the United States, a total of 68 countries around the world reported 12556 confirmed cases. [1]

Academician Wang Fusheng's team of the Fifth Medical Center of the People's Liberation Army General Hospital for this epidemic, in the epidemic, published a magazine entitled "Human Typical Monkey: Global Classification of Global Stocketing? (Human ATYPICAL MONKEYPOX: Early Warning for Global Outbreak?), Briefly summarized the epidemiology and clinical characteristics of the disease, and proposed a certain clinical management and prevention strategy.

Epidemiology and clinical characteristics

pathogen

Monkey acne virus is a dual -chain DNA virus with envelope. It belongs to the acne virus virus virus virus virus. Under the electron microscope, the monkey acne virus is a relatively large brick particle, which is about 200-250nm in size [2].

Figure 1 Monkey acne virus electron microscopy [6] 丨 avavalable from: https://www.statnews.com/2022/05/17/cdc-Expresses-concern-possibility--UndeTeCTED-wox-wread-in- in- U-K/

In 1958, scientists first separated monkey acne virus on monkeys from Singapore to Denmark. In 1970, the Democratic Republic of the Congo found the first case of human acne in a child [3]. Although monkey acne was discovered on the monkey at first, monkeys are not the main carriers. African rodents are most likely to be its natural host. Squirrels, Gangbey, Turkish mouse, different types of monkeys, and humans can infect monkey acne virus and become a source of infection [4, 5].

Monkey acne virus has two different genetic evolution branches, namely China -Africa Evolution Branch and West African Evolution. In this epidemic, many teams such as Portugal, Belgium, and the United States detected the genome sequences of the virus and found that they were mild West African evolutionary branches, which was closely related to the relationship between monkey acne virus discovered in the UK, Singapore and Israel in 2018 and 2019. [6].

spread

Direct contact with the infected animals may cause monkey acne virus to spread from animals to humans. In 2003, the epidemic outbreak of the United States was derived from Gambia Giant Rats imported from Ghana, and the latter caused domestic communication through local pet grassland dogs. The communication channels between people include: respiratory tract secretions, skin injury parts of the infected person, contacting the skin damage, contact with contaminated items, or long -face face -to -face airway droplets. In 2018, a medical staff in the UK was diagnosed in infection with the diagnosis of the monkey acne after taking the diagnosis of the monkey acne, providing indisputable evidence for people. On May 21, 2022, the World Health Organization issued a statement saying that the interpersonal communication of monkey acne was closely exposed to people with symptomatic patients [7].

This epidemic is particularly worth noting that many reports of the reports that have been reported are homosexual, bisexual or other male actor (MSM). The case group is mainly concentrated in male groups aged 20-50. The lack of immune protection of acne virus has also made sexual communication paths the focus of attention.

Clinical characteristics and diagnostic principles

Monkey acne is usually an acute self -limiting disease with symptoms lasting for 2 to 4 weeks. The incubation period is 6 to 13 days, and the longest fluctuation range can reach 5 to 21 days. Symptoms include fever, headache, lymph node enlargement, muscle pain (muscle and body pain), back pain, weakness (extremely weak), etc. The neck of the neck, of which the neck of the neck The lymphatic swelling behind the ear, armpit or groin area is a specific signs that distinguish between smallpox. The rash first appears on the face, and then spreads to other areas. It can develop from rash to pimples, blisters, and pustules, and eventually crushes off [2, 8]. Cases with the above clinical manifestations are combined with PCR technology to detect monkey acne virus specific DNAs, which can be further diagnosed, but it still needs to be identified with other rash diseases such as smallpox, chickenpox, measles, and syphilis. The overall mortality rate of monkey acne is 8.7%, and there are significant differences between different branches. Generally speaking, China -Africa branches can lead to a more severe prognosis of the disease. The mortality rate is higher, about 10.6%, and the mortality rate of West Africa branches. About 3.6%[9].

Prevention and treatment

prevention

In order to block the spread of monkey acne epidemic, both diagnosis and suspected cases need to be discovered, early isolation, early diagnosis, and early treatment. Those infected should be strictly isolated until the diseased parts are scabbing off, and those with close contact should also implement isolation and monitoring measures. The Belgian Health Authority has stipulated on May 19 that the case of monkey acne should be separated for 21 days [10].

The acne virus is an immune cross -reaction and cross -protection. A previous study showed that the effective rate of smallpox vaccines for monkey acne was 85%, and it was effective for 25 years. [5] Jynneos (also known as Imvamune or Imvanex) is a smallpox vaccine developed by Danish Bavarian Nordic. In 2019, it was approved by the US Food and Drug Administration (FDA) to prevent smallpox and monkey acne infection. At present, it is recommended to adopt a "circular vaccination" strategy for high -risk groups and close contacts, that is, the first ring is formed by the close contact with the close contact of the diagnostic case, and the second ring of the second dense personnel of the close contact person will be formed. Vaccine to cut off transmission channels to curb the spread of monkey acne virus [11]. The US Centers for Disease Control and Prevention has stated that vaccination can prevent disease seizures within 4 days after exposure, and vaccination within 14 days can reduce the severity of the disease [12].

treat

So far, there is no special treatment for monkey acne, which is clinically supported by symptomatic support treatment, controlling complications, and prevention of sequelae. [7]

TECOVIRIMAT, as a powerful inhibitor of acne virus VP37 protein, was approved by the European Drug Administration in 2022 to treat smallpox, monkey acne and acne. Brincidofovir is a DNA polymerase inhibitor approved by the US Food and Drug Administration for the treatment of ceilings, which may have certain therapeutic effects on monkey acne [5]. A recent retrospective observation research report, all three patients with acne treatment treated by Brincidofovir stopped treatment due to elevated liver enzymes, and a patient treated with Tecovirimat did not have adverse reactions, and the virus excretion and duration of the disease were obviously obvious. Shorten [13]. Of course, further clinical studies are still needed to clarify the effectiveness and safety of Tecovirimat and Brincidofovir in the treatment of human monkey acne. In addition, immunotherapy based on clinical experience, such as intravenous injection of acne immunoglobulin, also requires the support of clinical experimental data.

Look forward to

Over the past 50 years, the case of human monkey acne has increased slowly. Acne popular countries or regions, and there have been obvious ways to communicate with interpersonal communication, sexual contact communication has also become an important way of communication, and it has shown a rapid spread. This atypical outbreak has sounded the alarm to the global public health system. In the context of the popularity of new coronary viruses, the emergence of monkey acne epidemic can inevitably cause public concerns. However, monkey acne virus is different from the new coronary virus. Monkey acne virus is a dual-chain DNA virus with a stable structure and a lower mutation rate; the basic infection index of monkey acne virus R0 is about 0.6-1.0, which means that it continues people. The possibility of rumors is very small; the monkey acne virus has been closely exposed to transmission for a long time during interpersonal, which is easier to control and cut off the transmission pathway; more than human beings have more understanding of smallpox and monkey acne virus, and drugs and vaccines for smallpox virus are used. It will also provide certain reserve capabilities for monkey acne.

According to the suggestions of the WHO, conduct strong monitoring and improving the understanding of diseases in the world can help prevent the spread of the disease; clinicians need to pay close attention to and monitor the possible cases of monkey acne, early diagnosis and isolation in order Prevent further transmission and provide the best clinical care solutions; more in -depth research on monkey acne virus biology, epidemiology, dissemination and pathogenesis, accelerate the development of corresponding screening reagents, detection techniques, and therapeutic drugs on monkey acne. Perform precise prevention and treatment. At the same time, my country must also form a corresponding clinical diagnosis and treatment plan to further improve the level of immunization and protection of the population, and provide a practical and effective guarantee for the prevention and treatment of possible monkey acne epidemic.

references

[1] https://www.cdc.gov/

[2] di giulio db, eckburg pb. Human Monkeypox: An Emerging Zoonosis. The lancet infectious disateases 2004; 4 (1): 15-25. Doi: 10.1016/S1473-3099 (03) 00856-9. ID, ziegler p, kima e. A human infection caused by monkeypox virus in basankusu territory, democratic republic of the convebo. Bulletin of the World He Ganize 1972; 46; 46;

[4] Sklenovska N, Van Ranst M. Emergeence of Monkeypox As The Most Important Orthopoxvirus Infection in Humans. Front Public Health 2018; 6: 241. Doi: 10.3389/fubh.2018.00241.241841.241841.

[5] McCollum am, Damon Ik. Human Monkeypox. Clin Infect Dis 2014; 58 (2): 260-7. Doi: 10.1093/CID/CIT703.

[6] A CDC Expert Answers Questions on Monkeypox: Stat, 2022 Available from: https://www.statnews.com/2022/05/19/A- EXPERT-answers- On-monkeypox/.

[7] Disease Outbreak News;Multi-country monkeypox outbreak in non-endemic countries: World Health Organization, 2022 Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385.

[8] Mahase E. Monkeypox: What do we know about the outBreaks in Europe and North America? BMJ 2022; 377: O1274. Doi: 10.1136/BMJ.O1274.

[9] Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLOS Neglected Tropical Diseases 2022;16(2). doi: 10.1371/journal.pntd.0010141 Then, then, then

[10] FIRST MORST MONKEYPOX Quarantine OrderEd in Eu: RT, 2022 available from: https://www.rt.com/news/555928-belgium-quarantinepox-cases/.

[11] Kozlov M. Monkeypox Goes Global: why Scientists Are on Alert. Nature 2022; 606 (7912): 15-6. Doi: 10.1038/D41586-022-01421-8.

[12] Moore m, zahra f. Monkeypox. In: statpearls. Treasure Island (FL): Statpearls Publicish Copyright © 2022, Statpearls Publicish LLC. [13] Adler h, high s, hineld.Features and Management of Human Monkeypox: A Retrospective Observational Study in the Uk. The Lancet Infectious Diseases 2022. Doi: 10.1016/S1473-3099 (22) 00228-6.6.

Produced: Popular Science China-Starry Sky Plan

Special Note

1. Enter the "Boutique Column" at the bottom menu of the WeChat public account of the WeChat public account.

2. "Return" provides a monthly retrieval article function.Pay attention to the public account and reply to the year+month for the four digits, such as "1903", you can obtain an index of articles in March 2019, and so on.

Copyright explanation: Welcome to repost personal. Any form of media or institutions shall not reprint and extract without authorization.Reprinted authorization, please contact the background within the WeChat public account of "Return to Pu".

- END -