Since May 2022, several non-endemic countries around the world have reported cases of monkeypox with community transmission. To prepare for the medical response to monkeypox in advance, and to improve the ability of early clinical identification and standardized diagnosis and treatment, Today, the National Health and Medical Commission issued a notice on printing and distributing Notice of Monkeypox Diagnosis and Treatment Guidelines (2022 Edition). The notice requires that health administrative departments at all levels and traditional Chinese medicine management departments should attach great importance to them, conscientiously organize training related to monkeypox diagnosis and treatment, and effectively improve the ability of “four early mornings”.Once a suspected or confirmed case of monkeypox is discovered, it should be reported in a timely manner in accordance with relevant requirements, and efforts should be made to organize medical treatment to ensure the safety and health of the people.
The World Health Organization said on the 14th that it will hold a WHO emergency committee meeting on the 23rd of this month to evaluate Does the current monkeypox outbreak in many countries around the world constitute a “public health emergency of international concern”?
The latest data released by WHO shows that 39 countries have reported monkeypox diagnoses to WHO There are more than 1,600 cases and nearly 1,500 suspected cases, and the vast majority of confirmed cases are from Europe. The 39 countries include 7 countries where monkeypox has existed for many years and 32 countries with new outbreaks.
Monkeypox Guidelines
(2022 Edition)
Monkeypox is a zoonotic viral disease caused by monkeypox virus (MPXV) infection. The clinical manifestations are fever, rash, and lymphadenopathy. The disease is predominantly endemic in Central and West Africa. Since May 2022, monkeypox cases have also been reported in some non-endemic countries, with community transmission. In order to improve the clinician’s ability to identify monkeypox early and standardize the diagnosis and treatment, this diagnosis and treatment guideline is specially formulated.
I. Etiology
Monkeypox virus (MPXV) belongs to the genus Orthopoxvirus of the family Poxviridae, and is a group of four orthopoxviruses that are pathogenic to humans One of the virus genus, the other three are smallpox virus, vaccinia virus and vaccinia virus. Under the electron microscope, the monkeypox virus particles are brick-shaped or oval, with a size of 200nm×250nm, with an envelope, and there are structural proteins and DNA-dependent RNA polymerase in the virus particles , the genome is double-stranded DNA, about 197kb in length. Monkeypox viruses are divided into two subclades, the West African clade and the Congo Basin clade. The virus sequencing results of some cases in non-endemic countries are West African branches.
The main host of monkeypox virus is African rodents (including African squirrels, tree squirrels , Gambian kangaroo, dormouse, etc.).
Monkeypox virus is resistant to drying and low temperatures, and it is Can survive for several months. It is heat sensitive and can be inactivated by heating to 56°C for 30 minutes or 60°C for 10 minutes. It can be inactivated by ultraviolet rays and general disinfectants, and is sensitive to sodium hypochlorite, chloroxylenol, glutaraldehyde, formaldehyde and paraformaldehyde.
II. Epidemiology
(1) Source of infection p>
The main source of infection is rodents infected with monkeypox virus. Primates (including monkeys, chimpanzees, humans, etc.) can also become sources of infection after infection.
(2) Transmission route
Viruses enter the human body through mucous membranes and broken skin. Humans are mainly infected through contact with infected animal lesion exudates, blood, and other body fluids, or by being bitten or scratched by infected animals. It is mainly transmitted through close contact between people, and it can also be transmitted through droplets. Contact with virus-contaminated items may also be infected, and it can also be transmitted vertically through the placenta. Sexual transmission cannot be ruled out.
(3) susceptible population span>
The population is generally susceptible. There is a certain degree of cross-protection against monkeypox virus in those who have been previously vaccinated against smallpox.
III. Clinical manifestations
The incubation period is 5-21 days, mostly 6-13 days. In the early stage of the disease, chills and fever occur, and the body temperature is mostly above 38.5 °C, which may be accompanied by symptoms such as headache, drowsiness, fatigue, back pain and myalgia. Most patients have swollen lymph nodes in the neck, axilla, and groin. A rash appears 1-3 days after onset. The rash first appeared on the face and gradually spread to the extremities and other parts. The rashes were mostly distributed centrifugally. The rashes on the face and extremities were more common than on the trunk. The rashes could appear on the palms and soles of the feet, and the number of rashes ranged from several to thousands. etc.; can also involve the oral mucosa, digestive tract, genitalia, conjunctiva and cornea. The rash goes through stages ranging from macules, papules, herpes, pustules to scabs, herpes andPustules are mostly spherical, about 0.5-1 cm in diameter, hard in texture, and may be accompanied by obvious itching and pain. It takes about 2-4 weeks from the onset to the scab shedding. Erythema or hyperpigmentation, or even scarring, may remain after the scab falls off, and the scarring may last for several years. Complications may occur in some patients, including secondary bacterial infection at the site of skin lesions, bronchopneumonia, encephalitis, corneal infection, and sepsis.
Monkeypox is a self-limiting disease with a good prognosis in most cases. Severe cases are common in young children and immunocompromised people, and prognosis is related to the viral branch of infection, the degree of virus exposure, previous health status, and the severity of complications. The case fatality rate in the West African branch is about 3%, and the case fatality rate in the Congo Basin branch is about 10%.
IV. Laboratory Examination
(1) General Inspection p>
Peripheral blood leukocytes were normal or increased, and platelets were normal or decreased. Some patients may have elevated transaminase levels, lower blood urea nitrogen levels, and hypoproteinemia.
(2) Pathological examination span>
1. Nucleic acid detection: nucleic acid amplification detection method is used in skin rash, blister fluid, crust, oropharynx or nose Monkeypox virus nucleic acid can be detected in pharyngeal secretions and other specimens.
2. Virus culture: Monkeypox virus can be isolated by collecting the above specimens for virus culture. Virus culture should be carried out in a biosafety laboratory of level 3 or above.
V. Diagnosis and Differential Diagnosis
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(1) Diagnostic criteria
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1. Suspected case
Patients with the above clinical manifestations and any one of the following epidemiological history:
(1) Have a history of living in an overseas area where monkeypox cases are reported within 21 days before the onset of the disease; Close contact;
(3) Contact with the blood, body fluids or secretions of monkeypox virus-infected animals within 21 days before the onset of the disease.
2. Confirmed cases
Suspected cases and positive monkeypox virus nucleic acid test or cultured isolated monkeypox virus.
For cases that meet the criteria for suspected or confirmed cases, infectious disease reports should be made according to relevant requirements.
(2) Differential diagnosis
It is mainly differentiated from chickenpox, herpes zoster, herpes simplex, measles, dengue fever and other febrile and rash diseases. Differentiate from bacterial skin infections, scabies, syphilis and allergic reactions.
Six. Treatment
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Currently, there is no specific anti-monkeypox virus drug in China, mainly symptomatic support and treatment of complications.
(1) Symptomatic and supportive treatment. Bed rest, pay attention to supplement nutrition and water, maintain water and electrolyte balance. For those with high body temperature, physical cooling is the main method. If the temperature exceeds 38.5 °C, antipyretic analgesics should be given to reduce fever, but attention should be paid to prevent prostration caused by profuse sweating.
Keep the skin, mouth, eyes and nose clean and moist. secondary infection. Analgesics can be given if the pain at the rash site is severe.
(2) Complication treatment. In case of secondary bacterial infection of the skin, effective antibacterial drug treatment should be given, and adjustments should be made according to the isolation and identification of pathogenic bacteria and the results of drug susceptibility. Prophylactic use of antimicrobials is not recommended. When corneal lesions appear, eye drops, supplemented with vitamin A and other treatments can be applied. When encephalitis occurs, sedation, dehydration and intracranial pressure reduction, and airway protection are given.
(3) Psychological support therapy. Patients often have psychological problems such as tension, anxiety, depression, etc., psychological support, counseling and related explanations should be strengthened, and psychologists should be invited to consult and participate in disease diagnosis and treatment in time according to the condition , and give appropriate drug adjuvant therapy if necessary.
(4) Chinese medicine treatment. According to the principles of TCM “examination and treatment” and “three causes and measures”, the treatment is based on syndrome differentiation. Patients with clinical symptoms of fever are recommended to use Shengma Gegen Decoction, Shengma Biejia Decoction, Zixue Powder, etc.; patients with clinical symptoms of high fever, dense acne, sore throat, and multiple lymphadenopathy are recommended to use Qingying Decoction, Shengma Biejia Decoction, Xuanxue Powder, etc. Bai Chengqi Soup, etc.
VII. Discharge criteria
The patient can be discharged if the following criteria are met: normal body temperature, significant improvement in clinical symptoms, and scabs falling off.
VIII. Infection prevention and control in medical institutions p>
Suspected and confirmed cases should be placed in isolation wards. Suspected cases are isolated in a single room.
Medical staff implement standard precautions, take contact precautions, droplet precautions, wear disposable latex gloves, medical Protective masks, face shields or goggles, one timeSexual isolation gowns, etc., and good hand hygiene.
Strictly disinfect the patient’s secretions, feces and blood pollutants in accordance with the “Technical Specification for Disinfection in Medical Institutions” deal with.
Click “Read the original text“, Health Commission official website
Edit | Cheng Ting
Source | Health China CCTV News