According to the website of the National Health Commission, since May 2022, many non-endemic countries in the world have reported monkeypox cases, and there is community transmission. In order to prepare for the medical response to monkeypox in advance and improve the ability to identify and standardize diagnosis and treatment in early clinical practice, the National Health Commission and the State Administration of Traditional Chinese Medicine organized and formulated the "Guidelines for the Diagnosis and Treatment of Monkeypox (2022 Edition)" (hereinafter referred to as the "Diagnosis and Treatment Guidelines").
The "Diagnosis and Treatment Guidelines" clearly define the source of infection, transmission routes, susceptible populations and other contents of monkeypox. The full text is as follows:
Monkeypox diagnostic guide
(2022 edition)
Monkeypox is a type of virus (Monkeypox?) Zoonotic viral diseases caused by virus, MPXV) infection, clinically mainly manifest as fever, rash, and lymphadenopathy. The disease is mainly endemic in Central and West Africa. Cases of monkeypox have also been reported in some non-endemic countries since May 2022, with community transmission. In order to improve the clinician's ability to recognize monkeypox early and standardize diagnosis and treatment, this diagnosis and treatment guideline is specially formulated.
1. Etiology
Monkeypox virus (MPXV), classified in the genus Orthoptopoxvirus in the pox virus family, is one of the 4 positive pox viruses that cause disease in humans, and the other 3 are smallpox virus, pox virus and cowpox virus. Monkeypox virus particles are brick-shaped or oval in shape, 200 nm in size×250 nm in size, have an envelope, have structural proteins and DNA-dependent RNA polymerases in the viral particles, and the genome is double-stranded DNA, with a length of about 197 kb. Monkeypox virus is divided into two branches: the West African branch and the Congo Basin branch. The sequencing results of the virus in some cases in non-endemic countries are West African branches.
The main reservoir of monkeypox virus is African rodents (including African squirrels, tree squirrels, Gambian kangaroos, sleeping mice, etc.).
Monkeypox viruses are resistant to dryness and low temperatures and can survive for months on soil, scabs and covers. Heat sensitive, heated to 56 °C for 30 min or 60 °C for 10 min can be inactivated. It can be inactivated by ultraviolet rays and general disinfectants and is sensitive to sodium hypochlorite, chlorodimethylphenol, glutaraldehyde, formaldehyde and paraformaldehyde.
Epidemiology
(1) Source of infection
The main source of infection is rodents infected with monkeypox virus. Primates (including monkeys, chimpanzees, humans, etc.) can also be a source of infection after infection.
(2) Transmission routes
The virus invades the body through the mucous membranes and broken skin. Humans are infected mainly by contact with the lesion exudate, blood, and other body fluids of infected animals, or by biting or scratching infected animals. It is transmitted mainly through close contact between people, but also through droplets, and it can also be infected by contact with items contaminated with the virus, or it can be transmitted vertically through the placenta. Sexual transmission cannot yet be ruled out.
(3) Susceptible groups
People are generally susceptible. People who have been vaccinated against smallpox in the past have a degree of cross-protection against monkeypox virus.
3. Clinical manifestations
The incubation period is 5-21 days, mostly 6-13 days. Chills and fever occur in the early stage of the disease, and the body temperature is mostly above 38.5 °C, which can be accompanied by symptoms such as headache, drowsiness, fatigue, back pain and myalgia. Most patients present with lymphadenopathy in the neck, armpits, groin, and other areas.
A rash appears 1-3 days after the onset of the disease. The rash first appears on the face, gradually spreading to the limbs and other parts, the rash is mostly centrifugal distribution, the face and limb rash is more common than the trunk, the palms and soles of the feet can appear rashes, the number of rashes ranges from several to thousands; It may also involve the oral mucosa, digestive tract, genitals, conjunctiva, and cornea. The rash undergoes several stages from macules, papules, herpes, pustules to scabs, herpes and pustular eruptions are mostly spherical, about 0.5-1 cm in diameter, hard in texture, may be accompanied by obvious itching and pain.
From onset to scab shedding about 2-4 weeks. Erythema or pigmentation can remain after the scab is shed, and even scarring can last for several years. Some patients may develop complications, including secondary bacterial infections at the site of the lesion, bronchopneumonia, encephalitis, corneal infections, and sepsis.
Monkeypox is a self-limiting disease with a good prognosis for the most part. Severe cases are common in young children and immunocompromised populations, and prognosis is related to the branch of the virus infected, the degree of exposure to the virus, the previous state of health, and the severity of complications. The disease fatality rate of branches in West Africa is about 3%, and the disease fatality rate of branches in the Congo Basin is about 10%.
4. Laboratory examination
(1) General inspection
Peripheral blood leukocytes are normal or elevated, and platelets are normal or decreased. Some patients may have elevated transaminases levels, decreased blood urea nitrogen levels, and hypoproteinemia.
(2) Etiological examination
1. Nucleic acid detection: Monkeypox virus nucleic acid can be detected in specimens such as rash, herpes, scab, oropharynx or nasopharynx secretions by nucleic acid amplification detection method.
2. Virus culture: Collecting the above specimens for virus culture can be isolated to monkeypox virus. Virus culture should be carried out in biosafety laboratories at level III and above.
5. Diagnosis and differential diagnosis
(1) Diagnostic criteria
1. Suspected cases
Present with these clinical manifestations, including any of the following epidemiological histories:
(1) There is a history of travel in the area where overseas monkeypox cases have been reported within 21 days before the onset of illness;
(2) Have close contact with monkeypox cases within 21 days before the onset of illness;
(3) Have been exposed to the blood, body fluids or secretions of monkeypox virus-infected animals within 21 days before the onset of illness.
2. Confirmed cases
Suspected cases and monkeypox virus nucleic acid test positive or culture isolated monkeypox virus.
For cases that meet the criteria for suspected or confirmed cases, infectious disease reports should be made in accordance with relevant requirements.
(2) Differential diagnosis
It is mainly distinguished from other febrile eruptive diseases such as chickenpox, herpes zoster, herpes simplex, measles, dengue fever, etc., and also from skin bacterial infections, scabies, syphilis and allergic reactions.
6. Treatment
At present, there is no specific anti-monkeypox virus drug in China, mainly for symptomatic support and treatment of complications.
(1) Symptomatic supportive treatment. Bed rest, pay attention to supplement nutrition and water, maintain water and electrolyte balance. In the case of high body temperature, physical cooling is the mainstay, more than 38.5 ° C, give antipyretic analgesics to reduce fever, but pay attention to prevent a large amount of sweating caused by prostration.
Keep the skin, mouth, eyes and nose clean and moist, and avoid scratching the skin of the rash area to avoid secondary infection. Analgesics may be given when the pain in the rash area is severe.
(2) Treatment of complications. Effective antimicrobial therapy is given for secondary skin bacterial infections, adjusted according to the isolation and identification of pathogenic bacteria culture and susceptibility results. Prophylactic use of antibacterial drugs is not recommended. In the case of corneal lesions, eye drops may be used, supplemented by treatment such as vitamin A. Treatment such as sedation, dehydration, and airway protection is given when encephalitis occurs.
(3) Psychological support treatment. Patients often have psychological problems such as nervousness, anxiety, depression, etc., and should strengthen psychological support, counseling and related interpretation work, and promptly consult a psychologist and participate in the diagnosis and treatment of the disease according to the condition, and if necessary, give corresponding drugs to assist in treatment.
(4) Traditional Chinese medicine treatment. According to the principles of "judging the causes and discussing the treatment" and "three causes of the situation" in Traditional Chinese medicine, the treatment is dialectically applied. It is recommended for those with clinical symptoms of fever to use cohosh kudzu soup, lifting powder, purple snow powder, etc.; Clinical symptoms such as high fever, dense acne rash, sore throat, and multiple lymphadenopathy are recommended to use Qingying soup, cohosh turtle soup, Xuanbai Chengqi soup, etc.
7. Discharge criteria
Discharge from hospital if the following criteria are met: normal body temperature, marked improvement in clinical symptoms, and shedding of scabs.
8. Infection prevention and control in medical institutions
Suspected and confirmed cases should be placed in isolation wards. Suspected cases are isolated in a single room.
Medical staff implement standard prevention, take contact prevention, droplet prevention measures, wear disposable latex gloves, medical protective masks, protective face screens or goggles, disposable isolation gowns, etc., and do a good job of hand hygiene.
The patient's secretions, feces and blood contaminants are strictly disinfected in accordance with the "Technical Specifications for Disinfection of Medical Institutions".
Source: Popular Science China