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Ramírez-Olivencia G, Velasco Arribas M, Vera García MM, Casabona J, Martínez MJ, Membrillo De Novales FJ. Clinical and Epidemiological Characteristics of the 2022 Mpox Outbreak in Spain (CEME-22 Study). Open Forum Infect Dis 2024; 11:ofae105. [PMID: 38524223 PMCID: PMC10960598 DOI: 10.1093/ofid/ofae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Background We conducted a multicentric national study (SEIMC-CEME-22), to describe the clinical and epidemiological profile of the mpox outbreak in Spain, including the management of the disease. Methods This was a retrospective national observational study conducted by Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) and Foundation SEIMC-GESIDA. We included patients with a confirmed mpox diagnosis before 13 July 2022, and attended at the Spanish health network (the early phase of the outbreak). Epidemiological, clinical, and therapeutic data were collected. Results Of a total of 1472 patients from 52 centers included, 99% of them were cisgender men, mostly middle-aged, and 98.6% were residents in Spain. The main suspected route of transmission was sexual exposure, primarily among MSM. Occupational exposure was reported in 6 patients. Immunosuppression was present in 40% of patients, mainly due to human immunodeficiency virus (HIV). Only 6.5% of patients had been vaccinated against orthopoxvirus. Virus sequencing was performed in 147 patients (all B.1 lineage). Rash was the most frequent symptom (95.7%), followed by fever (48.2%), adenopathies (44.4%) myalgias (20.7%), proctitis (17%), and headache (14.7%). Simultaneously diagnosed sexually transmitted infections included syphilis (n = 129), gonococcal infection (n = 91), HIV (n = 67), chlamydia (n = 56), hepatitis B (n = 14), and hepatitis C (n = 11). No therapy was used in 479 patients (33%). Symptomatic therapies and antibiotics were used in 50% of cases. The most used therapy regimens were systemic corticoids (90 patients), tecovirimat (6 patients), and cidofovir (13 patients). Smallpox immunoglobulins were used in 1 patient. Fifty-eight patients were hospitalized, and 1 patient died. Conclusions Mpox outbreak in Spain affected primarily middle-aged men who were sexually active and showed a high rate of HIV infection. A range of heterogeneous therapeutics options was performed.
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Affiliation(s)
- G Ramírez-Olivencia
- Hospital Central de la Defensa "Gómez Ulla." Infectious Diseases Unit, Madrid, Spain
- Grupo de Estudio de Patología Importada, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
| | - M Velasco Arribas
- Grupo de Estudio de Patología Importada, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Hospital Fundación Alcorcón, Department of Internal Medicine-Infectious Department, Research Department, Alcorcón, Spain
| | - M M Vera García
- Centro Sanitario Sandoval, HIV/STI Unit, Madrid, Spain
- Grupo de Estudio de ITS, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
| | - J Casabona
- Grupo de Estudio de ITS, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Centre for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - M J Martínez
- Hospital Clinic, Microbiology Department, Barcelona, Spain
- Grupo de Estudio de Patología Importada, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
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Okoli GN, Van Caeseele P, Askin N, Abou-Setta AM. A global systematic evidence review with meta-analysis of the epidemiological characteristics of the 2022 Mpox outbreaks. Infection 2023:10.1007/s15010-023-02133-5. [PMID: 38051425 DOI: 10.1007/s15010-023-02133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND In 2022, there were outbreaks of Mpox where the disease is not endemic. We summarized published full-text epidemiological data from the outbreaks. METHODS A global evidence review (protocol: osf.io/j3kb7) with systematic literature search up to February 09, 2023. We focused on experimental/observational studies of laboratory confirmed Mpox, excluding case reports and case series of < 5 cases. Epidemiological data were pooled using an inverse variance, random-effects model, and pooled estimates presented with associated 95% confidence intervals. RESULTS We included 66 studies. Mean incubation period was 7.8 days (6.6-9.0 days, 8 studies: 560 cases), reproductive number 1.8 (1.7-1.9, 6 studies), mean duration from symptom onset to diagnosis 5.8 days (4.8-6.8 days, 4 studies: 982 cases), mean symptom duration 17.5 days (14.7-20.2 days, 3 studies: 292 cases), mean serial interval 8.5 days (7.3-9.9 days, 1 study), hospitalisation 6% (4-9%, 26 studies: 5339 cases), and vaccine effectiveness 78% (65-91%, 3 studies: 953 cases). Highly relevant clinical manifestations were pleomorphic skin lesions 82% (68-94%, 26 studies: 4093 cases), anogenital lesions 64% (51-77%, 9 studies: 10,398 cases), fever 54% (50-57%, 52 studies: 25,992 cases), and lymphadenopathy 51% (46-57%, 42 studies: 17,803 cases), with cases mostly men who have sex with men (MSM). Possibly relevant manifestations were perianal lesions, fatigue, asthenia, myalgia, and headache. CONCLUSIONS The 2022 Mpox outbreaks presented with sex-related clinical manifestations and were mostly reported among MSM.
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Affiliation(s)
- George N Okoli
- George & Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada.
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Paul Van Caeseele
- Department of Medical Microbiology & Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Nicole Askin
- Neil John Maclean Library, University of Manitoba, Winnipeg, MB, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Caldeira MB, Neves JM, Pestana M, Corte-Real R, Borrego MJ, Cordeiro R, Machado J, Pelerito A, Carvalho ILD, Núncio MS, Fernandes C. Demographic and Clinical Characteristics of Mpox Patients Attending an STD Clinic in Lisbon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6803. [PMID: 37835073 PMCID: PMC10572837 DOI: 10.3390/ijerph20196803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/03/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023]
Abstract
Mpox is a viral disease caused by the monkeypox virus, which marked the year of 2022 with a global outbreak. While previously considered to be a zoonosis of almost exclusive animal-to-human transmission, the current outbreak has been attributed to human-to-human transmission, particularly sexual transmission. As a new sexually transmissible disease, we studied the epidemiological and clinical features, as well as the concomitant occurrence of other sexually transmissible diseases, treatment approach, and outcome of our 291 patients, in the current outbreak. We found a total of 169 concomitant sexually transmissible infections of bacterial and viral origins, corresponding to 107 patients. Neisseria gonorrhoeae was the most common agent, particularly in the anal location. With this work, we emphasize the need for a thorough epidemiological and medical history, as well as a concomitant complete laboratorial screening for other STIs in patients with confirmed or suspected mpox.
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Affiliation(s)
- Margarida Brito Caldeira
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Entidade Pública Empresarial, 1169-050 Lisbon, Portugal
| | - José Miguel Neves
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Entidade Pública Empresarial, 1169-050 Lisbon, Portugal
| | - Mafalda Pestana
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Entidade Pública Empresarial, 1169-050 Lisbon, Portugal
| | - Rita Corte-Real
- Molecular Biology Department, Centro Hospitalar Universitário de Lisboa Central, Entidade Pública Empresarial, 1169-050 Lisbon, Portugal
| | - Maria José Borrego
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
| | - Rita Cordeiro
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
| | - Jorge Machado
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
| | - Ana Pelerito
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
| | - Isabel Lopes De Carvalho
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
| | - Maria Sofia Núncio
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
| | - Cândida Fernandes
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Entidade Pública Empresarial, 1169-050 Lisbon, Portugal
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Ramírez-Soto MC. Monkeypox Outbreak in Peru. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1096. [PMID: 37374300 DOI: 10.3390/medicina59061096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
Monkeypox (Mpox) is a zoonotic disease caused by the Orthopoxvirus monkeypox virus (MPXV). Since 1970, outbreaks of MPXV have occurred in several Sub-Saharan African countries. However, from May 2022 to April 2023, recent outbreaks of Mpox occurred in several countries outside of Africa, and these cases quickly spread to over 100 non-endemic countries on all continents. Most of these cases were found in the region of the Americas and the Europe region. In Latin America, the highest all-age Mpox rates per million inhabitants were in Peru, Colombia, Chile, and Brazil. Given its global impact, Mpox was declared as an international Public Health Emergency by WHO in July 2022. MPXV infection disproportionately affects men who have sex with men and members of the HIV-infected population. Vaccination is the current strategy for controlling and preventing Mpox in high-risk groups. In this context, Peru has the fourth-highest number of Mpox cases in Latin America and faces significant challenges in disease control. Because of this, in this review, we discuss the epidemiology, public health indicators, and prevention of Mpox in the 2022 Peru outbreak so that health authorities can join forces to control MPXV transmission.
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Affiliation(s)
- Max Carlos Ramírez-Soto
- Centro de Investigación en Salud Pública, Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15011, Peru
- Facultad de Ciencias de la Salud, Universidad Tecnológica del Peru, Lima 15046, Peru
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Gamo Guerrero M, Simón Gozalbo A, Martín Díaz M, Díez Madueño K, Del Río Pena E, De la Cueva P, Talaván T, Jiménez E, Torres J, Valencia J, Cuevas G, Bibiano C, Ryan P. Interdisciplinary management of mpox-related local complications: report on a series of cases. Front Med (Lausanne) 2023; 10:1184924. [PMID: 37324126 PMCID: PMC10267306 DOI: 10.3389/fmed.2023.1184924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
Monkeypox (mpox) is a viral zoonosis, and human-to-human transmission can result from close contact with the respiratory secretions and mucocutaneous lesions of an infected person. The prodromal phase is followed by an eruptive phase, with skin and/or mucosal lesions that progress through several stages at different sites. In this study, we describe the importance of interdisciplinary care management and follow-up of patients with complicated mpox. A cross-sectional study was conducted from May 2022 until August 2022 at a secondary hospital in Madrid (Spain). Out of 100 patients with mpox seen at this institution, we selected and analyzed 11 with local complications. All the patients were male at birth, and the mean age was 32 (30-42) years. The clinical manifestations included skin rash or mucosal lesions, fever, myalgia and lymphadenopathies. The most frequent local complications were pharyngitis associated with dysphagia, penile edema, infection of the mucocutaneous lesions, and ulceration of the genital lesions. A multidisciplinary team was created for the care of patients with complications secondary to mpox. The team comprised dermatologists and specialists in infectious diseases, preventive medicine, and emergency medicine. This approach improved the ability to diagnose and treat early with supportive, topical, and systemic treatment. In our center most of the cases were self-limiting, and none were life-threatening. An interdisciplinary response to a public health alert enhances the management of complex patients and should be implemented in successive outbreaks of mpox.
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Affiliation(s)
| | | | | | | | | | - Pablo De la Cueva
- Dermatology Service, Infanta Leonor Hospital, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Tamar Talaván
- Local Laboratory, Infanta Leonor Hospital, Madrid, Spain
| | - Eva Jiménez
- Preventive Medicine Service, Infanta Leonor Hospital, Madrid, Spain
| | - Juan Torres
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
| | - Jorge Valencia
- Infectious Diseases Unit, Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
| | - Guillermo Cuevas
- Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
- Infectious Diseases Unit, Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
| | - Carlos Bibiano
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Emergency Service, Infanta Leonor Hospital, Madrid, Spain
| | - Pablo Ryan
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
- Infectious Diseases Unit, Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
- Biomedical Network Research Centre on Infectious Diseases (CIBERINFECT), Madrid, Spain
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AbdullGaffar B, Abdulrahman S. Monkeypox virus, herpes simplex virus, and cytomegalovirus skin coinfections. J Med Virol 2023; 95:e28500. [PMID: 36653827 DOI: 10.1002/jmv.28500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
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