Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022
John P Thornhill, Sapha Barkati, Sharon Walmsley, Juergen Rockstroh, Andrea Antinori, Luke B Harrison, Romain Palich, Achyuta Nori, Iain Reeves, Maximillian S Habibi, Vanessa Apea, Christoph Boesecke, Linos Vandekerckhove, Michal Yakubovsky, Elena Sendagorta, Jose L Blanco, Eric Florence, Davide Moschese, Fernando M Maltez, Abraham Goorhuis, Valerie Pourcher, Pascal Migaud, Sebastian Noe, Claire Pintado, Fabrizio Maggi, Ann-Brit E Hansen, Christian Hoffmann, Jezer I Lezama, Cristina Mussini, AnnaMaria Cattelan, Keletso Makofane, Darrell Tan, Silvia Nozza, Johannes Nemeth, Marina B Klein, Chloe M Orkin, SHARE-net Clinical Group, Camille Anger, Andrea Antinori, Vanessa J Apea, Carmen B Arenzana, Sapha Barkati, Nesli Basgoz, Marcel Behr, Khadija Benomar, Vincent Bérot, Antoine Blais, Jose Luis Blanco, Alexandre Bleibtreu, Christoph Boesecke, Cécile Brin, Kaitlyn L Broderick, Andrew Bui-Nguyen, Sonia Burrel, Daniel Camprubi, João Caria, Antonella Castagna, Alba Català, Anna Maria Catellan, Arpita Chakravarti, Harry L Coleman, Ever Arturo Corral-Herrera, Katherine Coyne, Guillermo Cuervo, Subathira Dakshina, Fernando De la Calle-Prieto, Nicolas de Loredo, Marie-Angélique De Scheerder, Sacha de Stoppelaar, Marta Díaz-Menéndez, Daniela Drauz, Reggio Emilia, Sara Esperti 3rd, Hamzah Farooq, Eric Florence, Nadav Friedel, Irene Fuertes, Anna Rosa Garbuglia, David Garcia, Ariane Gavaud, Vanessa Gilera, Enrico Girardi, Ana Gonzalez-Cordón, Bram Goorhuis, Christina Greenaway, Thomas Grunemwald, Giovanni Guaraldi, Maximillian S Habibi, Anna-Brit E Hansen, David Harrington, Luke B Harrison, Christian Hoffmann, Emmanuelle Huchet, Marina Klein, Gitte Kronborg, Caroline Lascoux-Combe, Tiziana Lazzarotto, Itzchak Levy, Jezer Ivan Lezama-Mora, Michael Libman, Liana Macpherson, Fabrizio Maggi, Keletso Makofane, Fernando Maltez, Anne-Geneviève Marcelin, Stéphane Marot, Mikel Martinez, Anja Masuhr, James McMahon, Pascal Migaud, Sharmistha Mishra, Jean-Michel Molina, Gentiane Monsel, Davide Moschese, José Muñoz, Cristina Mussini, Johannes Nemeth, Emanuele Nicastri, Sebastian Noe, Achyuta Vithal Nori, Agathe Nouchi, Silvia Nozza, Will Nutland, Eline Op De Coul, Chloe Orkin, Mario Ostrowski, Matthew Oughton, Romain Palich, Yael Paran, Robert Pilarski, Claire Pintado, Sébastien Poulin, Valérie Pourcher, Diana Póvoas, Iain Reeves, Daniel Richardson, Anna Riddell, Josep Riera, Giuliano Rizzardini, Jürgen Rockstroh, Giada Rossini, Emma Rubenstein, Carolina Sandoval, Carl-Knud Schewe, Cornelia J Schinkel, Elena Sendagorta, Suneeta Soni, Lazzaro Spallanzani, Cornelia Staehelin, Harmut Stocker, Jason Szabo, Linda Taggart, Darrell Tan, Réjean Thomas, John P Thornhill, Benoît Trottier, Francesco Vaia, Linos Vandekerckhove, Donald Vinh, Yara Wakim, Sharon Walmsley, Clemens Wendtner, Anat Wieder, Michal Yakubovsky, Gerasimos J Zaharatos, John P Thornhill, Sapha Barkati, Sharon Walmsley, Juergen Rockstroh, Andrea Antinori, Luke B Harrison, Romain Palich, Achyuta Nori, Iain Reeves, Maximillian S Habibi, Vanessa Apea, Christoph Boesecke, Linos Vandekerckhove, Michal Yakubovsky, Elena Sendagorta, Jose L Blanco, Eric Florence, Davide Moschese, Fernando M Maltez, Abraham Goorhuis, Valerie Pourcher, Pascal Migaud, Sebastian Noe, Claire Pintado, Fabrizio Maggi, Ann-Brit E Hansen, Christian Hoffmann, Jezer I Lezama, Cristina Mussini, AnnaMaria Cattelan, Keletso Makofane, Darrell Tan, Silvia Nozza, Johannes Nemeth, Marina B Klein, Chloe M Orkin, SHARE-net Clinical Group, Camille Anger, Andrea Antinori, Vanessa J Apea, Carmen B Arenzana, Sapha Barkati, Nesli Basgoz, Marcel Behr, Khadija Benomar, Vincent Bérot, Antoine Blais, Jose Luis Blanco, Alexandre Bleibtreu, Christoph Boesecke, Cécile Brin, Kaitlyn L Broderick, Andrew Bui-Nguyen, Sonia Burrel, Daniel Camprubi, João Caria, Antonella Castagna, Alba Català, Anna Maria Catellan, Arpita Chakravarti, Harry L Coleman, Ever Arturo Corral-Herrera, Katherine Coyne, Guillermo Cuervo, Subathira Dakshina, Fernando De la Calle-Prieto, Nicolas de Loredo, Marie-Angélique De Scheerder, Sacha de Stoppelaar, Marta Díaz-Menéndez, Daniela Drauz, Reggio Emilia, Sara Esperti 3rd, Hamzah Farooq, Eric Florence, Nadav Friedel, Irene Fuertes, Anna Rosa Garbuglia, David Garcia, Ariane Gavaud, Vanessa Gilera, Enrico Girardi, Ana Gonzalez-Cordón, Bram Goorhuis, Christina Greenaway, Thomas Grunemwald, Giovanni Guaraldi, Maximillian S Habibi, Anna-Brit E Hansen, David Harrington, Luke B Harrison, Christian Hoffmann, Emmanuelle Huchet, Marina Klein, Gitte Kronborg, Caroline Lascoux-Combe, Tiziana Lazzarotto, Itzchak Levy, Jezer Ivan Lezama-Mora, Michael Libman, Liana Macpherson, Fabrizio Maggi, Keletso Makofane, Fernando Maltez, Anne-Geneviève Marcelin, Stéphane Marot, Mikel Martinez, Anja Masuhr, James McMahon, Pascal Migaud, Sharmistha Mishra, Jean-Michel Molina, Gentiane Monsel, Davide Moschese, José Muñoz, Cristina Mussini, Johannes Nemeth, Emanuele Nicastri, Sebastian Noe, Achyuta Vithal Nori, Agathe Nouchi, Silvia Nozza, Will Nutland, Eline Op De Coul, Chloe Orkin, Mario Ostrowski, Matthew Oughton, Romain Palich, Yael Paran, Robert Pilarski, Claire Pintado, Sébastien Poulin, Valérie Pourcher, Diana Póvoas, Iain Reeves, Daniel Richardson, Anna Riddell, Josep Riera, Giuliano Rizzardini, Jürgen Rockstroh, Giada Rossini, Emma Rubenstein, Carolina Sandoval, Carl-Knud Schewe, Cornelia J Schinkel, Elena Sendagorta, Suneeta Soni, Lazzaro Spallanzani, Cornelia Staehelin, Harmut Stocker, Jason Szabo, Linda Taggart, Darrell Tan, Réjean Thomas, John P Thornhill, Benoît Trottier, Francesco Vaia, Linos Vandekerckhove, Donald Vinh, Yara Wakim, Sharon Walmsley, Clemens Wendtner, Anat Wieder, Michal Yakubovsky, Gerasimos J Zaharatos
Abstract
Background: Before April 2022, monkeypox virus infection in humans was seldom reported outside African regions where it is endemic. Currently, cases are occurring worldwide. Transmission, risk factors, clinical presentation, and outcomes of infection are poorly defined.
Methods: We formed an international collaborative group of clinicians who contributed to an international case series to describe the presentation, clinical course, and outcomes of polymerase-chain-reaction-confirmed monkeypox virus infections.
Results: We report 528 infections diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries. Overall, 98% of the persons with infection were gay or bisexual men, 75% were White, and 41% had human immunodeficiency virus infection; the median age was 38 years. Transmission was suspected to have occurred through sexual activity in 95% of the persons with infection. In this case series, 95% of the persons presented with a rash (with 64% having ≤10 lesions), 73% had anogenital lesions, and 41% had mucosal lesions (with 54 having a single genital lesion). Common systemic features preceding the rash included fever (62%), lethargy (41%), myalgia (31%), and headache (27%); lymphadenopathy was also common (reported in 56%). Concomitant sexually transmitted infections were reported in 109 of 377 persons (29%) who were tested. Among the 23 persons with a clear exposure history, the median incubation period was 7 days (range, 3 to 20). Monkeypox virus DNA was detected in 29 of the 32 persons in whom seminal fluid was analyzed. Antiviral treatment was given to 5% of the persons overall, and 70 (13%) were hospitalized; the reasons for hospitalization were pain management, mostly for severe anorectal pain (21 persons); soft-tissue superinfection (18); pharyngitis limiting oral intake (5); eye lesions (2); acute kidney injury (2); myocarditis (2); and infection-control purposes (13). No deaths were reported.
Conclusions: In this case series, monkeypox manifested with a variety of dermatologic and systemic clinical findings. The simultaneous identification of cases outside areas where monkeypox has traditionally been endemic highlights the need for rapid identification and diagnosis of cases to contain further community spread.
Copyright © 2022 Massachusetts Medical Society.
Source: PubMed