Clinical Presentation and Virological Assessment of Confirmed Human Monkeypox Virus Cases in Spain   : A Prospective Cohort Study

Tarín-Vicente, Eloy José; Agud-Dios, Manuel; Alemany, Andrea; Ubals, María; Suñer, Clara; Antón, Andrés; Arando, Maider; Arroyo‐Andrés, Jorge; Calderón-Lozano, Lorena; Casañ, Cristina; Cabrera, José Miguel; Coll, Pep; Descalzo, Vicente; Folgueira, María Dolores; García-Pérez, Jorge-Néstor; Gil-Cruz, Elena; González-Rodríguez, Borja; Gutiérrez‐Collar, Christian; Hernández-Rodríguez, Águeda; López-Roa, Paula; Meléndez, María de los Ángeles; Montero‐Menárguez, Julia; Muñoz‐Gallego, Irene; Palencia-Pérez, Sara Isabel; Paredes, Roger; Pérez-Revilla, Alfredo; Piñana, María; Prat, Núria; Ramírez, Aída; Rivero, Ángel; Rubio‐Muniz, Carmen Alejandra; Vall-Mayans, Martí; Acosta-Velásquez, Kevin Stephen; Wang, An; Marks, Michael; Ortiz‐Romero, Pablo L.; Mitjà, Oriol

doi:10.2139/ssrn.4162718

Cited by 7 publications

(13 citation statements)

References 14 publications

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“…Genital rash, although reported in fewer than one half of cases, was common; 36% of persons developed rash in four or more body regions. Other recent reports describe similar clinical characteristics ( 6 , 7 ). Clinicians should be vigilant for patients with rash consistent with monkeypox, regardless of whether the rash is disseminated or was preceded by prodrome.…”

Section: Discussionsupporting

confidence: 74%

Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022

Philpott¹,

Hughes²,

Alroy³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

283

251

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this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).Monkeypox, a zoonotic infection caused by an orthopoxvirus, is endemic in parts of Africa. On August 4, 2022, the U.S. Department of Health and Human Services declared the U.S. monkeypox outbreak, which began on May 17, to be a public health emergency (1,2). After detection of the first U.S. monkeypox case), CDC and health departments implemented enhanced monkeypox case detection and reporting. Among 2,891 cases reported in the United States through July 22 by 43 states, Puerto Rico, and the District of Columbia (DC), CDC received case report forms for 1,195 (41%) cases by July 27. Among these, 99% of cases were among men; among men with available information, 94% reported male-to-male sexual or close intimate contact during the 3 weeks before symptom onset. Among the 88% of cases with available data, 41% were among non-Hispanic White (White) persons, 28% among Hispanic or Latino (Hispanic) persons, and 26% among non-Hispanic Black or African American (Black) persons. Forty-two percent of persons with monkeypox with available data did not report the typical prodrome as their first symptom, and 46% reported one or more genital lesions during their illness; 41% had HIV infection. Data suggest that widespread community transmission of monkeypox has disproportionately affected gay, bisexual, and other men who have sex with men and racial and ethnic minority groups. Compared with historical reports of monkeypox in areas with endemic disease, currently reported outbreak-associated cases are less likely to have a prodrome and more likely to have genital involvement. CDC and other federal, state, and local agencies have implemented response efforts to expand testing, treatment, and vaccination. Public health efforts should prioritize gay, bisexual, and other men who have sex with men, who are currently disproportionately affected, for prevention and testing, while addressing equity, minimizing stigma, and maintaining vigilance for transmission in other populations. Clinicians should test patients with rash consistent with

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Section: Discussionsupporting

confidence: 74%

Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022

Philpott¹,

Hughes²,

Alroy³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

283

251

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“…2 ) with a high degree of heterogeneity between studies. Individual study CHR estimates ranged from 1.5% (0.4–3.9) in the study by Tarín-Vicente and colleagues 49 to as high as 73.5% (46.8–92.0) in the study by Kalthan and colleagues and showed a strong temporal trend ( Fig. 2 ).…”

Section: Resultsmentioning

confidence: 86%

“…(2022) 48 Spain Clade II Retrospective May–July 2022 Median age 37; 98.9% male; 290 reported MSM, 6 reported heterosexual out of 332 reporting sexual contact Confirmed Human to human Not specified 530 30 0 Low Tarín-Vicente et al. (2022) 49 Spain Clade II Retrospective May–June 2022 37 years (IQR, 31–42); 97% (175/181) male; 92% gay, bisexual, MSM Confirmed Human to human Treatment not specified for proctitis, tonsillitis, and bacterial skin abscess (38.7% required treatment) 181 2 0 Low Thornhill et al. (2022) 27 Various Not specified Retrospective April–June 2022 Median age 38 (range 18–68); 527/528 men; 98% gay or bisexual men Confirmed Human to human Cidofovir; Tecovirimat; Vaccinia immune globulin 528 70 0 Low Yinka-Ogunleye et al.…”

Section: Resultsmentioning

confidence: 99%

Global monkeypox case hospitalisation rates: A rapid systematic review and meta-analysis

DeWitt¹,

Polk²,

Williamson³

et al. 2022

eClinicalMedicine

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“…In contrast, recent reports from European countries where most patients are receiving effective ART have noted no deaths or evident excess in hospitalizations among persons with HIV infection and monkeypox to date (3,4,6). In addition, WHO has stated that a more severe disease course has not been reported in persons with HIV infection who are receiving ART and have a robust immune system (23), a finding supported by recent large cohort studies (5,7,8).…”

Section: Monkeypox In Persons With Hiv Infectionmentioning

confidence: 93%

“…Reports from the current outbreak suggest transmission patterns and clinical manifestations might not follow the classic presentation of monkeypox (5)(6)(7)(8)(9)(10). Although any person can acquire monkeypox, epidemiologic data indicate that transmission is currently most intense among interconnected networks of sexually active MSM, with transmission occurring primarily through intimate skin-to-skin contact during sex (6).…”

mentioning

confidence: 97%

Interim Guidance for Prevention and Treatment of Monkeypox in Persons with HIV Infection — United States, August 2022

O’Shea¹,

Filardo²,

Morris³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

105

118

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On August 5, 2022, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).Monkeypox virus, an orthopoxvirus sharing clinical features with smallpox virus, is endemic in several countries in Central and West Africa. The last reported outbreak in the United States, in 2003, was linked to contact with infected prairie dogs that had been housed or transported with African rodents imported from Ghana (1). Since May 2022, the World Health Organization (WHO) has reported a multinational outbreak of monkeypox centered in Europe and North America, with approximately 25,000 cases reported worldwide; the current outbreak is disproportionately affecting gay, bisexual, and other men who have sex with men (MSM) (2). Monkeypox was declared a public health emergency in the United States on August 4, 2022. † Available summary surveillance data from the European Union, England, and the United States indicate that among MSM patients with monkeypox for whom HIV status is known, 28%-51% have HIV infection (3-10). Treatment of monkeypox with tecovirimat as a first-line agent is available through CDC for compassionate use through an investigational drug protocol. No identified drug interactions would preclude coadministration of tecovirimat with antiretroviral therapy (ART) for HIV infection. Pre-and postexposure prophylaxis can be considered with JYNNEOS vaccine, if indicated. Although data are limited for monkeypox in patients with HIV, prompt diagnosis, treatment, and prevention might reduce the risk for adverse outcomes and limit monkeypox spread. Prevention and treatment considerations will be updated as more information becomes available. BackgroundSigns and Symptoms: Classically, monkeypox occurs in three stages. After an incubation period of approximately 1-2 weeks, a prodrome, characterized by fever and lymphadenopathy occurs, which is followed by the onset of a deep-seated vesicular or pustular rash that often begins centrally and spreads to the limbs (11). Transmission of monkeypox can occur through direct contact with the infectious rash, scabs, or body fluids, through respiratory secretions during prolonged face-to-face contact or intimate physical contact, or through touching items, such as clothing or linens, that previously touched a patient's infectious rash or body fluids. § * These authors contributed equally to this report. † h t t p s : / / w w w. w a s h i n g t o n p o s t . c o m / h e a l t h / 2 0 2 2 / 0 8 / 0 4 / monkeypox-public-health-emergency-united-states-becerra/ § https://www.cdc.gov/poxvirus/monkeypox/transmission.html

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Clinical Presentation and Virological Assessment of Confirmed Human Monkeypox Virus Cases in Spain : A Prospective Cohort Study

Cited by 7 publications

References 14 publications

Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022

Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022

Global monkeypox case hospitalisation rates: A rapid systematic review and meta-analysis

Interim Guidance for Prevention and Treatment of Monkeypox in Persons with HIV Infection — United States, August 2022

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