TY - JOUR
T1 - Monkeypox virus infection in humans across 16 countries - April-June 2022
AU - SHARE-net Clinical Group
AU - Thornhill, John P
AU - Barkati, Sapha
AU - Walmsley, Sharon
AU - Rockstroh, Juergen
AU - Antinori, Andrea
AU - Harrison, Luke B
AU - Palich, Romain
AU - Nori, Achyuta
AU - Reeves, Iain
AU - Habibi, Maximillian S
AU - Apea, Vanessa
AU - Boesecke, Christoph
AU - Vandekerckhove, Linos
AU - Yakubovsky, Michal
AU - Sendagorta, Elena
AU - Blanco, Jose L
AU - Florence, Eric
AU - Moschese, Davide
AU - Maltez, Fernando M
AU - Goorhuis, Abraham
AU - Pourcher, Valerie
AU - Migaud, Pascal
AU - Noe, Sebastian
AU - Pintado, Claire
AU - Maggi, Fabrizio
AU - Hansen, Ann-Brit E
AU - Hoffmann, Christian
AU - Lezama, Jezer I
AU - Mussini, Cristina
AU - Cattelan, AnnaMaria
AU - Makofane, Keletso
AU - Tan, Darrell
AU - Nozza, Silvia
AU - Nemeth, Johannes
AU - Klein, Marina B
AU - Orkin, Chloe M
N1 - NPP
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
KW - Adult
KW - Animals
KW - Exanthema
KW - Fever/etiology
KW - Humans
KW - Infection Control
KW - Male
KW - Monkeypox virus/genetics
KW - Monkeypox/epidemiology
U2 - 10.1056/NEJMoa2207323
DO - 10.1056/NEJMoa2207323
M3 - A1: Web of Science-article
C2 - 35866746
SN - 0028-4793
VL - 387
SP - 679
EP - 691
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 8
ER -