Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report
Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report
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DOI：
10.1016/s1473-3099(19)30294-4
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发表时间：
2019-08-01
影响因子：
56.3
通讯作者：
Satheshkumar, Panayampalli Subbian
中科院分区：
文献类型：
--
作者：
Yinka-Ogunleye, Adesola;Aruna, Olusola;Satheshkumar, Panayampalli Subbian
背景2017年9月，人类猴痘在尼日利亚重新出现，距离上次报告病例已过去39年。我们旨在描述2017-18年尼日利亚人猴痘疫情的临床和流行病学特征。方法我们回顾了2017年9月22日至2018年9月16日期间发生的人猴痘病例的流行病学和临床特征。使用标准化的病例调查表收集数据，其中人类猴痘的病例定义基于先前制定的指南。通过实时PCR病毒鉴定和检测阳性抗正痘病毒IgM抗体确诊。对7例患者进行了全基因组测序。单倍型分析结果，遗传距离数据和流行病学数据被用来推断一系列可能的事件，为潜在的人与人之间的传播西非分支的猴痘病毒。结果122证实或可能的情况下，人类猴痘记录在17个国家，包括7例死亡（病死率为6%）。感染猴痘病毒的人年龄在2天到50岁之间（中位数29岁[IQR 14]），84人（69%）为男性。所有122例患者均有水疱脓疱性皮疹，发热、瘙痒、头痛和淋巴结肿大也很常见。皮疹影响身体的各个部位，面部受影响最大。病例和接触者的分布表明，既有原发性人畜共患病传播，也有继发性人传人传播。记录了两例与保健有关的感染。基因组分析表明，该病毒的多个介绍和一个单一的介绍沿着与人对人的传播在监狱facility.Interpretation这项研究描述了最大的记录人类爆发的西非分支的猴痘病毒。我们的研究结果表明猴痘病毒在尼日利亚具有地方性，并有一些人传人的证据。需要进一步研究，以探索动物宿主和尼日利亚病毒传播的风险因素。版权所有（C）2019世界卫生组织。由爱思唯尔有限公司出版。保留所有权利。
Background In September, 2017, human monkeypox re-emerged in Nigeria, 39 years after the last reported case. We aimed to describe the clinical and epidemiological features of the 2017-18 human monkeypox outbreak in Nigeria.Methods We reviewed the epidemiological and clinical characteristics of cases of human monkeypox that occurred between Sept 22, 2017, and Sept 16, 2018. Data were collected with a standardised case investigation form, with a case definition of human monkeypox that was based on previously established guidelines. Diagnosis was confirmed by viral identification with real-time PCR and by detection of positive anti-orthopoxvirus IgM antibodies. Whole-genome sequencing was done for seven cases. Haplotype analysis results, genetic distance data, and epidemiological data were used to infer a likely series of events for potential human-to-human transmission of the west African clade of monkeypox virus.Findings 122 confirmed or probable cases of human monkeypox were recorded in 17 states, including seven deaths (case fatality rate 6%). People infected with monkeypox virus were aged between 2 days and 50 years (median 29 years [IQR 14]), and 84 (69%) were male. All 122 patients had vesiculopustular rash, and fever, pruritus, headache, and lymphadenopathy were also common. The rash affected all parts of the body, with the face being most affected. The distribution of cases and contacts suggested both primary zoonotic and secondary human-to-human transmission. Two cases of health-care-associated infection were recorded. Genomic analysis suggested multiple introductions of the virus and a single introduction along with human-to-human transmission in a prison facility.Interpretation This study describes the largest documented human outbreak of the west African clade of the monkeypox virus. Our results suggest endemicity of monkeypox virus in Nigeria, with some evidence of human-tohuman transmission. Further studies are necessary to explore animal reservoirs and risk factors for transmission of the virus in Nigeria. Copyright (C) 2019 World Health Organization. Published by Elsevier Ltd. All rights reserved.