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      Estudio descriptivo del brote de viruela del simio en las Islas Canarias, mayo a octubre de 2022 Translated title: Outbreak of monkeypox in the Canary Islands from may 15 to june 6, 2022

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          RESUMEN

          Fundamentos:

          Desde mayo de 2022, países no endémicos notificaron la aparición de casos no importados de viruela del simio (Mpox), siendo España uno de los más afectados. El objetivo del estudio fue describir las características clínico-epidemiológicas de los casos confirmados de Mpox en las Islas Canarias y las principales dificultades en el rastreo de contactos.

          Métodos:

          Se realizó un estudio retrospectivo observacional descriptivo con casos confirmados de Mpox y sus contactos estrechos en la Comunidad Autónoma de Canarias. Se realizó un análisis descriptivo, indicando frecuencias y porcentajes para variables cualitativas y mediana (rango intercuartílico) para cuantitativas.

          Resultados:

          Se notificaron ciento setenta y siete casos de Mpox en las Islas Canarias, con una mediana de edad de 39 años (32,8-48,3), un 46,6% de seropositivos por VIH, y un 6,8% de extranjeros. La manifestación clínica más frecuente fue exantema anogenital (68,8 %), y en estadio de pústulas (61,4%). Ciento tres declararon conductas sexuales de riesgo. Solo cincuenta y tres (30%) colaboraron en la identificación de contactos estrechos. Se produjeron dificultades al establecer comunicación con los casos, al comunicar las medidas de aislamiento, en la solicitud de pruebas y, finalmente, debido al procesamiento de muestras con retraso.

          Conclusiones:

          La manifestación clínica más frecuente al diagnóstico es el exantema anogenital en estadio de pústulas. La mayoría de los casos reportan relaciones sexuales de riesgo. Las principales barreras en el rastreo de contactos resultan la dificultad para contactar con los casos, la falta de datos de identificación y la inexperiencia de los profesionales sanitarios en relación con Mpox.

          ABSTRACT

          Background:

          Since May 2022, non-endemic countries reported the appearance of non-imported cases of monkeypox (Mpox). Spain was one of the most affected countries. The objective of the study was to describe the clinical-epidemiological characteristics of the first confirmed cases of Mpox in the Canary Islands and the main difficulties in contact tracing.

          Methods:

          Retrospective observational descriptive study with confirmed cases of Mpox and their close contacts in the Autonomous Community of the Canary Islands. We conducted a descriptive analysis, using frequencies and percentages for qualitative variables, and median (interquartile range) for quantitative variables.

          Results:

          One hundred and seventy-seven cases of Mpox were reported in the Canary Islands, with a median age of 39 years (32.8-48.3); 46.6% were HIV seropositive, and 6.8% were foreign. The most frequent clinical symptom was anogenital rash (68.8%), and at pustules stage (61.4%). One hundred and three declared risky sexual behaviors. Only fifty-three (30%) collaborated in the identification of close contacts. There were difficulties in: establishing communication with the cases, communicating the isolation measures, requesting tests, and due to delayed sample processing.

          Conclusions:

          Most common clinical symptom at diagnosis is anogenital rash in pustule stage. Most of the cases report risky sexual relations. The main barriers in contact tracing are the difficulty in contacting cases, the lack of identification data and the lack of experience of health professionals regarding Mpox.

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          Most cited references18

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          Clinical features and management of human monkeypox: a retrospective observational study in the UK

          Background Cases of human monkeypox are rarely seen outside of west and central Africa. There are few data regarding viral kinetics or the duration of viral shedding and no licensed treatments. Two oral drugs, brincidofovir and tecovirimat, have been approved for treatment of smallpox and have demonstrated efficacy against monkeypox in animals. Our aim was to describe the longitudinal clinical course of monkeypox in a high-income setting, coupled with viral dynamics, and any adverse events related to novel antiviral therapies. Methods In this retrospective observational study, we report the clinical features, longitudinal virological findings, and response to off-label antivirals in seven patients with monkeypox who were diagnosed in the UK between 2018 and 2021, identified through retrospective case-note review. This study included all patients who were managed in dedicated high consequence infectious diseases (HCID) centres in Liverpool, London, and Newcastle, coordinated via a national HCID network. Findings We reviewed all cases since the inception of the HCID (airborne) network between Aug 15, 2018, and Sept 10, 2021, identifying seven patients. Of the seven patients, four were men and three were women. Three acquired monkeypox in the UK: one patient was a health-care worker who acquired the virus nosocomially, and one patient who acquired the virus abroad transmitted it to an adult and child within their household cluster. Notable disease features included viraemia, prolonged monkeypox virus DNA detection in upper respiratory tract swabs, reactive low mood, and one patient had a monkeypox virus PCR-positive deep tissue abscess. Five patients spent more than 3 weeks (range 22–39 days) in isolation due to prolonged PCR positivity. Three patients were treated with brincidofovir (200 mg once a week orally), all of whom developed elevated liver enzymes resulting in cessation of therapy. One patient was treated with tecovirimat (600 mg twice daily for 2 weeks orally), experienced no adverse effects, and had a shorter duration of viral shedding and illness (10 days hospitalisation) compared with the other six patients. One patient experienced a mild relapse 6 weeks after hospital discharge. Interpretation Human monkeypox poses unique challenges, even to well resourced health-care systems with HCID networks. Prolonged upper respiratory tract viral DNA shedding after skin lesion resolution challenged current infection prevention and control guidance. There is an urgent need for prospective studies of antivirals for this disease. Funding None.
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            Human monkeypox.

            Human monkeypox is a zoonotic Orthopoxvirus with a presentation similar to smallpox. Clinical differentiation of the disease from smallpox and varicella is difficult. Laboratory diagnostics are principal components to identification and surveillance of disease, and new tests are needed for a more precise and rapid diagnosis. The majority of human infections occur in Central Africa, where surveillance in rural areas with poor infrastructure is difficult but can be accomplished with evidence-guided tools and educational materials to inform public health workers of important principles. Contemporary epidemiological studies are needed now that populations do not receive routine smallpox vaccination. New therapeutics and vaccines offer hope for the treatment and prevention of monkeypox; however, more research must be done before they are ready to be deployed in an endemic setting. There is a need for more research in the epidemiology, ecology, and biology of the virus in endemic areas to better understand and prevent human infections.
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              Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022

              Since May 2022, an outbreak of monkeypox has been ongoing in non-endemic countries. We report four cases in Italy in young adult men reporting condomless sexual intercourse. The patients are in good clinical condition with no need for specific antiviral drugs. Biological samples from seminal fluid were positive for monkeypox viral DNA. For many other viruses found in semen there is no evidence of sexual transmission. The possibility of sexual transmission of monkeypox virus needs to be investigated.
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                Author and article information

                Journal
                Rev Esp Salud Publica
                Rev Esp Salud Publica
                resp
                Revista Española de salud pública
                Ministerio de Sanidad
                1135-5727
                2173-9110
                05 April 2023
                Jan-Dec 2023
                : 97
                : e202304028
                Affiliations
                [1 ] originalServicio de Epidemiología y Prevención, Dirección General de Salud Pública. normalizedDirección General de Salud Pública Santa Cruz de Tenerife, Spain
                [2 ] originalHospital Universitario de Canarias, Servicio Canario de Salud. normalizedServicio Canario de Salud Santa Cruz de Tenerife, Spain
                [3 ] originalDepartamento de Medicina Preventiva y Salud Pública, Universidad de La Laguna. normalizedUniversidad de La Laguna Santa Cruz de Tenerife, Spain
                [4 ] originalFundación Canaria Instituto de Investigación Sanitaria de Canarias, FIISC. normalizedFundación Canaria Instituto de Investigación Sanitaria de Canarias, FIISC. Santa Cruz de Tenerife, Spain
                Author notes
                Correspondencia: Ana Hernández-Aceituno Hospital Universitario de Canarias. Carretera Ofra, s/n. CP 38320. La Laguna (Santa Cruz de Tenerife). España. anahdez989@ 123456gmail.com

                Los autores declaran que no existe conflicto de intereses.

                Article
                e202304028
                10541246
                37017138
                d99203fd-555b-45f4-843a-9f8cc1367594

                Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons

                History
                : 10 June 2022
                : 09 March 2023
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 18
                Categories
                Original Breve

                viruela del simio,viruela del mono,epidemiologia,rastreo,contactos,vigilancia,monkeypox,epidemiology,surveillance,close contacts,contact tracing

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