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Article(id=1240929922584212269, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401492, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1706284800000, receivedDateStr=2024-01-27, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773790348907, onlineDateStr=2026-03-18, pubDate=1717948800000, pubDateStr=2024-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773790348907, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773790348907, creator=13701087609, updateTime=1773790348907, updator=13701087609, issue=Issue{id=1240929920461886112, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773790348400, creator=13701087609, updateTime=1773827281389, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241084828704109275, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241084828704109276, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2084, endPage=2087, ext={EN=ArticleExt(id=1240929923259495250, articleId=1240929922584212269, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis and discussion on the epidemiological characteristics of 35 cases of monkeypox in Shangcheng district of Hangzhou city, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=

Objective To understand the clinical features and epidemiological characteristics of monkeypox cases in Shangcheng district, Hangzhou city, providing reference basis for monkeypox epidemic prevention and control work. Methods Data on 35 monkeypox cases detected by medical institutions in Shangcheng district, Hangzhou city from July to December 2023 were collected, including demographic information, clinical manifestations, epidemiological information, laboratory test results, and the clinical features and epidemiological characteristics of the cases were analyzed. Results All 35 monkeypox cases were male sexual contacts, with a median age of 28 years (range: 20 to 37 years). None had a history of smallpox vaccination, and all of them were identified through active medical consultation. Among them, 25 cases (71.43%) admitted to having had male homosexual contact within 21 days before onset, with an interval from last exposure to onset ranging from 1 to 14 days, median (Q1, Q3) of 6 (5, 9) days. Clinical symptoms mainly included fever, rash, inguinal lymph node pain, and muscle soreness; 24 cases (68.57%) presented with fever, all 35 cases had a rash, of which 9 cases (25.71%) had painful rashes, predominantly in the genital or anal region, accounting for 65.71% (23/35). Eleven cases (31.43%) of monkeypox cases were co-infected with Human Immunodeficiency Virus (HIV), with a 48.57% (17/35) prevalence of sexually transmitted diseases. Throat swabs and vesicle swabs were collected from all cases for nucleic acid testing, with a positive detection rate of 62.86% (22/35)in throat swabs, median CT value of 31, and 100% (35/35) in vesicle swabs, median CT value of 22. Conclusion The main clinical feature of monkeypox is rash, and the early recognition of skin rash by clinical doctors is key to early detection of cases.The high positive rate of monkeypox nucleic acid detection in vesicle specimens indicates the need for timely nucleic acid testing in high-risk individuals presenting with rash symptoms for early diagnosis and treatment.

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目的 了解杭州市上城区猴痘病例的临床特点和流行特征，为猴痘疫情防控工作提供参考依据。方法 收集2023年7—12月间杭州市上城区医疗机构发现的35例猴痘病例的基本人口学信息、临床表现、流行病学信息以及实验室检测结果等资料，分析病例的临床特点与流行特征。结果 35例猴痘病例均为男男性接触者，中位年龄28岁（20～37岁），均无天花疫苗接种史，均通过主动就诊方式发现，其中25例（71.43%）承认在发病前21 d内有男男性行为，末次暴露时间至发病时间间隔为1～14 d，M（Q1，Q3）为6（5，9）d。临床症状以发热、皮疹、腹股沟淋巴结痛、肌肉酸痛为主；24例（68.57%）出现发热，35例均出现皮疹，其中9例（25.71%）皮疹伴疼痛，皮疹部位以生殖器或肛周为主，占比65.71%（23/35）。11例（31.43%）猴痘病例合并人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染，性传播疾病患病比例为48.57%（17/35）。所有病例均采集咽拭子和疱液拭子进行核酸检测，其中咽拭子阳性检出率为62.86%（22/35），CT值中位数为31，疱液拭子阳性检出率为100%（35/35），CT值中位数为22。结论 猴痘临床特征以皮疹为主，临床医生对猴痘病例皮疹的识别是早期发现病例的关键。皮疹疱液标本猴痘核酸检测阳性率较高，高危人群出现皮疹症状后，应及时进行核酸检测，以实现早期诊断及治疗。

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方芳，E-mail:
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杨茜（1994—），女，硕士，医师，研究方向：传染病预防与控制

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杨茜（1994—），女，硕士，医师，研究方向：传染病预防与控制

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杨茜（1994—），女，硕士，医师，研究方向：传染病预防与控制

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A case of monkeypox and literature review[J].Journal of Diagnosis and Therapy on Dermato-Venereology, 2023, 30(3):187-189., articleTitle=A case of monkeypox and literature review, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240929924387763111, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, xref=1., ext=[AuthorCompanyExt(id=1240929924391957415, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, companyId=1240929924387763111, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Hangzhou Shangcheng District Center for Disease Control and Prevention, Hangzhou, Zhejiang 310000, China), AuthorCompanyExt(id=1240929924400346024, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, companyId=1240929924387763111, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.杭州市上城区疾病预防控制中心，浙江 杭州 310000)]), AuthorCompany(id=1240929924584895411, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, xref=2., ext=[AuthorCompanyExt(id=1240929924605866932, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, companyId=1240929924584895411, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.苏州市相城区疾病预防控制中心，江苏 苏州 215100)])], figs=[ArticleFig(id=1240929927114059923, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=EN, label=Figure 1, caption=Temporal distribution of 35 monkeypox cases in Shangcheng district of Hangzhou from July to December, 2023, figureFileSmall=6a2vMKONofqDq9w0K+HOkw==, figureFileBig=xkHxj22mQkCQmIaCzGhX3w==, tableContent=null), ArticleFig(id=1240929927206334626, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=CN, label=图1, caption=2023年7—12月杭州市上城区35例猴痘病例发病时间分布, figureFileSmall=6a2vMKONofqDq9w0K+HOkw==, figureFileBig=xkHxj22mQkCQmIaCzGhX3w==, tableContent=null), ArticleFig(id=1240929927432827065, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=EN, label=Figure 2, caption=Time distribution of the confirmed cases of 35 monkeypox cases in Shangcheng District of Hangzhou from July to December, 2023, figureFileSmall=VISuCtZlV+t3aoFKXfNj4Q==, figureFileBig=MtujSJq5s/QxCFEmUk8lCQ==, tableContent=null), ArticleFig(id=1240929927525101763, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=CN, label=图2, caption=2023年7—12月杭州市上城区35例猴痘病例确诊时间分布, figureFileSmall=VISuCtZlV+t3aoFKXfNj4Q==, figureFileBig=MtujSJq5s/QxCFEmUk8lCQ==, tableContent=null), ArticleFig(id=1240929927596404939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=EN, label=Table 1, caption=

Basic information of 35 patients with monkeypox

, figureFileSmall=null, figureFileBig=null, tableContent=
项目数值占比（%）
性别
男35100
女00
居住地
本地3497.14
非本地12.86
年龄[岁，M（Q1，Q3）]28（20，37）
), ArticleFig(id=1240929927818703060, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=CN, label=表1, caption=

35例猴痘患者的基本资料

, figureFileSmall=null, figureFileBig=null, tableContent=
项目数值占比（%）
性别
男35100
女00
居住地
本地3497.14
非本地12.86
年龄[岁，M（Q1，Q3）]28（20，37）
), ArticleFig(id=1240929927936143585, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=EN, label=Table 2, caption=

Distribution of risk exposure in 35 patients with monkeypox

, figureFileSmall=null, figureFileBig=null, tableContent=
项目数值占比（%）
境外旅居史
有38.57
无3291.43
是否MSM
是35100
否00
有无高危啮齿类动物、灵长类动物接触史
有00
无35100
发病前21 d内有无MSM
有2571.43
无1028.57
暴露地点
性伴家中624.00
酒店（宾馆）1976.00
末次暴露至发病时间间隔[d，M（Q1，Q3）]6（5，9）
), ArticleFig(id=1240929928061972716, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=CN, label=表2, caption=

35例猴痘患者风险暴露情况分布

, figureFileSmall=null, figureFileBig=null, tableContent=
项目数值占比（%）
境外旅居史
有38.57
无3291.43
是否MSM
是35100
否00
有无高危啮齿类动物、灵长类动物接触史
有00
无35100
发病前21 d内有无MSM
有2571.43
无1028.57
暴露地点
性伴家中624.00
酒店（宾馆）1976.00
末次暴露至发病时间间隔[d，M（Q1，Q3）]6（5，9）
), ArticleFig(id=1240929928208773364, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=EN, label=Table 3, caption=

First symptoms

, figureFileSmall=null, figureFileBig=null, tableContent=
首发症状病例数占比（%）
发热2468.57
皮疹35100.00
皮疹伴疼痛925.71
腹股沟淋巴结痛720.00
淋巴结肿大720.00
肌肉痛514.29
头痛38.57
), ArticleFig(id=1240929928313630972, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=CN, label=表3, caption=

首发症状情况

, figureFileSmall=null, figureFileBig=null, tableContent=
首发症状病例数占比（%）
发热2468.57
皮疹35100.00
皮疹伴疼痛925.71
腹股沟淋巴结痛720.00
淋巴结肿大720.00
肌肉痛514.29
头痛38.57
), ArticleFig(id=1240929928422682891, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=EN, label=Table 4, caption=

STD infection history of 35 patients

, figureFileSmall=null, figureFileBig=null, tableContent=
既往感染性病数值占比（%）
HIV感染1131.43
梅毒1028.57
HIV合并梅毒414.29
其他00
), ArticleFig(id=1240929928544317721, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929922584212269, language=CN, label=表4, caption=

35例患者的性病感染史情况

, figureFileSmall=null, figureFileBig=null, tableContent=
既往感染性病数值占比（%）
HIV感染1131.43
梅毒1028.57
HIV合并梅毒414.29
其他00
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杭州市上城区35例猴痘流行病学特征分析与讨论
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杨茜 1 , 倪志敏 1 , 方芳 2
现代预防医学 | 疾病预防控制 2024,51(11): 2084-2087
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现代预防医学 | 疾病预防控制 2024, 51(11): 2084-2087
杭州市上城区35例猴痘流行病学特征分析与讨论
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杨茜1, 倪志敏1, 方芳2
作者信息
  • 1.杭州市上城区疾病预防控制中心，浙江 杭州 310000
  • 2.苏州市相城区疾病预防控制中心，江苏 苏州 215100

    • 杨茜（1994—），女，硕士，医师，研究方向：传染病预防与控制

通讯作者:

方芳，E-mail:
Analysis and discussion on the epidemiological characteristics of 35 cases of monkeypox in Shangcheng district of Hangzhou city
Qian YANG1, Zhi-min NI1, Fang FANG2
Affiliations
  • Hangzhou Shangcheng District Center for Disease Control and Prevention, Hangzhou, Zhejiang 310000, China
出版时间: 2024-06-10 doi: 10.20043/j.cnki.MPM.202401492
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摘要
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目的 了解杭州市上城区猴痘病例的临床特点和流行特征，为猴痘疫情防控工作提供参考依据。方法 收集2023年7—12月间杭州市上城区医疗机构发现的35例猴痘病例的基本人口学信息、临床表现、流行病学信息以及实验室检测结果等资料，分析病例的临床特点与流行特征。结果 35例猴痘病例均为男男性接触者，中位年龄28岁（20～37岁），均无天花疫苗接种史，均通过主动就诊方式发现，其中25例（71.43%）承认在发病前21 d内有男男性行为，末次暴露时间至发病时间间隔为1～14 d，M（Q1，Q3）为6（5，9）d。临床症状以发热、皮疹、腹股沟淋巴结痛、肌肉酸痛为主；24例（68.57%）出现发热，35例均出现皮疹，其中9例（25.71%）皮疹伴疼痛，皮疹部位以生殖器或肛周为主，占比65.71%（23/35）。11例（31.43%）猴痘病例合并人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染，性传播疾病患病比例为48.57%（17/35）。所有病例均采集咽拭子和疱液拭子进行核酸检测，其中咽拭子阳性检出率为62.86%（22/35），CT值中位数为31，疱液拭子阳性检出率为100%（35/35），CT值中位数为22。结论 猴痘临床特征以皮疹为主，临床医生对猴痘病例皮疹的识别是早期发现病例的关键。皮疹疱液标本猴痘核酸检测阳性率较高，高危人群出现皮疹症状后，应及时进行核酸检测，以实现早期诊断及治疗。

猴痘  /  流行特征  /  男男性接触者  /  核酸检测  /  疫情防控

Objective To understand the clinical features and epidemiological characteristics of monkeypox cases in Shangcheng district, Hangzhou city, providing reference basis for monkeypox epidemic prevention and control work. Methods Data on 35 monkeypox cases detected by medical institutions in Shangcheng district, Hangzhou city from July to December 2023 were collected, including demographic information, clinical manifestations, epidemiological information, laboratory test results, and the clinical features and epidemiological characteristics of the cases were analyzed. Results All 35 monkeypox cases were male sexual contacts, with a median age of 28 years (range: 20 to 37 years). None had a history of smallpox vaccination, and all of them were identified through active medical consultation. Among them, 25 cases (71.43%) admitted to having had male homosexual contact within 21 days before onset, with an interval from last exposure to onset ranging from 1 to 14 days, median (Q1, Q3) of 6 (5, 9) days. Clinical symptoms mainly included fever, rash, inguinal lymph node pain, and muscle soreness; 24 cases (68.57%) presented with fever, all 35 cases had a rash, of which 9 cases (25.71%) had painful rashes, predominantly in the genital or anal region, accounting for 65.71% (23/35). Eleven cases (31.43%) of monkeypox cases were co-infected with Human Immunodeficiency Virus (HIV), with a 48.57% (17/35) prevalence of sexually transmitted diseases. Throat swabs and vesicle swabs were collected from all cases for nucleic acid testing, with a positive detection rate of 62.86% (22/35)in throat swabs, median CT value of 31, and 100% (35/35) in vesicle swabs, median CT value of 22. Conclusion The main clinical feature of monkeypox is rash, and the early recognition of skin rash by clinical doctors is key to early detection of cases.The high positive rate of monkeypox nucleic acid detection in vesicle specimens indicates the need for timely nucleic acid testing in high-risk individuals presenting with rash symptoms for early diagnosis and treatment.

Monkeypox  /  Epidemic characteristics  /  Men who have sex with men  /  Nucleic acid testing  /  Epidemic prevention and control
杨茜, 倪志敏, 方芳. 杭州市上城区35例猴痘流行病学特征分析与讨论. 现代预防医学, 2024 , 51 (11) : 2084 -2087 . DOI: 10.20043/j.cnki.MPM.202401492
Qian YANG, Zhi-min NI, Fang FANG. Analysis and discussion on the epidemiological characteristics of 35 cases of monkeypox in Shangcheng district of Hangzhou city[J]. Modern Preventive Medicine, 2024 , 51 (11) : 2084 -2087 . DOI: 10.20043/j.cnki.MPM.202401492
正文
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猴痘是由猴痘病毒引起的人畜共患疾病。我国于2022年9月首次报告了一例由境外输入的猴痘病例，2023年6月，我国新增106例猴痘确诊病例报告，提示出现本土传播[1]，同时2023年8月全球传染病疫情监测结果显示，中国大陆地区猴痘报告病例数仍以缓慢的形势增长，且与境外猴痘疫情流行特征基本一致，主要影响男男性行为（men who have sex with men，MSM）人群[2]。基因组测序结果显示，目前在全球流行的猴痘病毒主要有2个进化支，包括刚果盆地(中非)进化支与西非进化支。其中西非进化支导致了2022年欧洲及其他非流行区猴痘疫情，病情多呈自限性，病例病死率相对较低，主要在MSM人群中流行，且部分感染者缺乏典型的临床表现[3]，难以及时鉴别病例，容易造成疫情的进一步传播。
2023年7月7日杭州市上城区报告了杭州市上城区首例猴痘病例，随后病例数不断增加。本研究于传染病监测系统中收集了2023年7—12月杭州市上城区猴痘病例信息，分析了猴痘的流行特征及临床特点，为疫情防控策略的制订和措施实施提供科学依据。
1　对象与方法
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1.1　研究对象
截至2023年12月，杭州市上城区经医疗机构发现并报告共计35例猴痘病例，病例均已通过中国疾病预防控制信息系统进行网络直报。猴痘的确诊病例定义参照国家卫生健康委员会发布的《猴痘防控技术指南（2022年版）》[4]。
1.2　研究方法
通过流行病学调查，收集病例的基本信息，并对病例的临床特点和流行病学特征进行分析，讨论疫情分布特点、防控措施及建议。
1.3　标本采集与检测
采集所有主动就诊且疑似猴痘病例的咽拭子和疱液拭子，送至杭州市疾病预防控制中心应用实时荧光定量PCR法进行猴痘病毒核酸检测和高通量测序。
1.4　数据收集及分析
采用Excel 2016和SPSS 22整理分析数据。计数资料采用频数或者构成比进行描述，正态分布的计量资料使用均数和标准差进行描述，非正态分布资料使用中位数和四分位数间距进行描述。率的比较用χ2检验，均值的比较用Wilcoxcon秩和检验。检验水准α=0.05。
2　结果
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2.1　人群分布情况
35名病例均为男性，其中有34例为本地常住居民，占比97.14%，非本地常住居民1例，占比2.86%；病例年龄最小为20岁，最大为37岁，中位年龄为28岁；职业主要涉及餐饮、地产、销售及其他，未发现职业聚集性，未发现病例间有明确的流行病学关联。见表1。
2.2　风险暴露情况
2.2.1　暴露对象
35例病例中仅3例在发病前21 d存在境外旅居史（分别为巴厘岛、泰国和新加坡），占比8.57%，无境外旅居史32例，占比91.43%；均有MSM，均无高危啮齿类动物、灵长类动物接触史。其中25例病例承认在发病前21 d内存在MSM，仅2例表示知道性伴为确诊猴痘病例，其余均不知晓性伴的健康状况。
2.2.2　暴露地点
25名承认发病前21 d有MSM的病例中，19例病例的性伴均非固定性伴，以网约为主，占比76.00%（19/25），具体的暴露地点分布为6例发生在性伴家中，19例发生在酒店（宾馆）。
2.2.3　末次暴露到发病时间间隔
对25例承认在发病前21 d内存在MSM的病例的末次暴露时间进行分析发现，末次暴露时间至发病时间的间隔为1～14 d，M（Q1，Q3）为6（5，9）d。见表2。
2.3　发病就诊情况
2.3.1　发现方式
35例病例均为主动就诊发现，涉及到9家医疗机构，6个不同的科室，其中在皮肤科就诊的病例最多，有20例（57.14%），其次是发热门诊7例（20.00%）、感染科3例（8.57%）、性病门诊3例（8.57%）、肛肠科1例（2.86%）、急诊科1例（2.86%）。
2.3.2　主要症状特征
病例首发症状以发热、皮疹、腹股沟淋巴结痛和肌肉酸痛等为主。35例病例中有24例（68.57%）出现发热，35例病例均出现皮疹，且有9例（25.71%）皮疹伴疼痛，23例（65.71%）出现皮疹的病例出疹部位均为生殖器或肛周，四肢或躯干出现皮疹的情况较少；7例（20.00%）出现腹股沟淋巴结痛；7例（20.00%）出现淋巴结肿大；5例（14.29%）出现肌肉痛；3例（8.57%）出现头痛。见表3。
2.3.3　发病到确诊的时间间隔
首例病例的发病时间是7月1日，发病时间为8月的有16例（45.71%），7月的15例（42.86%），10月的3例（8.57%），9月的1例（2.86%），11月和12月无发病。发病时间分布情况见图1。
病例发病至确诊时间间隔为2～22 d，M（Q1，Q3）为7（5，9）d，确诊时间分布情况见图2。
2.3.4　既往病史
35例病例均无基础疾病史，性传播疾病患病情况如下：有11例为HIV感染者，占比31.43%（11/35）；10例为梅毒感染，占比28.57%（10/35）；4例合并感染HIV与梅毒（4/35），占比14.29%；均否认其他性病史，性传播疾病患病比例为48.57%（17/35）。均无天花疫苗接种史。见表4。
2.4　实验室检测结果
所有病例均采集咽拭子和病灶拭子进行核酸检测，其中咽拭子猴痘病毒阳性率为62.86%（22/35），疱液拭子阳性率为100%（35/35），咽拭子核酸阳性检出率低于疱液拭子（χ2=21.013，P<0.001）。其中，咽拭子的CT值M（Q1，Q3）为31（23，39），疱液拭子的CT值M（Q1，Q3）为22（17，32），前者高于后者（Z=-5.601，P<0.001）。此外，对所有阳性标本进行全基因组测序，均属于西非株。
2.5　治疗及转归
所有病例病情均较轻，有2例在门诊就诊后自行回居住地，另外33例病例出于隔离目的收住入院，未出现严重并发症，经临床对症治疗后均痊愈出院，愈后较好。
3　讨论
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猴痘作为自限性疾病，在欧美等非流行地区的流行病学特点是感染集中在MSM人群，尤其是有多个性伴侣者，大多数病例症状较轻[5]。本研究中35例病例均为MSM人群，符合非流行地区的流行病学特征，提示目前国内猴痘感染的主要高风险因素仍然是MSM[6]。35例病例年龄范围为20～37岁，可能与我国于1980年停止接种天花疫苗以及40岁以下人群对正痘病毒缺乏免疫力而更容易感染猴痘有关[7]。MSM人群关于猴痘预防知识的知晓率仅47.2%，低于对艾滋病和梅毒等性传播疾病的知晓[8]，因此要加强对该人群猴痘相关知识的宣传教育，使其掌握猴痘防控知识，做好自身健康监测，早识别相关症状，及时主动就医。
既往研究显示猴痘潜伏期通常为6～13 d（最长可达21 d）[9]，本研究潜伏期（末次暴露时间至发病时间的间隔）中位数为6 d，与多数研究结果基本一致，但也出现了7例潜伏期少于5 d的情况，不排除病例末次暴露时间存在回忆偏倚，也可能确实是存在潜伏期低于既往研究的情况，因此需要更多的病例分析进行佐证。
猴痘的典型临床症状为发热、离心性皮疹、淋巴结肿大，前驱症状包括寒战、头痛或淋巴结肿大等。美国CDC的一项关于1 195个猴痘病例的研究中发现有42%的病例没有典型前驱症状，以皮疹为首发症状[10]。本研究中所有病例均出现皮疹，且65.71%的病例出疹部位为生殖器或肛周等隐私部位，与2022年以来猴痘疫情的皮疹分布特点一致[11]。林海瑞等[12]研究发现有31.25%病例未出现发热症状，本研究结果基本与此一致（31.43%）。仅20.00%的病例出现淋巴结肿大，临床症状不典型，与其他报道中提到的部分病例无发热等前驱症状一致[13]，无典型临床症状对于临床上早发现、早诊断、早治疗的实施比较困难，临床医生对猴痘病例皮疹的识别是早期发现病例的关键，应加强医务人员猴痘相关知识的培训，提高医务人员对猴痘的早期识别能力。
本研究中有31.43%的病例合并HIV感染，低于甄若楠等[14]研究中的近50%的猴痘病例是HIV感染者。猴痘病例伴有性传播疾病的比例为48.57%，低于西班牙研究显示的76%的猴痘患者伴有性传播疾病比例[15]。陈楚明等[16]研究发现非HIV感染人群比合并HIV感染人群出现肛周和生殖器皮疹以及发热症状的比例高，在本研究中尚未发现是否合并感染HIV病例的临床表现存在差异性，需要后期大样本量研究来探讨患有性传播疾病是否会影响感染猴痘的临床症状。
本研究中病例均为主动就诊时发现，且发病至就诊时间间隔为2～22 d，时间间隔中位数为7 d，就诊时间较长，可能与该病的临床症状较轻以及大部分病例出现皮疹的部位位于肛周或生殖器等隐私部位而不愿主动就诊有关。猴痘病例就医科室中以皮肤科和发热门诊为主，分别占比57.14%（20/35），20.00%（7/35）。提示皮肤科、发热门诊等相关临床科室的医务人员是猴痘相关健康知识培训的重点人群。
目前猴痘病毒的分离检测主要采用的是病原学核酸扩增，有报道显示疱液病毒载量一般高于咽拭子，核酸检测阳性率更好，应该将疱液作为首选标本[17]，本研究采集了35例病例的咽拭子和疱液标本进行核酸检测，疱液阳性检出率为100%，而咽拭子阳性检出率仅62.86%，与报道一致。其中咽拭子CT中位值为31，疱液CT中位值为22，通过秩和检验发现差异具有统计学意义（P<0.001），提示疱液核酸检测结果CT值低于咽拭子核酸检测结果，验证皮疹处采集的疱液病毒载量高，传染性更强，与杨立刚等[18]报道结果一致。
综上所述，本研究提供了杭州地区关于猴痘患者的流行病学及临床特征的数据分析，目前猴痘患者在国内以MSM为主，患者症状较轻，以非典型临床症状为主，皮疹为主要临床表现，均通过主动就诊发现，需要加强对皮肤科、发热门诊等科室医务人员关于猴痘相关知识的培训，提高鉴别诊断能力，及时采取疱液拭子送检，早期发现，减少疫情传播风险。
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2024年第51卷第11期
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doi: 10.20043/j.cnki.MPM.202401492
  • 接收时间：2024-01-27
  • 首发时间：2026-03-18
  • 出版时间：2024-06-10
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  • 收稿日期：2024-01-27
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    1.杭州市上城区疾病预防控制中心，浙江 杭州 310000
    2.苏州市相城区疾病预防控制中心，江苏 苏州 215100

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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