Epidemiological Aspects and Basic Directions of the Protective Medications against Monkeypox Development

L. F. Stovba, A. Petrov, N. K. Cherniкova, A. L. Khmelev, S. L. Kuznetsov, S. Borisevich
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Abstract

Relevance. After smallpox eradication, in conditions of population immunity to orthopoxviruses absence, Monkeypox virus became most significant orthopoxvirus, pathogenic for humans. Therefore the generalization of data on the areas of infection outbreaks, human diseases and methods of prevention and treatment of monkey pox is important task. Aim. To characterize the problem of monkeypox in the world based on an analysis of foreign scientific publications over the past 20 years. Materials and methods. The work used publications presented in the main international medical information databases PubMed, Web of Science, Embase, etc. To analyze the publications, the analytical epidemiological method was used. Results and discussion. Monkeypox virus, obtained and identified in 1958, by genetic and phenotypic differences divides on two clades: West-African with lethality 3.6% and Central-African (Congo Basin) with lethality 10%. Monkeypox virus transmission to men happens in two ways, either from animal-to-human or human-to-human. Monkey pox is endemic only on African continent, but In 2003 year the first outbreak, numbering 47 confirmed cases, was occurred in non-endemic country – USA and the largest monkeypox outbreak began in Nigeria in September 2017 year and continue to the present. Comparison of the genome sequences of strains, isolated from patients in non-endemic countries, showed, that it genetically close to West-african strains, belong to II clades and were descended from a common ancestor. Many cases of disease in humans in the current outbreak have been traced to sexual transmission especially among men, who identify ourselves as gay or bisexual. The basis method for identification of agent in present time is PCR-RT targeting on the tumor necrosis factor (TNF) receptor gene. Usually monkeypox of human is mild, self-limiting disease. The symptoms of monkeypox are varied and non-specific. One of the most frequently observed clinical symptoms is lymphadenopathy. Most patients recover during some weeks. However, specific antiviral treatment – tecovirimat (S-246) and brincidofovir (CMX-001) – may be used for seriously ill or immunocompromised individuals. For prophylactic disease in present time are use vaccines JYNNEOSTM, ACAM2000R and Aventis Pasteur (APSV). Conclusion. General vaccination against monkeypox don't develop accordingly to modern recommendations WHO. Ring vaccination is recommended to conduct for suppression of spread virus in nidus of infection among population. Timely international coordination is needed to prevent the global spread of a disease with epidemic potential.
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流行病学方面和猴痘发展保护性药物的基本方向
相关性。消灭天花后,在人群对正痘病毒缺乏免疫力的条件下,猴痘病毒成为对人类致病的最重要的正痘病毒。因此,普及有关猴痘的感染爆发地区、人类疾病以及预防和治疗方法的数据是一项重要任务。目的根据对过去 20 年国外科学出版物的分析,描述世界猴痘问题的特点。材料和方法。这项工作使用了主要国际医学信息数据库 PubMed、Web of Science、Embase 等中的出版物。在分析这些出版物时,使用了流行病学分析方法。结果与讨论。猴痘病毒于 1958 年被发现并鉴定,根据基因和表型的差异,猴痘病毒分为两个支系:西非支系的致死率为 3.6%,中非支系(刚果盆地)的致死率为 10%。猴痘病毒传染给人类有两种途径,一种是动物传染给人,另一种是人传染给人。猴痘仅在非洲大陆流行,但2003年在非猴痘流行国美国首次爆发,有47例确诊病例,2017年9月在尼日利亚爆发了最大规模的猴痘疫情,并持续至今。对从非疫区国家患者身上分离出的菌株基因组序列进行比较后发现,这些菌株在基因上与西非菌株接近,属于第二支系,是共同祖先的后代。在本次疫情中,许多人类病例都可追溯到性传播,尤其是在自称为同性恋或双性恋的男性中。目前鉴定病原体的基础方法是针对肿瘤坏死因子(TNF)受体基因的 PCR-RT。人类猴痘通常是一种轻微的自限性疾病。猴痘的症状多种多样,没有特异性。最常见的临床症状之一是淋巴结肿大。大多数患者在数周内即可痊愈。不过,重症患者或免疫力低下者可使用特效抗病毒药物--替考韦瑞(S-246)和布林昔多韦(CMX-001)。目前,预防性疾病可使用 JYNNEOSTM、ACAM2000R 和 Aventis Pasteur (APSV) 疫苗。结论根据世界卫生组织的现代建议,猴痘的一般疫苗接种没有得到发展。建议进行环状接种,以抑制病毒在人群中的传播。需要及时进行国际协调,以防止具有流行潜力的疾病在全球蔓延。
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