发病机制的特点、流行病学、诊断、治疗和预防天花的方法、乌克兰和世界天花问题的现状

O. Bobrova, N. Mikhanovska, K. Kryvonos
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摘要

介绍。猴痘是一种由正痘病毒引起的人畜共患疾病,其特征是发热、全身中毒和皮疹,在某些情况下可导致致命后果;《国际卫生条例》所涵盖的传染病。该疾病的病原体被归类为生物制剂-生物武器的制剂。与2022年暴发有关的大多数猴痘病例发生在西半球。目的:研究猴痘的病因学、发病学、流行病学方面的数据,诊断、治疗和预防猴痘的现代方法,乌克兰和世界的问题状况。材料和方法:为了完成这项任务,在美国国家医学图书馆(NLM)的PubMed Medline、Cochrane系统评价数据库、美国卫生部联邦机构疾病控制与预防中心网站的医学出版物电子数据库中对出版物进行了综述。结果:第二代ACAM2000和第三代JYNNEOS™猴痘疫苗目前已上市。这两种疫苗都能产生对猴痘的免疫力。暴露后接种疫苗有助于预防或减轻猴痘的严重程度。ACAM2000是FDA批准用于预防天花的单剂量牛痘疫苗。在接种疫苗4周后达到完全免疫。FDA扩大了对研究方案的准入,允许在暴发期间使用ACAM2000进行猴痘免疫接种。ACAM2000的免疫原性和保护功效与第一代Dryvax®天花疫苗相当。天花疫苗病毒是天花疫苗中的减毒活病毒。接种天花疫苗后出现的脑炎和格林-巴勒综合征病例表明,发病率不仅因地而异,而且在同一地区也因年而异。为了控制疫情,预防以减少人际传播的风险,立即发现新病例和采取监测措施是必要的。向疑似或确诊猴痘患者提供护理并处理其标本的卫生保健工作者应使用标准预防措施来控制感染。从疑似患有猴痘的动物或人身上采集的标本应由训练有素的人员在装备齐全的实验室中处理。根据世卫组织的建议,从患者身上采集的样本应适当贴上标签,并准备使用三重包装进行运输。为防止猴痘通过动物贸易进一步传播,必须将可能感染天花的圈养动物与其他动物隔离,并隔离30天。结论:1。猴痘病毒曾经是非洲某些地区的地方性疾病,现在已成为全球关注的问题,西半球地区报告的病例越来越多。鉴于人与人之间的传播通常是通过空气传播的飞沫或直接接触感染者的粘液分泌物发生的,建议保持社交距离并追踪接触者。3.在过去6个月中,中年人中已确认猴痘病例,这可以解释为天花疫苗的交叉免疫丧失。4. 猴痘病毒在细胞质中繁殖并成熟,产生原发性病毒血症。严重的猴痘病程表现为支气管肺炎、呼吸窘迫综合征、脑炎、视网膜上的绒毛膜疤痕等。为了尽量减少并发症的风险,建议及时治疗。5. 世界各地的医疗机构都致力于了解猴痘病例是如何在西半球国家越来越多地发生的。猴痘的病因治疗方法的研究是有前景的。
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Features of the pathogenesis, epidemiology, diagnostics, approaches to the treatment and prevention of small pox, the current state of the problem in Ukraine and the world
Introduction. Monkey pox is an anthropozoonous disease caused by orthopoxvirus, characterized by fever, general intoxication and skin rash, in some cases it can lead to fatal consequences; an infectious disease covered by international health regulations (IHR). The causative agent of the disease is classified as a biological agent - agent of a biological weapon. Most of the monkeypox cases associated with the 2022 outbreak are in the Western Hemisphere. Purpose: study of data on etiological, pathogenetic, epidemiological aspects, modern approaches to the diagnosis, treatment and prevention of monkeypox, the state of the problem in Ukraine and the world. Materials and methods: to perform the task, a review of publications was conducted in electronic databases of medical publications PubMed Medline of the US National Library of Medicine (NLM), Cochrane Database of Systematic Reviews, CDC (Centers for Disease Control and Prevention) website of the federal agency of the Ministry of Health USA. Results: The second generation ACAM2000 and third generation JYNNEOS™ monkeypox vaccines are currently available. Both vaccines are able to create immunity against monkeypox. Post-exposure vaccination can help prevent or reduce the severity of monkeypox. ACAM2000 is a single-dose vaccinia vaccine licensed by the FDA for the prevention of smallpox. Full immunity is achieved 4 weeks after vaccination. FDA expanded access to investigational protocol allows use of ACAM2000 for monkeypox immunization during an outbreak. The immunogenicity and protective efficacy of ACAM2000 is equivalent to that of the first generation Dryvax® smallpox vaccine. Smallpox vaccine virus is used as a live attenuated virus in the smallpox vaccine. Cases of encephalitis and Guillain-Barré syndrome following smallpox vaccination show that the incidence varies not only from place to place, but also from year to year in the same place. For the purposes of containment of the outbreak, prevention to reduce the risk of transmission from person to person, immediate detection of new cases and surveillance measures are necessary. Health care workers who provide care to patients with suspected or confirmed monkeypox who work with their specimens should use standard precautions to control infection. Specimens taken from animals or humans suspected of having monkeypox should be handled in equipped laboratories by trained personnel. According to WHO recommendations, samples taken from patients should be appropriately labeled, prepared for transportation using triple packaging. To prevent the further spread of monkeypox through the animal trade, captive animals potentially infected with smallpox must be isolated from other animals and quarantined for 30 days. Conclusions: 1.The monkeypox virus, which used to be endemic to certain regions of Africa, is now a global concern, with cases increasingly being reported in regions of the Western Hemisphere. 2. In connection with the fact that transmission from person to person most often occurs through airborne droplets or through direct contact with the mucous secretions of an infected person, social distancing and contact tracing are advisable. 3. In the last 6 months, cases of monkeypox have been confirmed among middle-aged people, which can be explained by the loss of cross-immunity from the smallpox vaccine. 4. The monkeypox virus multiplies in the cytoplasm and matures, creating primary viremia. Manifestations of a severe course of monkeypox are bronchopneumonia, respiratory distress syndrome, encephalitis, chorioretinal scars on the retina, etc. To minimize the risk of complications, it is advisable to provide timely treatment. 5. Medical organizations around the world are focused on understanding how cases of monkeypox are increasingly occurring in countries in the Western Hemisphere. 6. The study of etiotropic methods of treating monkey pox is promising.
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