Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series,The Lancet

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Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series
The Lancet ( IF 98.4 ) Pub Date : 2022-11-17 , DOI: 10.1016/s0140-6736(22)02187-0
John P Thornhill ₁ , Romain Palich ₂ , Jade Ghosn ₃ , Sharon Walmsley ₄ , Davide Moschese ₅ , Claudia P Cortes ₆ , Rafael Mello Galliez ₇ , Amy B Garlin ₈ , Silvia Nozza ₉ , Oriol Mitja ₁₀ , Asa E Radix ₁₁ , Jose Luis Blanco ₁₂ , Brenda Crabtree-Ramirez ₁₃ , Melanie Thompson ₁₄ , Lothar Wiese ₁₅ , Hubert Schulbin ₁₆ , Ariela Levcovich ₁₇ , Marco Falcone ₁₈ , Anna Lucchini ₁₉ , Elena Sendagorta ₂₀ , Carl-Johan Treutiger ₂₁ , Ruth Byrne ₂₂ , Katherine Coyne ₂₃ , Eric A Meyerowitz ₂₄ , Anna M Grahn ₂₅ , Ann-Brit Eg Hansen ₂₆ , Valerie Pourcher ₂ , Michelle DellaPiazza ₂₇ , Rachel Lee ₂₈ , Marcel Stoeckle ₂₉ , Aniruddha Hazra ₃₀ , Vanessa Apea ₃₁ , Emma Rubenstein ₃₂ , Joyce Jones ₃₃ , Aimee Wilkin ₃₄ , Anuradha Ganesan ₃₅ , Andrés F Henao-Martínez ₃₆ , Eric J Chow ₃₇ , Boghuma K Titanji ₃₈ , Jason E Zucker ₃₉ , Dimie Ogoina ₄₀ , Chloe M Orkin ₁ ,

Affiliation

Department of Infection and Immunity, Blizard Institute and SHARE Collaborative, Queen Mary University of London, Barts Health NHS Trust, London, UK.
Infectious Diseases Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre Louis Epidemiology and Public Health Institute, Sorbonne University, INSERM 1136, Paris, France.
Department of Infectious Diseases, Bichât University Hospital, Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, INSERM U1137, IAME, Paris, France.
University Health Network, University of Toronto, Toronto, ON, Canada.
Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
Faculty of Medicine, University of Chile, Santiago, Chile.
Núcleo de Enfrentamento e Estudos de Doenças Infecciosas Emergentes e Reemergentes, Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Disease Prevention and Control Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA; Division of Infectious Diseases and Vaccinology, Berkeley School of Public Health, University of California, San Francisco, CA, USA.
Department of Infectious and Tropical Diseases, IRCCS-Ospedale San Raffaele, Milan, Italy.
Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain.
Department of Medicine, Callen-Lorde Community Health Center, NYU Grossman School of Medicine, New York, NY, USA.
Servicio de Enfermedades Infecciosas, Hospital Clinic de Barcelona, Universidad de Barcelona, Instituto para la Investigación Médica August Pi I Suñe, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
Thacker & Thompson MD, Atlanta, GA, USA.
Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark.
Praxis Kreuzberg Clinic, Berlin, Germany.
Shamir (Assaf Harofe) Medical Centre, Tel Aviv, Israel.
Infectious Diseases Unit, Cisanello University Hospital, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Sexual Health Clinic, National Health Service, Torino, Italy.
Servicio de Dermatología, Hospital Universitario La Paz, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
Department of Infectious Diseases/Venhälsan, South General Hospital, Stockholm, Sweden.
Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Homerton Healthcare Trust, London, UK.
Montefiore Medical Center, New York, NY, USA.
Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Infectious Diseases, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.
Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA.
George Washington University Hospital, Washington, DC, USA.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA.
Department of Global Health, Wolfson Institute and SHARE Collaborative, Queen Mary University of London, Barts Health NHS Trust, London, UK.
Department of Infectious Diseases, Saint-Louis and Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, The Henry M Jackson Foundation for the Advancement of Military Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.
University of Colorado Anschutz Medical Campus, Aurora, USA.
Public Health-Seattle & King County, Seattle, WA, USA; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
Columbia University Irving Medical Center, New York, NY, USA.
Infectious Diseases Unit, Department of Internal Medicine, Niger Delta University, Amassoma, Niger; Niger Delta University Teaching Hospital, Okolobir, Bayelsa, Nigeria.

Background

Between May and November, 2022, global outbreaks of human monkeypox virus infection have been reported in more than 78 000 people worldwide, predominantly in men who have sex with men. We describe the epidemiological and clinical characteristics of monkeypox virus infection in cisgender (cis) and transgender (trans) women and non-binary individuals assigned female sex at birth to improve identification and understanding of risk factors.

Methods

International collaborators in geographical locations with high numbers of diagnoses of monkeypox virus infection were approached and invited to contribute data on women and non-binary individuals with confirmed monkeypox virus infection. Contributing centres completed deidentified structured case-report spreadsheets, adapted and developed by participating clinicians, to include variables of interest relevant to women and non-binary individuals assigned female at birth. We describe the epidemiology and clinical course observed in the reported infections.

Findings

Collaborators reported data for a total of 136 individuals with monkeypox virus infection who presented between May 11 and Oct 4, 2022, across 15 countries. Overall median age was 34 years (IQR 28–40; range 19–84). The cohort comprised 62 trans women, 69 cis women, and five non-binary individuals (who were, because of small numbers, grouped with cis women to form a category of people assigned female at birth for the purpose of comparison). 121 (89%) of 136 individuals reported sex with men. 37 (27%) of all individuals were living with HIV, with a higher proportion among trans women (31 [50%] of 62) than among cis women and non-binary individuals (six [8%] of 74). Sexual transmission was suspected in 55 (89%) trans women (with the remainder having an unknown route of transmission) and 45 (61%) cis women and non-binary individuals; non-sexual routes of transmission (including household and occupational exposures) were reported only in cis women and non-binary individuals. 25 (34%) of 74 cis women and non-binary individuals submitted to the case series were initially misdiagnosed. Overall, among individuals with available data, rash was described in 124 (93%) of 134 individuals and described as anogenital in 95 (74%) of 129 and as vesiculopustular in 105 (87%) of 121. Median number of lesions was ten (IQR 5-24; range 1–200). Mucosal lesions involving the vagina, anus, or oropharynx or eye occurred in 65 (55%) of 119 individuals with available data. Vaginal and anal sex were associated with lesions at those sites. Monkeypox virus DNA was detected by PCR from vaginal swab samples in all 14 samples tested. 17 (13%) individuals were hospitalised, predominantly for bacterial superinfection of lesions and pain management. 33 (24%) individuals were treated with tecovirimat and six (4%) received post-exposure vaccinations. No deaths were reported.

Interpretation

The clinical features of monkeypox in women and non-binary individuals were similar to those described in men, including the presence of anal and genital lesions with prominent mucosal involvement. Anatomically, anogenital lesions were reflective of sexual practices: vulvovaginal lesions predominated in cis women and non-binary individuals and anorectal features predominated in trans women. The prevalence of HIV co-infection in the cohort was high.

Funding

None.

中文翻译：

2022 年爆发期间女性和非二元个体中的人猴痘病毒感染：全球病例系列

背景

2022 年 5 月至 11 月期间，全球报告了人类猴痘病毒感染暴发，全球有超过 78 000 人感染，其中主要是男男性行为者。我们描述了顺性别（cis）和跨性别（trans）女性以及出生时被指定为女性的非二元个体中猴痘病毒感染的流行病学和临床特征，以提高对危险因素的识别和理解。

方法

我们联系了猴痘病毒感染确诊人数较多的地区的国际合作者，并邀请他们提供有关确诊猴痘病毒感染的女性和非二元个体的数据。贡献中心完成了去识别化的结构化病例报告电子表格，由参与的临床医生改编和开发，以包括与女性和出生时被指定为女性的非二元个体相关的感兴趣变量。我们描述了在报告的感染中观察到的流行病学和临床过程。

发现

合作者报告了 2022 年 5 月 11 日至 10 月 4 日期间来自 15 个国家的总共 136 名猴痘病毒感染者的数据。总体中位年龄为 34 岁（IQR 28-40；范围 19-84）。该队列由 62 名跨性别女性、69 名顺式女性和 5 名非二元性别个体组成（由于人数较少，她们与顺式女性一起组成一类出生时被指定为女性的人群，以便进行比较）。 136 人中有 121 人（89%）报告与男性发生性行为。所有个体中有 37 人（27%）感染艾滋病毒，其中跨性别女性（62 人中的 31 人[50%]）的比例高于顺式女性和非二元性别个体（74 人中的 6 人[8%]）。 55 名（89%）跨性别女性（其余的传播途径未知）和 45 名（61%）顺式女性和非二元个体中怀疑有性传播；仅在独联体妇女和非二元性别个体中报告了非性传播途径（包括家庭和职业接触）。在提交给病例系列的 74 名顺性别女性和非二元性别个体中，有 25 名 (34%) 最初被误诊。总体而言，在有可用数据的个体中，134 名个体中有 124 名 (93%) 出现皮疹，129 名个体中有 95 名 (74%) 出现肛门生殖器性皮疹，121 名个体中有 105 名 (87%) 出现水疱脓疱性皮疹。皮损数量中位数为 10 个（IQR 5-24；范围 1-200）。在 119 名有可用数据的个体中，有 65 名 (55%) 发生了涉及阴道、肛门、口咽或眼睛的粘膜病变。阴道性交和肛交与这些部位的病变有关。通过 PCR 从所有 14 个测试样本的阴道拭子样本中检测到猴痘病毒 DNA。 17 人 (13%) 住院治疗，主要是因为病变的细菌重复感染和疼痛治疗。 33 人 (24%) 接受了替科维马治疗，6 人 (4%) 接受了暴露后疫苗接种。没有死亡报告。