猴痘死亡報告人數隨著病例增加升級
資料來源：利茲 . 謝勒 / 2022 年 8 月 2 日 / Medscape / 財團法人台灣紅絲帶基金會編譯
據這些國家的公共衛生當局稱，自上週以來，已確認四人死於不斷升級的全球猴痘疫情：西班牙兩人、印度一人和巴西一人。
美國臨床醫生應該開始擔心嗎？據公共衛生專家稱，還沒有。
雖然猴痘在其他方面健康的人中通常具有自限性和無威脅性，但世衛組織歐洲高級緊急事務官員凱瑟琳·斯莫爾伍德在給美聯社的一份聲明中承認，猴痘「會導致嚴重的併發症」。
儘管如此，「猴痘死亡通報並沒有改變我們對歐洲疫情的評估」，她說。在大多數情況下，這種疾病是自限性的，不需要治療。
截至 7 月 27 日，該評估基於歐洲疾病控制中心和世衛組織歐洲區域監測，該監測報告在 37 個國家和歐洲地區報告了 12,689 例確診病例。
病例還繼續在美國大部分地區及其領土蔓延。截至 7 月 29 日，有 5,189 例 CDC 確診病例。但美國專家似乎對歐洲和東南亞的死亡人數並沒有過分驚慌。
阿梅什·阿達利亞( Amesh Adalja)博士
約翰霍普金斯大學健康安全中心的高級學者 Amesh Adalja 醫學博士告訴 Medscape Medical News：「我認為，當全世界有數萬例病例時，就會有一些致命的病例」。
「但這在流行國家以外似乎並不常見……住院人數也不是很驚人」，他說。
巴西和西班牙當局分享了有關死亡病例的有限信息（例如，兩名年輕人，一名患有腦炎，一名患有淋巴瘤和免疫系統減弱）。 Adalja 說，這些報告缺少某些關鍵數據。
與死亡有關的因素包括潛在的醫療條件和免疫抑制。某些表現形式將會導致死亡（例如，腦部感染或皮膚病變的嚴重感染），一些患者儘管接受了抗病毒治療，但仍然死亡。
「這些訊息對於臨床醫生來說很重要，以便能夠了解在這種新情況下正在發生的事情」，Adalja 說。
他說，美國臨床醫生應該留意危險信號。
「猴痘最令人恐懼的併發症是中樞神經系統受累，任何可能顯示腦炎的狀況——感覺器官混濁、精神狀態改變、認知改變——都應該提醒臨床醫生病毒可能導致腦部感染」，Adalja 解釋說。
其他危險信號包括頑固性或持續性疼痛（尤其是與病變相關且類似於直腸炎）、持續發熱導致脫水，並伴有通常會降低生理儲備的合併症，以及嚴重的免疫功能低下。此外，Adalja 指出，淋巴結腫大是一個令人擔憂的問題，尤其是那些危害氣道的淋巴結，這在 2003 年美國猴痘爆發期間發生了這種情況。
除了這些危險信號之外，美國的臨床醫生和其他醫療保健提供者還應該借鑒世界衛生組織的做法，重點關注最主要的傳播方式，目前也就是性接觸期間的皮膚接觸以及那些感染風險最高的群體。
「我們必須清楚，這種病毒已經進入了一個性社交網絡，並能夠利用該網絡，在該網絡中，彼此密切接觸的個人在短時間內與多個人密切接觸」，阿達利亞說道。
「但這並不特定於在這個群體中，從歷史上看，目前這也仍非這個群體中曾出現過特殊狀況」，他補充說。
在陷入類似 COVID 的恐慌之前，是時候可深吸一口氣了。
「在美國，這是一種通常不會產生嚴重病例的疾病」，阿達利亞說，「所以我認為死亡人數會很低」。
Adalja披露沒有任何財務贊助相關的關係。
Liz Scherer 是一名獨立記者，專門研究傳染病和新興疾病、大麻素療法、神經病學、腫瘤學和女性健康。
Monkeypox Fatalities Reported as Cases Escalate
Liz Scherer / August 02, 2022 / Medscape
Four fatalities from the escalating global monkeypox outbreak have been confirmed since last week: two in Spain, one in India, and one in Brazil, according to public health authorities in those countries.
Should US clinicians start worrying? Not yet, according to public health experts.
While monkeypox is generally self-limiting and nonthreatening in otherwise healthy people, Catherine Smallwood, a senior emergency official at WHO Europe, acknowledged in a statement to the Associated Press that monkeypox “can cause severe complications.”
Still, “the notification of deaths due to monkeypox does not change our assessment of the outbreak in Europe,” she said; in most cases, the disease is self-limiting and does not require treatment.
As of July 27, that assessment was based on European Center for Disease Control and WHO Regional Europe surveillance, which reported 12,689 confirmed cases across 37 countries and European regions.
Cases also continue to spread throughout the majority of the United States and its territories. There were 5189 CDC-confirmed cases as of July 29. But US experts appear not to be unduly alarmed by the European and Southeast Asian fatalities.
Dr Amesh Adalja
“I think that when you have tens of thousands of cases worldwide, that there are going to be some cases that are fatal,” Amesh Adalja, MD, a senior scholar at the Johns Hopkins University Center for Health Security, told Medscape Medical News.
“But this doesn’t seem to be very common outside the endemic countries…and the hospitalization numbers are not very alarming,” he said.
Brazilian and Spanish authorities have shared limited information about the case fatalities (eg, two people were young, one had encephalitis, and one had lymphoma and a weakened immune system). Adalja said that the reports are missing certain key pieces of data.
Factors linked to fatalities include underlying medical conditions and immunosuppression. Some manifestations have led to death (eg, a brain infection or superinfection of a skin lesion), and some patients have died despite receiving antiviral therapy.
“These are important for clinicians to know to be able to understand what is happening in this new situation,” Adalja said.
US clinicians should be on the lookout for red flags, he said.
“The most feared complication of monkeypox is central nervous system involvement, anything that could indicate encephalitis — clouding of sensorium, mental status changes, change in cognition — those should alert the clinician that the virus might be causing a brain infection,” Adalja explained.
Other red flags include intractable or unremitting pain (especially in relation to lesions and similar to proctitis), unremitting fever leading to dehydration in the presence of comorbidities that commonly lower physiologic reserves, and being severely immunocompromised. In addition, swollen lymph nodes are a concern, especially those that compromise the airways, something that happened during the 2003 US monkeypox outbreak, Adalja noted.
In addition to those red flags, it behooves clinicians and other healthcare providers in the US to take a page from the WHO playbook by focusing on the most dominant mode of transmission, which currently is skin-to-skin contact during sexual encounters, as well as groups at highest risk for becoming infected.
“We have to be clear that this virus has gotten itself into a sexual social network and has been able to exploit that network, where individuals who have close contact with each other are in close contact with multiple individuals in short periods of time,” said Adalja.
“It isn’t specific to this group, and historically, this has not been something that has been seen in this group,” he added.
It’s time to take a breath before heading into a COVID-like panic.
“In the United States, this is a disease that does not usually produce severe cases,” said Adalja, “so I think that the number of fatalities will be low.”
Adalja has disclosed no relevant financial relationships.
Liz Scherer is an independent journalist specializing in infectious and emerging diseases, cannabinoid therapeutics, neurology, oncology, and women’s health.