Epidemic Information

"Monkeypox Diagnosis and Treatment Guidelines (2022 Edition)" Released: Sets Clear Standards for Dia
• Since May 2022, multiple non-endemic countries worldwide have reported monkeypox cases, with evidence of community transmission. No monkeypox cases have been detected in China as of yet.
  
  
  On June 15, the National Health Commission (NHC) of China, in conjunction with the National Administration of Traditional Chinese Medicine, released the Monkeypox Diagnosis and Treatment Guidelines (2022 Edition). The guidelines mandate that once suspected or confirmed monkeypox cases are identified, they must be reported promptly in accordance with relevant regulations, and all-out efforts should be made to organize medical treatment to safeguard public life and health.
  
  
  According to the guidelines, monkeypox is a zoonotic viral disease caused by monkeypox virus (MPXV) infection, clinically characterized by fever, rash, and lymphadenopathy (swollen lymph nodes). The primary sources of infection are MPXV-infected rodents. Infected primates (including monkeys, chimpanzees, humans, etc.) can also serve as sources of infection.

  How Does Monkeypox Virus Spread?

  The virus enters the human body through mucous membranes and broken skin. Humans are mainly infected by contact with lesions, exudates, blood, or other body fluids of infected animals, or through bites/scratches from infected animals. Human-to-human transmission occurs primarily via close contact, but can also occur through respiratory droplets, contact with virus-contaminated objects, and vertical transmission via the placenta. Sexual transmission cannot be ruled out.

  What Symptoms Occur After Monkeypox Infection?

  In the early stage of illness, symptoms include chills, fever (often above 38.5°C), accompanied by headache, lethargy, fatigue, back pain, and muscle aches. Most patients develop swollen lymph nodes in the neck, armpits, groin, and other areas. A rash appears 1–3 days after symptom onset. The illness duration from onset to scab shedding is approximately 2–4 weeks. Some patients may develop complications, including secondary bacterial infections at skin lesion sites, bronchopneumonia, encephalitis, corneal infections, and sepsis.
  
  
  Monkeypox is a self-limiting disease, with good prognosis for most patients. Severe cases are more common in young children and immunocompromised individuals. Prognosis depends on viral clade (West African or Congo Basin), degree of viral exposure, pre-existing health status, and severity of complications. Prior smallpox vaccination provides some level of cross-protective immunity against monkeypox.
  
  
  The guidelines specify that suspected and confirmed cases should be isolated in designated wards. Suspected cases require single-room isolation. Patients may be discharged when their body temperature normalizes, clinical symptoms significantly improve, and scabs have shed.
  
  
  The following content from the Monkeypox Diagnosis and Treatment Guidelines (2022 Edition) is sourced from the official website of the National Health Commission of China:

  Monkeypox Diagnosis and Treatment Guidelines

  (2022 Edition)
  
  
  Monkeypox is a zoonotic viral disease caused by monkeypox virus (MPXV) infection, clinically characterized by fever, rash, and lymphadenopathy. The disease is primarily endemic in central and western Africa. Since May 2022, non-endemic countries have also reported monkeypox cases with community transmission. To enhance clinicians’ capacity for early identification and standardized management of monkeypox, these guidelines are formulated.

  1. Etiology

  MPXV belongs to the Poxviridae family and Orthopoxvirus genus, one of four orthopoxviruses known to infect humans (the others are variola virus, vaccinia virus, and cowpox virus). Under electron microscopy, MPXV particles are brick-shaped or oval, measuring 200nm×250nm, with an envelope containing structural proteins and a DNA-dependent RNA polymerase. The genome is double-stranded DNA, approximately 197kb in length. MPXV has two clades: West African clade and Congo Basin clade. Viral sequencing of cases in non-endemic countries during the current outbreak has identified the West African clade.
  
  
  The primary hosts of MPXV are African rodents (including African squirrels, tree squirrels, Gambian pouched rats, dormice, etc.).
  
  
  MPXV is resistant to dry conditions and low temperatures, surviving for months in soil, scabs, and fabrics. It is heat-sensitive, inactivated at 56°C for 30 minutes or 60°C for 10 minutes. Ultraviolet light and common disinfectants (sodium hypochlorite, chloroxylenol, glutaraldehyde, formaldehyde, paraformaldehyde, etc.) can inactivate the virus.

  2. Epidemiology

  (1) Source of Infection

  Infected rodents are the primary source. Infected primates (including monkeys, chimpanzees, humans) can also transmit the virus.

  (2) Transmission Routes

  The virus enters the body through mucous membranes and broken skin. Zoonotic transmission occurs via contact with infected animal lesions, body fluids, blood, or bites/scratches. Human-to-human transmission occurs via close contact, respiratory droplets, contaminated objects, and vertical transmission (placental). Sexual transmission remains a potential route (not excluded).

  (3) Susceptible Population

  The general population is susceptible. Prior smallpox vaccination provides partial cross-protective immunity.

  3. Clinical Manifestations

  Incubation period: 5–21 days (typically 6–13 days). Early symptoms include chills, fever (>38.5°C), headache, lethargy, fatigue, backache, and myalgia. Lymphadenopathy (neck, armpits, groin) is common. A rash appears 1–3 days after fever, starting on the face and spreading centrifugally to limbs (more common on face/extremities than trunk), including palms/soles, with 数个 to thousands of lesions. Mucous membranes (oral, genital), conjunctiva, and cornea may be involved. The rash progresses through macules → papules → vesicles → pustules → scabs; vesicles/pustules are spherical (0.5–1cm diameter), firm, with pruritus/pain. Illness duration: 2–4 weeks from onset to scab shedding. Post-scab skin may show erythema, pigmentation, or scars (lasting years). Complications include secondary bacterial infections, bronchopneumonia, encephalitis, corneal ulcers, and sepsis.
  
  
  Monkeypox is self-limiting, with favorable prognosis for most. Severe cases occur in young children and immunocompromised individuals. Case fatality rate: ~3% for West African clade, ~10% for Congo Basin clade.

  4. Laboratory Examinations

  (1) Routine Tests

  Peripheral blood: normal or elevated white blood cells; normal or decreased platelets. Some patients show elevated transaminases, decreased blood urea nitrogen, and hypoproteinemia.

  (2) Etiological Tests

  1. Nucleic Acid Testing: MPXV DNA can be detected in skin lesions, vesicle fluid, scabs, or oropharyngeal/nasopharyngeal swabs via PCR.
  2. Virus Culture: MPXV can be isolated from 上述 specimens in BSL-3 or higher laboratories.

  5. Diagnosis and Differential Diagnosis

  (1) Diagnostic Criteria

  1. Suspected Case:
     • Clinical symptoms + any of the following epidemiological history:
       (1) Travel to monkeypox-endemic regions within 21 days prior to onset;
       (2) Close contact with a monkeypox case within 21 days;
       (3) Contact with blood/body fluids of infected animals within 21 days.
  2. Confirmed Case:
     • Suspected case + positive MPXV nucleic acid test or virus culture isolation.
  
  
  All suspected/confirmed cases must be reported as per infectious disease regulations.

  (2) Differential Diagnosis

  Differentiate from other febrile rash illnesses (varicella, herpes zoster, herpes simplex, measles, dengue) and conditions like bacterial skin infections, scabies, syphilis, and allergic reactions.

  6. Treatment

  No specific antiviral drugs are currently available in China; management focuses on supportive care and complication treatment.

  (1) Symptomatic Support

  • Rest, adequate nutrition/hydration, electrolyte balance.
  • Physical cooling for fever; antipyretics (e.g., acetaminophen) for temperatures >38.5°C (avoid excessive sweating-induced collapse).
  • Keep skin/mucous membranes (oral, eye, nasal) clean and moist; avoid scratching lesions to prevent secondary infection. Analgesics for severe pain.

  (2) Complication Management

  • Secondary bacterial infections: antibiotics based on culture/sensitivity testing (no prophylactic use).
  • Corneal lesions: ophthalmic drops + vitamin A supplementation.
  • Encephalitis: sedation, intracranial pressure reduction, airway protection.

  (3) Psychological Support

  Address anxiety/depression through counseling; consult psychiatrists as needed, with adjunctive medications if required.

  (4) Traditional Chinese Medicine (TCM)

  Treatment based on TCM principles:
  
  
  • For fever: Shengma Gegen Tang (Cimicifuga and Pueraria Decoction), Shengjiang San (升降散), Zixue San (Purple Snow Powder).
  • For high fever, dense rash, sore throat, lymphadenopathy: Qingying Tang (Qingying Decoction), Shengma Biejia Tang (Cimicifuga and Turtle Shell Decoction), Xuanbai Chengqi Tang (Xuanbai Chengqi Decoction).

  7. Discharge Criteria

  Discharge is permitted when:
  
  
  • Body temperature normalizes,
  • Clinical symptoms significantly improve,
  • Scabs have fully shed.

  8. Infection Prevention and Control in Healthcare Settings

  • Suspected/confirmed cases: isolated in single rooms (for suspected cases) or designated isolation wards.
  • Healthcare workers: use standard precautions (gloves, N95 masks, face shields/goggles, isolation gowns) and perform hand hygiene rigorously.
  • Disinfect patient secretions, excreta, and blood-contaminated materials according to Technical Specifications for Disinfection in Healthcare Facilities.
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