猴痘的流行病學、傳染途徑與感控措施

Monkeypox: Epidemiology, Transmission, Treatment, and Prevention

2022年5月，英國出現1例境外移入猴痘個案，原以為是零星的境外移入案例，不料公佈後醫療同仁提高警覺，竟揪出全球上萬例確診，促成世界衛生組織（WHO）於7月宣布猴痘疫情列為「國際關注公共衛生緊急事件」。臺灣疾病管制署亦將猴痘列為第二類法定傳染病，採購抗病毒藥物及疫苗、研訂猴痘檢驗之實驗室操作標準流程、進行檢驗網絡佈建，提升檢驗量能。此次猴痘疫情為1970年以來最大規模之人傳人事件，主要由男男性行為者，因頻繁的肢體接觸病灶肌膚、口鼻分泌物、共用床上用品等方式感染。預防猴痘之疫苗目前不需要大規模接種，未完整防護而暴露確診病人，可於4天內接種疫苗作暴露後預防；抗病毒藥物Tecovirimat僅供高風險或病情嚴重者服用，而現階段照護依循標準防護措施、飛沫傳染及接觸傳染防護措施之原則，但是需要注意環境清潔時應避免揚起灰塵或皮屑的清潔方式。

The monkeypox outbreak in 2022 has been the largest non-endemic outbreak since its isolation in 1958. Neglected for decades in Africa, this viral disease is mainly transmitted by men who have sexual intercourse with men, particularly those who have multiple and often anonymous partners. The monkeypox virus is transmitted through close contact, direct skin contact with virus-laden lesions, virus-containing droplets, or fomites. Unlike in previous endemic cases, patients in this outbreak have been reported to exhibit atypical symptoms: instead of systemic lesions, only local lesions around the genital and anal regions, fewer prodromal symptoms, or even asymptomatic infection. Tecovirimat, a VP37 protein inhibitor, can be administered to high-risk or severely ill patients, including children. Post-exposure prophylaxis is strongly recommended within 4 days of exposure. Both Tecovirimat and JYNNEOS, a live, attenuated non-replicating orthopoxvirus vaccine, are available from the Taiwan Centers for Disease Control. Additionally, contact and droplet isolation precautions should be taken when caring for patients with monkeypox infection. Care must be taken not to dry dust, vacuum, or sweep surfaces, as they may spread infectious particles. Wet cleaning methods, such as mopping, are preferred.