Beijing, August 8 (Shao Meng) Chinese mainland reported 29 new confirmed cases of monkeypox in June, 6 new cases in July, and the Chinese Center for Disease Control and Prevention and the General Administration of Customs successively released the monkeypox epidemic situation in August, suggesting that the recent monkeypox epidemic is on the rise... This summer, monkeypox seems to be making a comeback, and the "confrontation" with the disease in China has begun.

Infection: People who face monkeypox head-on

According to the China Disease Control News, 7 new confirmed cases of monkeypox were reported Chinese mainland July, which is more than four times the data reported in June.

Sun Kai (pseudonym) from Guangdong is one of these 491. On July 7, he suddenly felt pain in his back, which he did not pay attention to at that time. About 12 days later, he noticed an ulcer surface at the base of his genitals, followed by a low-grade fever. After 3 days, another "acne" appeared on the back, and the symptoms did not disappear after going to the hospital to inject penicillin for a few days. "Because I had high-risk same-sex sex before, I realized that it might be monkeypox, and I went to the Shenzhen Chronic Disease Prevention and Control Center, which can be tested, and began to be hospitalized after testing positive."

Monkeypox imprint on the back of Sun Kai (pseudonym). Photo courtesy of interviewee

Unlike the monkeypox case map widely circulated on the Internet, Sun Kai's symptoms are mild, "a total of 3 'pox'". After 3 days of hospitalization, the "acne" began to scab and fall off, and the whole process took less than two weeks. "My doctor said that people in the past period had a few slightly more severe symptoms, and the recent wave has been milder."

Since June, the Third People's Hospital of Shenzhen has begun to admit monkeypox cases. Lu Hongzhou, president of the hospital and director of the National Clinical Research Center for Infectious Diseases, introduced to that the main symptoms of the cases admitted to the hospital are monkeypox herpes, mostly scattered on the skin of the head and face, trunk and limbs, and external genital herpes is also more common, some patients complain of mild pain or itching, some accompanied by fever, lymph node swelling. At present, all of them are mild, and there are no severe cases or deaths.

Pan Yuejun has also felt the recent increase in monkeypox cases. He is the director of the Red Ribbon Service Center in Shibei District, Qingdao, and has been an AIDS prevention and treatment volunteer for 15 years. Qingdao Sixth People's Hospital, where his public welfare organization resides, has also begun to receive monkeypox cases since June.

In July, inquiries became more frequent. They began to take on more monkeypox related science popularization work. "Everyone is more concerned about a few questions, are there many cases? What exactly are the symptoms? Is there a vaccine that can be prevented? Pan Yuejun said.

Drugs used by Sun Kai (pseudonym) in the hospital. Photo courtesy of interviewee

Transmission: The risk of mass transmission is extremely low

The sudden increase in cases has raised concerns about whether monkeypox will spread more widely in the country, and photos of localized rashes have been posted on social media asking if it means infected.

Monkeypox has been spreading continuously since May 2022 in previously non-endemic countries such as Europe and the United States. In September last year, the first imported case of monkeypox was reported in the country. However, the global monkeypox outbreak has previously shown a downward trend. On 5 May this year, WHO officially announced that the monkeypox outbreak no longer constitutes a public health emergency of international concern.

According to the "Monkeypox Prevention and Control Plan" (hereinafter referred to as the "Plan") issued by the National Disease Control Administration and the National Health Commission in July, monkeypox is a self-limited disease, and the virus is mainly transmitted through direct contact with the diseased skin or mucous membranes of the case, and can also be transmitted through contact with items contaminated by the virus and long-term close inhalation of respiratory droplets of the case. The incubation period of the virus is 7-5 days, mostly 21-6 days, and the symptoms are fever, headache, back pain, myalgia, lymphadenopathy, rash, etc.

The Plan points out that the outbreak in many countries around the world since May 2022 has been mainly transmitted through sexual contact among men who have sex with men (MSM), and most cases are young and middle-aged men, which spread through large gatherings and subsequent MSM in the community. Lu Hongzhou said that most of the monkeypox patients admitted to the hospital are men who have sex with men, but there are also cases of close contact with monkeypox patients and frequent sharing of their clothes and towels. At present, the cases admitted to the hospital are all mild, and there are no severe cases or deaths. The deaths reported abroad are all immunocompromised people, such as untreated AIDS patients.

Lu Hongzhou disagreed with the suggestion to publish the patient's travel trajectory. He noted that the current human-to-human transmission of monkeypox patients is not considered to be at risk of large-scale transmission.

There is no vaccine or specific antiviral drug for monkeypox in China. Lu Hongzhou introduced that at present, patients are mainly treated symptomatically: such as antipyretic, skin secondary infection can be applied antibacterial ointment.

However, according to the WeChat public account of China Biologics, the replicate defective Tiantan strain monkeypox vaccine independently developed by Sinopharm China Biotech Beijing Institute of Biological Products has been officially accepted for clinical trial by the Center for Drug Evaluation of the National Medical Products Administration on July 7.

Data map: On July 2022, 7, local time, Maryland, USA, color transmission electron microscopy of monkeypox particles (orange) found in infected cells (brown) cultured in laboratories. Image source: Visual China

Confrontation: Prevention and control have already been launched

After recovering from the illness, Sun Kai chose to share his experience on social media, and more than 20 cases of infection or suspected monkeypox infection have come to him for consultation. "The symptoms are mild, but there is a more serious one, there may be one or two hundred 'popsis' on the body, but he is the earlier wave."

"The reason for sending it," he said, "is that I rarely see patients tell about monkeypox experiences, and many people who come to me for consultation are very panicked and want everyone to know more about it, so as not to have six gods and no masters." In fact, monkeypox may not be as scary as you think, and the symptoms vary from person to person. ”

Unlike the panic of some segments of the population, the health care system doesn't panic much. In the past year or so, relevant departments have successively issued a number of prevention and control measures such as "Guidelines for the Diagnosis and Treatment of Monkeypox (2022 Edition)", "Technical Guidelines for the Prevention and Control of Monkeypox (2022 Edition)" and "Monkeypox Prevention and Control Plan", and made in-depth interpretations from the aspects of transmission characteristics, prevention and disposal. According to the above documents, diagnosed cases can be directly reported online through the monitoring and reporting management module of the Chinese Disease Control and Prevention Information System.

The hospital was also quick to respond. Lu Hongzhou introduced that at present, the fever clinic of Shenzhen Third Hospital is the department that receives suspected cases of monkeypox in the clinic, and all suspected cases are sampled and sent for testing and diagnosis by professional medical staff. The admission ward is a negative pressure ward specializing in the treatment of infectious diseases, and an independent ward for monkeypox cases has been established, which is managed and treated by medical staff with rich experience in professional infectious disease areas.

"If there are suspected monkeypox patients who come to the clinic, they are guided to the fever clinic, and after routine examination, the receiving doctor will take samples such as herpes fluid and throat swabs and send them to the CDC of the Municipal Center for Disease Control and Prevention to further detect monkeypox virus nucleic acid to confirm the diagnosis, and then conduct sanitize in the suspected patient's reception room." Lu Hongzhou said.

He said that if patients in the hospital have home isolation conditions, they can go home and isolate themselves, and if they request admission and isolation, they can be admitted to the hospital isolation ward for isolation. Hospitals will require patients to wear masks and gloves, educate them about monkeypox transmission, and ask patients to stay at home and reduce going out.

Nonprofits and volunteers are already taking action. Pan Yuejun said that after the first imported case of monkeypox appeared in China last year, his organization began to popularize monkeypox-related science. After the first case of monkeypox appeared in Qingdao, science popularization efforts were further increased.

In addition to publicizing monkeypox science on public accounts, Douyin, related groups, and adding monkeypox science popularization content to daily consultations, they also held two offline patient activities, with volunteers popularizing monkeypox prevention related knowledge, so that key groups can timely detect, check, take treatment measures, and avoid more transmission.

Data map: In 2022, the New York City government opened a temporary clinic in Manhattan to vaccinate susceptible people against monkeypox. The picture shows the public consultation on monkeypox vaccination. Photo by China News Agency reporter Liao Pan

Hidden worries: worry about infection, more worried about "social death"

According to the Monkeypox Prevention and Control Plan, after receiving reports of suspected cases and confirmed cases in their jurisdictions, county (city, district) level disease control institutions should promptly organize and carry out epidemiological investigations, find out the source of infection, and master, trace and manage close contacts.

The plan repeatedly emphasizes that all localities should pay attention to protecting the privacy of cases, close contacts and key groups in the process of monkeypox epidemic prevention and control.

However, due to the information currently disclosed, most cases are men who have sex with men (MSM), and some patients dare not take the initiative to test and treat. In the consultation received by Pan Yuejun for monkeypox patients, the most asked was not symptoms, but "Will it leak privacy?" Will it be 'social death'? ”

The other day, he received a call for help from a patient. The other party has fever, diarrhea, herpes and other symptoms, and is highly suspected of monkeypox, but is worried that once he goes to the hospital to diagnose it, his family and colleagues will be transferred, "life and work may be affected, and there will be no way to live in the future." In the end, the other party chose to isolate at home and wait for recovery with medication.

The Shenzhen Longgang District CDC also found this problem. Their August paper on the epidemiological investigation of 8 monkeypox cases pointed out that due to public opinion and secular pressure, infected people are not highly motivated to seek medical treatment. "The onset to medical attention is longer, and the symptoms are milder; There are difficulties in the investigation and handling of the epidemic, and there are certain difficulties in epidemic prevention and control. ”

After sharing his symptoms and experiences on social media, Sun Kai also received some attacks, and the medical history of acquaintances and epidemiological history were leaked. Pan Yuejun also noted that in the past two months, the information of many infected people in at least two places has been leaked, including home addresses and work units.

Data map: On July 2022, 7, local time, Maryland, USA, color transmission electron microscopy of monkeypox particles (orange) found in infected cells (brown) cultured in laboratories. Image source: Visual China

Appeal: Stigmatizing information is not conducive to monkeypox prevention and control

Some of the attacks and discriminatory remarks that appeared during the same period also caused Pan Yuejun to worry.

In his view, it is important to avoid stigmatizing infected people. On the one hand, it can make infected people ashamed to get tested, visit a doctor, or even distrust the public health system; On the other hand, the population is generally susceptible to monkeypox virus, and overemphasizing specific groups may ignore other transmission routes, making the public mistakenly believe that monkeypox only affects some specific groups, causing other groups to take it lightly, but it is not conducive to monkeypox prevention and control.

Lu Hongzhou believes that although men who have sex with men are the key population infected with monkeypox virus, it does not mean that men who have sex with men are infected with monkeypox, and offensive and discriminatory remarks are obviously inappropriate. The statement that "only gay men need to worry" is absolutely false, monkeypox virus does not identify the sexual orientation of patients, as long as there are close contacts with monkeypox patients are at risk of monkeypox.

"Avoiding contact with monkeypox patients is an effective preventive measure, and developing good living habits is also a better preventive measure: such as not sharing towels and clothing with others, reducing daily direct skin contact with others, etc. Once people with suspected contact history develop symptoms such as fever, rash, and lymphadenopathy, they should be alert to the possibility of monkeypox infection. Lu Hongzhou reminded. (End)