猴痘的临床管理和感染预防与控制：生活指南，2025年5月

Living guidelineMay2025 Clinical management andinfection prevention andcontrol for mpox Living guidelineMay2025 accuracy of this translation. The origin are endorsed or recommended by WHOin preference to others of a similar nature that are not Tables Acknowledgements Abbreviations Definitions Aerosol-generating procedures:Medical procedures that are reported to be aerosol using nebulized hypertonic saline, dentistry and autopsy procedures[2,3]. Airborne infection isolation room (AIIR):A room with a high ventilation rate and tasks of a simple and routine nature. This term comprises[5,6]: 1.Executive summary 1.1Clinicalquestion:WhataretheclinicalandIPCinterventionstouseincaringforpatientswithmpox? 1.2Newinfectionpreventionandcontrolrecommendations•Infection prevention and control measures including hand hygiene, dedicated personal 1.3Newclinicalmanagementrecommendations •WHO recommends rapid initiation of antiretroviral therapy (ART) in people with mpox•WHO suggests thatmothers with mpox continue breastfeeding whilst limiting direct•WHO suggests that mothers who recover from mpox infection and who had withheld 2.Introduction 2.1Mpoxclades 2.1.1UpdateofmpoxoutbreaksbyviruscladeusingofevidenceavailablebyJanuary2025 2.1.2CladeIaMPXV 2.1.5CladeIIbMPXV 2.2Naturalhistory 2.3Signsandsymptoms 2.3.1Severediseaseandcomplications 2.4Laboratoryfindings 2.5Differentialdiagnosis 2.6Pregnantpeopleandpostpartumperiod 2.7Mid-and-long-termeffects 2.8Transmissionandviralshedding 2.8.1Infectiousperiod 2.8.2Children 3.Who dothese recommendationsapply to? 3.1Riskfactorsforseveredisease 3.2Prognosis 3.2.1Riskforadverseoutcomes 3.3Rateofcomplications 3.3.1Rateof complications 4.Recommendations for the mpoxcare pathway 4.1Screeningandtriage 4.1.1Screening 4.1.1.1Practicalinfo 4.1.2Triage 4.2Testingformpox 5.Recommendationsforpatientswithmildoruncomplicatedmpox(home-basedcare) 5.1Infectionpreventionandcontrol(IPC)considerationsinhome-basedcare 5.1.1Infection prevention and controlmeasures 5.1.1.1Practicalinfo 5.1.1.1.1Implementationconsiderations 5.1.1.1.2Handhygiene •Alcohol-based hand rub or soap and water should beused for hand hygiene.•The person with mpox should have their own soap that they do not share with other 5.1.1.1.3Personalbelongings •The person with mpox and their family and household members should implement thefollowing measures:•Avoid sharing personal items such as eating utensils, linens, towels, electronic•Avoid sharing a bed or sleeping area with other people or animals.•Avoid direct contact with upholstered furniture, such as couches or chairs. 5.1.1.1.4Handlinglinen,laundry •Only the person with mpox or their dedicated caregiver should handle and laundertheir bedding, clothing etc.•Linens and bedding should be carefully lifted and rolled to preventdispersion of•Linens, towels, and clothing from the patient with MPXV should be laundered 5.1.1.1.5Environmentalcleaning •Only the person with mpox or their dedicated caregiver should clean and disinfect theenvironment and objects/surfaces.•Dishes and utensils and household surfaces, such as furniture, beds, toilets or floors, orany location where the patient has had contact should be cleaned with water and soapand disinfected regularly.•Common household disinfectants or sodium hypochlorite (household bleach) productsmay be used [123,[124,125,126]. Disinfectants should be prepared and applied to•One study found that the use of a minimum of 0.05% sodium hypochloritesolutions or 70% ethanol is efficacious against MPXV when wiped on commonnon-porous surfaces in low-resource settings with a 1-minute contact time [123].•Use damp mopping, avoid dry sweeping to prevent dispersion of particles.•Carpeting and household furnishing should be steam cleaned where possible. Avoid 5.1.1.1.6WASHandwastemanagement 5.1.2Isolation of patients with mpox 5.1.2.1Practicalinfo 5.1.2.1.1Implementationconsiderations 5.1.2.3Clinical question/PICO •Population: Person with non-severe mpox is being cared for athome•Intervention: Mpox patient isolated until all lesions are fully healed•Comparator: Mpox patient does not isolate when all non-healed lesions are covered 5.1.2.4Summary 5.1.3Symptomaticmanagement 5.1.3.1Painandfevermanagement 5.1.3.1.1Practicalinfo 5.1.3.2Nutrition 5.1.3.2.1Practicalinfo 5.1.3.3Monitoring of signs and symptoms of complications 5.1.3.3.1Practical info including self- 5.1.3.4General skin care 5.1.3.5Antimicrobial therapy or prophylaxis 5.1.3.5.1Practicalinfo 6.Recommendations for patients athigh risk and those withcomplications or severe mpox 6.1Infectionpreventionandcontrolinhealthfacilities(Newrecommendations) 6.1.1.1Practicalinfo 6.1.1.1.1Implementation considerations 6.1.1.2Riskassessment 6.1.1.2.1Handhygiene 6.1.1.2.2Patientplacement •Place patients on contact and dropletprecautions for mpox in a single room.•If a single room is not available or single rooms are limited:•Patients suspec