202.3 🩺 內科專科考前版

202.3.0.1 1️⃣ Mpox Differential Diagnosis

Disease	Key Differentiation
HSV	Painful, recurrent, type-specific PCR
VZV	Dermatomal pattern (zoster), recurrent
Syphilis	Painless chancre (1°), 紅疹 (2°); RPR +
LGV proctitis (MSM)	Chlamydia trachomatis L1-L3; tender LAP, “groove sign”
Molluscum	Pearly, umbilicated, not painful
Scabies	Itchy, burrows, family clusters
Folliculitis bacterial	Smaller, follicular

202.3.0.2 2️⃣ Mpox Lesion Photographs

• Crucial for awareness
• CDC website + WHO galleries
• Lesion staging: macule → papule → vesicle → pustule → crust
• 2022 outbreak: anogenital, oral lesions common

202.3.0.3 3️⃣ 2022 Outbreak Atypical Features

• Limited cutaneous distribution
• Anogenital, oral lesions
• Skip prodrome
• Mild systemic
• Sexual transmission dominant
• Importance of physician awareness

202.3.0.4 4️⃣ 2024 Clade Ib Outbreak

• DRC origin, spreading
• More severe (mortality higher)
• More household + heterosexual + pediatric transmission
• WHO PHEIC August 2024
• JYNNEOS vaccine deployment to Africa critical
• Surveillance + early detection priority

202.3.0.5 5️⃣ JYNNEOS Vaccine Pearls

• 2 doses 4 wk apart subcutaneous
• ID (intradermal) dose-sparing during shortage
• Pre-exposure: MSM multi-partner, occupational
• Post-exposure: < 4 days highly effective, 4-14 days may reduce severity
• Pregnancy + breastfeeding: not contraindicated (non-replicating)
• Immunocompromise: safer than ACAM2000

202.3.0.6 6️⃣ ACAM2000 vs JYNNEOS

Feature	ACAM2000	JYNNEOS
Type	Live replicating vaccinia	Non-replicating (MVA-BN)
Mode	Scarification	Subcutaneous / ID
Immunocompromise	Contraindicated	Safe
Adverse events	Myocarditis, eczema vaccinatum, progressive vaccinia	Local site, mild
Smallpox preferred	Yes (stockpile)	Equivalent
Mpox preferred	(Available)	Preferred

202.3.0.7 7️⃣ Tecovirimat (TPOXX) — Beyond STOMP

• 2024 STOMP NEGATIVE for adult Clade I Mpox
• 各 trial result variable
• Compassionate use for:
  • Severe disease
  • Immunocompromise (HIV CD4 < 200)
  • Pregnant
  • Pediatric (especially Clade Ib)
  • Pre-existing skin disease
• 14-day course
• Side effects: headache, nausea, vomiting

202.3.0.8 8️⃣ 健保 / Taiwan

• 通報 mandatory Mpox + suspected smallpox
• JYNNEOS 自費 (limited availability)
• Tecovirimat — limited supply
• ID consult + isolation
• 2022-2024 Mpox cases sporadic in Taiwan

202.3.0.9 9️⃣ Public Health Response

• Isolation until lesions crusted + new skin
• Contact tracing
• Vaccination of high-risk contacts
• Public messaging
• Surveillance

202.3.0.10 10. Pediatric Considerations

• More severe in young children
• 2024 Clade Ib outbreak pediatric impact significant
• JYNNEOS not yet routine pediatric (off-label)
• Vaccination of caregivers

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