版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
Page1
Multi-countryoutbreakofmpox
ExternalSituationReport19,published30March2023
DataasreceivedbyWHOnationalauthoritiesby17:00CEST,27March2023
Riskassessment
Globalrisk–Moderate
Laboratoryconfirmedcases
86724
Deaths
112
Countries/areas/territories
110
WHORegionalrisk
•AfricanRegion,EasternMediterraneanRegion,EuropeanRegion,RegionoftheAmericas–Moderate
•SouthEastAsiaRegion,WesternPacificRegion–Low
Highlights
•Sincethelast
situationreport
publishedon16March2023,228newmpoxcases(0.3%increaseintotalcases)andonenewrelateddeathhavebeenreportedtoWHO.
•Globally,thenumberofmpoxcasescontinuestodecline,buttheWesternPacificregionisshowingan
increaseincases,mainlydrivenbyanoutbreakwithlocaltransmissioninJapan.
•HIVprevalenceamongmpoxcasesinthecurrentoutbreakishigherthantheestimatedHIVprevalence
intheadultpopulationoramongmenwhohavesexwithmeninallWHOregions,excepttheAfricanregion,fromwherethereisnoHIVinformationformpoxcasesavailable.
•MpoxcaseslivingwithHIVpresentadditionalsexuallytransmittedinfectionsslightlymorecomparedwith
mpoxcaseswithoutHIV.
•PreliminaryresultsfromanimalstudyinNigeriaprovideevidenceoforthopoxvirusinfections,butpresenceof
monkeypoxviruswasnotconfirmed.
•Morestudiesareneededincountrieswherempoxcasesarereportedtoidentifytheanimalreservoirof
monkeypoxvirusandlearnmoreabouttheepidemiologyofmpoxinAfrica.
EpidemiologicalUpdate
Datasource:
WHOMulti-countrympoxoutbreak-Globaltrends
Page2
From1January2022through27March2023,acumulativetotalof86724laboratory-confirmedcasesofmpox,
including112deaths,havebeenreportedtoWHOfrom110countries/territories/areas(hereafter‘countries’)inallsixWHORegions(Table1).Sincethelast
situationreport
publishedon16March2023,228newcases(0.3%increaseintotalcases)andonenewdeathhavebeenreported.
Thenumberofweeklynewcasesreportedgloballyhasdeclinedby20%inweek12(20Marchthrough26March
2023)(n=88cases)comparedtoweek11(13Marchthrough19March2023)(n=110cases).Thenumberofreportedweeklycaseswasunder100inthelastweekforthefirsttimesinceMay2022.TheWesternPacificRegionreportedanincreaseincases(n=46)inthelastthreeweekscomparedtothethreeweeksprior,drivenbyanoutbreakofmpoxamongmeninJapan,withlocaltransmission.1Theotherregionshavereportedadeclineincasereportsorobservednoproportionalincrease(Table1).
From13Februarythrough27March2023,14countriesreportedanincreaseincaseswhencomparingthepast
threeweeks(7Marchthrough27March2023)tothethreeweeksprior(13Februarythrough6March2023),withthehighestrelativeincreasereportedinJapan(n=36vs.n=8).Asof27March2023,28ofthe110affectedcountrieshavereportednewcaseswithinthelast21days,themaximumdiseaseincubationperiod.SixteenofthemareintheAmericas,fourareinEurope,threeareintheAfricanRegion,threeareintheWesternPacificRegion,andonecountryeachareintheEasternMediterraneanRegionandtheSouth-EastAsiaRegion.From14Marchthrough27March2023,onenewdeathwasreported,fromNigeria.
Asof27March2023,the10countriesthathavereportedthehighestcumulativenumberofcasesglobally
continuetobetheUnitedStatesofAmerica(n=30063),Brazil(n=10890),Spain(n=7546),France(n=4128),Colombia(n=4089),Mexico(n=3937),Peru(n=3785),theUnitedKingdom(n=3738),Germany(n=3692),andCanada(n=1478).Together,thesecountriesaccountfor84.6%ofthecasesreportedglobally.
Table1.NumberofcumulativeconfirmedmpoxcasesanddeathsreportedtoWHO,byWHORegion,from1January2022to27March202317:00CEST
WHORegion
TotalConfirmedCases
Total
Deaths
Casesinlast3weeks1
3-weekchangein
cases(%)
RegionoftheAmericas
58991
86
270
-443
EuropeanRegion
25852
6
6
-67%
AfricanRegion
1454
18
11
-79%
WesternPacificRegion
301
0
46
820%
EasternMediterraneanRegion
83
1
1
-
South-EastAsiaRegion
43
1
3
-
Total
86724
112
337
-39%
(-)Zerocaseswerereportedinatleastoneofthethree-weekperiodsinthepastsixweeks
1Usingthethreemostrecentlycompletedinternationalstandardweeks(Monday-Sunday)
Page3
Figure1.EpidemiologicalcurvesofweeklyaggregatedconfirmedcasesofmpoxbyWHORegion,from1January2022to26March2023,17:00CEST*
*Thisfigureshowsaggregatedweeklydata,forcompletedepidemiologicalweeksendingonSundays.Dataonthecurrentweekwillbe
presentedinthenextsituationreport.
Page4
TheepidemiccurvesshowninFigure1suggeststhattheoutbreakcontinuestowaneintheEuropeanandthe
AmericasRegions.IntheAfricanRegion,theepidemiccurveshowsmoresustainedtransmission,whiletheWesternPacificRegionistheonlyoneshowinganriseincasereportsinthelastweeks.MostofthenewcasesinthisregionarereportedbyJapan.TheremainingtworegionsofSouth-EastAsiaandEasternMediterraneanreportsporadiccasesandclustersratherthansustainedtransmission.
Otherkeyepidemiologicalfindings:
•Asof27March2023,96.4%(74579/77359)ofcaseswithavailabledataaremen,withamedianageof
34years(interquartilerange:29-41years).Thispatternhasbeenquitestableovertime.
•Ofcaseswithagedataavailable,1.1%(930/83072)arechildrenaged0-17years,including271(0.3%)aged0-4years.ThemajorityofpediatriccaseswerereportedfromtheRegionoftheAmericas(681/930;73%).TheoverallproportionofchildcasesintheAmericasis1.2%(703/56752),similartotheproportionwhichhasbeenobservedglobally.
•Amongcaseswithinformationavailable,84.2%(25572/30388)haveidentifiedasgay,bisexualandothermenwhohavesexwithmen.Thisproportion,whileslightlyfluctuatingovertime,hasconsistentlybeenabove75%,highlightingthatmosttransmissioncontinuestooccurinthiscommunity.
•Ofallreportedmodesoftransmission,skinandmucosalcontactduringsexwasthemostreported,in15353of22293(68.9%)ofallreportedtransmissionevents.
•Whereinformationisavailable,themostreportedexposuresettingisapartysettingwithsexualcontact,comprising3806of5559(68.0%)reportedexposuresettings.Inthelastthreemonths,transmissioninahouseholdsetting,asaproportionofallsettingsreported,hasincreasedfromaround10%to22%.
•Amongthecases(n=33849)whoreportedatleastonesymptom,themostcommonsymptomisanyrash,reportedin80.7%ofcases,followedbyfever(59.1%),andgeneralizedorgenitalrash(47.3%and44.1%respectively).Thesymptomatologyofcaseshasbeenveryconsistentovertimeinthisoutbreak.
DetailedinformationontherouteoftransmissionisnotavailableformostcasesfromtheWHOAfricanRegion,andavailableinformationontransmissionmightnotfullydescribetheepidemiologicalspreadofthevirusintheregion.Countriesfromthisregionhavereportedperson-to-persontransmission,includingtransmissionthroughsexualcontact,aswellas,insomecontexts(primarilyinCentralAfrica),infectionfromknownorpresumedcontactwithinfectedanimals.
AnalysisofmpoxinpeoplelivingwithHIV
Fromglobalsurveillancedataofthecurrentoutbreak,48%(17581/36357)ofmpoxcaseswithavailableinformationwerepeoplelivingwithHIV.Atotalof98%(17317/17374)ofmpoxcaseswithHIVco-infectionaremale,and94%(16501/17581)self-identifiedasgay,bisexualandothermenwhohavesexwithmen(MSM).TheWHOregionaldistributionofHIVprevalenceamongMSMwithmpoxrangesfrom33%(2/6)intheSouth-EastAsiaRegion,to39%(3968/10205)intheEuropeanRegion,45%(9/20)intheEastern-MediterraneanRegion,50%(3/6)intheWesternPacificRegion,and56%(12519/22357)intheAmericas(Table2).NoHIVdatawereavailablefortheAfricanRegionintheglobalsurveillancedata.ThisprevalenceofHIVamongreportedmpoxcasesismuchhigherthantheHIVprevalenceestimatedamongthegeneralpopulationoramongMSMacrossallregions.2
Page5
Figure2.AgeandsexdistributionofmpoxcasesamongpeoplelivingwithHIVfrom1January2022to26March2023.
Table2.HIVprevalenceamongconfirmedcasesofmpoxinmenwhohavesexwithmen(MSM)byWHORegion,from1January2022to26March2023
WHOregion
HIVprevalenceamongMSMmpoxcaseswithHIVinformation
HIVprevalenceamongallMSMmpoxcases
AFRO
Nodata
Nodata
EMRO
45%(9/20)
35%(9/26)
EURO
39%(3968/10205)
16%(3968/25271)
PAHO
56%(12519/22357)
24%(12519/52553)
SEARO
33%(2/6)
9%(2/22)
WPRO
50%(3/6)
2%(3/198)
•AmongreportedmpoxcasesinpeoplelivingwithHIVforwhichinformationwasavailable,65%werereportedtobeimmunocompromised(Figure3).Theimmunocompromisedstatuswasdefinedbytheclinicianwhoassessedthecase,andnodataontheCD4countofcaseswasavailable.Immunocompromisedcasesshowedbothahigherhospitalizationrateandmortalitywhencomparedtonon-immunocompromisedcases.
Page6
Figure3.SchemashowingthedistributionofmpoxcaseswithHIVreportedtoWHOfrom1January2022to26March2023
*Around1/3ofcountriesdoesnotreportHIVstatus
**Only1%ofHIV-casesfromsurveillancedataisimmunocompromised
•AmongcasereportsforpersonswithmpoxandlivingwithHIV,318werehealthcareworkersandtwoweresexworkers.
•Atotalof19%(935/4899)ofmpoxcaseslivingwithHIVreportedatleastoneothersexuallytransmittedinfection(STI),comparedto14%(777/5594)ofthosewithoutHIV(p-value<.00001).TheslightlyhigherproportionofSTIsamongpersonswithmpoxlivingwithHIVmaysuggestriskiersexualactivitiesinthisgroup,orincreasedaccesstoSTItesting.
Page7
Figure4.GeographicdistributionofconfirmedcasesofmpoxreportedtooridentifiedbyWHOfromofficialpublicsourcesfrom1January2022to27March202317:00CEST
Page8
StudyoftheanimalreservoirofmonkeypoxvirusinNigeria
Thepreliminaryresultsofananimalstudytoinvestigatethereservoirofmonkeypoxvirus(MPXV)conductedinNigeriabetween2018and2019waspublishedFebruary2023.Atotalof240rodentsweresampledduringtheperiod,fromforest,urbanandperi-urbanlocationsassociatedwithrecenthumancasesinfouroftheaffectedstates.3
Molecularanalysesbyreal-timepolymerasechainreaction(PCR)identified,inarodent,anunknownorthopoxvirus(OPXV)whichtestednegativeformpoxonaMPXV-specificassay.SerologicalanalysisofsamplesfromtwoanimalsinaruralandanurbanlocationtestedpositivebyELISAforOPXVantibody(OPXVIgG).Theurbanlocationwasclosetoacorrectionalfacilitywhereampoxoutbreakhadbeenreportedin2017.4TheserologicaltestcouldnotdistinguishbetweendifferentOPXVspeciesandwasunabletoascertainwhetherthetwoanimalswereexposedtoMPXVoranotherOPXVcirculatinginsmallmammalsinNigeria.
ThestudyshowedmolecularandserologicevidenceofOPXVinfectionbutcouldnotconfirmthepresenceofMPXVinanimalsinNigeria.SimilarinvestigationsintheDemocraticRepublicoftheCongo,conductedin2012,2013,and2015,detectedOPXVIgGinsixrodents,butnonewaspositiveforMPXVbyPCR.5
NigeriahasexperiencedaresurgenceofmpoxsinceSeptember2017.Priortothis,threecasesofmpoxwerereportedintheliteraturefrom1971and1978.3Between2017andDecember2022,atotalof988confirmedmpoxcaseswererecorded,ofwhich762werein2022.6MonkeypoxviruscladeIIisthecirculatingvirusinNigeria.WhileMPXVwasthoughttobeenzooticinNigeria,thereisapaucityofevidenceofanimaltohumantransmission,withthevirusyettobeidentifiedinanimals.Epidemiologicalandmolecularstudieshavedemonstratedhumantohumantransmissionduringoutbreaks.
MorestudiesareneededincountrieswherempoxcasesarereportedtoidentifytheanimalreservoirofMPXVanddeterminetheroleofzoonosisintheepidemiologyofmpoxinAfrica.Inthemeantime,publichealthmeasuresmustbetakentoreducehuman-to-humantransmissionofmpoxandstoptheoutbreakinNigeria.Studiesarealsoneededtoidentifyotherorthopoxvirusesfoundinanimalstudiesandassesstheiranimalhealthandpublichealthimportance.
References:
1.Multinationalspreadofmonkeypox(mpox)|OsakaPrefecturalInfectiousDiseaseSurveillanceCenter.AccessedMarch29,2023.http://www.iph.pref.osaka.jp/040/20230317114302.html
2.2022-global-aids-update_en.pdf.AccessedMarch29,2023.
/sites/default/files/media_asset/2022-global-aids-update_en.pdf
3.MesekoC,AdedejiA,ShittuI,etal.OrthopoxvirusInfectionsinRodents,Nigeria,2018–2019.EmergInfectDis.2023;29(2):433-434.doi:10.3201/eid2902.221411
4.Yinka-OgunleyeA,ArunaO,DalhatM,etal.OutbreakofhumanmonkeypoxinNigeriain2017-18:aclinicalandepidemiologicalreport.LancetInfectDis.2019;19(8):872-879.doi:10.1016/S1473-3099(19)30294-4
5.LiY,OlsonVA,LaueT,LakerMT,DamonIK.Detectionofmonkeypoxviruswithreal-timePCRassays.JClinVirolOffPublPanAmSocClinVirol.2006;36(3):194-203.doi:10.1016/j.jcv.2006.03.012
6.NigeriaCentreforDiseaseControlandPrevention.AccessedMarch29,2023.
.ng/diseases/sitreps/?cat=8&name=An%20Update%20of%20Monkeypox%20Outbreak
%20in%20Nigeria
Page9
RegionalUpdate:AfricanRegion
Mpoxsituationupdate:Africanregion
Between1January2022and27March2023,1454laboratory-confirmedcaseshavebeenreportedfrom10Africancountries,includingNigeria(822),theDemocraticRepublicoftheCongo(DRC)(439),Ghana(124),theCentralAfricaRepublic(CAR)(27),Cameroon(18),Liberia(10),Congo(5),SouthAfrica(5),Benin(3),andMozambique(1).TwocountriesintheWHOAfricaRegion(GhanaandSouthAfrica)hadnotreportedhumanmpoxbefore2022.ItshouldbenotedthatSudan,whichispartoftheWHOEasternMediterraneanregion,hasalsoreportedsporadiccasesacrossthecountryforthefirsttime,aswellassignificantCladeImpoxoutbreaksinrefugeecampsin2022,whichhadnotpreviouslybeendescribed.Therestofthisreportreferstothe
epidemiologyintheWHOAfricanregion,notincludingothercountriesonthecontinent.
Thesixcountrieswiththehighestnumberofcasesinthe
AfricanRegion
areNigeria(55.6%),DRC(29.7%),Ghana
(8.3%),CAR(1.8%),Cameroon(1.2%),andLiberia(0.7%).Threecountries,Nigeria,DRC,andGhanaaccountfor93.7%(1385)ofallmpoxcasesintheregion.Fivecountries(Benin,Cameroon,Congo,Mozambique,andSouthAfrica)havenotreportednewcasesin2023.
TheaverageageofmpoxcasesreportedintheWHOAfricanregionis19.9years,rangingfrom0-87years.Morethanhalfaremales(52.2%).Predominantsignsandsymptomsincluderash(18.3%),fever(17.4%),dysphagia(10.1%),pain(10.1%),andheadache(7.3%).
Eighteendeathshavebeenreportedintheregionsince2022,fromNigeria(9),Ghana(4),Cameroon(3),CAR(1),andMozambique(1).DeathsreportedintheDRCamongsuspectedcasesofmpoxarenotincludedinthesedata,whichcompriseconfirmedandprobablecasesreportedtoWHOglobally.WHOsupportscountriesininvestigatingoutbreaks,modesoftransmission,andcharacteristicsofmpoxintheregion,byimprovinglaboratorytestingcapacitytoperformgenomicsequencingtoidentifythemaincladesinvolvedintheoutbreak.BothcladesIandIIarecirculatinginAfricancountries;CladeIispredominantinCAR,CongoRepublicandDRC;cladeIIisdominantinBenin,Ghana,NigeriaandSouthAfrica;whileCameroonhasreportedbothclades.
WHOresponsetompoxintheAfricanregion
WHOisprovidingtechnicalassistanceandcoordinatingcollaborativeeffortsacrossvarioussectorstodeviseefficientresponseplansforcontainingandpreventingthetransmissionofmpoxintheregion.
Surveillanceandcaseinvestigation
WHOassistscountriesinupdatingtheirriskprofilesformpox,enhancingtheirabilitytodetectandreportcases,improvingtheiralertmanagementsystems,andestablishingorreinforcingtheirnationalcontacttracingsystems.WHOalsoaidscountriesinconductingcaseinvestigationsandspecimencollection,aswellasstrengtheningtheircapacityfordataanalysis.
•WHOconcludedaplantointegratempoxintotheAfricanRegionIntegratedDiseaseSurveillanceandResponse(IDSR)systemandcontinuestosupportcountriestoincludempoxasanotifiabledisease.
•GuidancenotestostrengthenmpoxsurveillanceintheWHOAfricanRegionhavebeendeveloped.
•Aregional
dashboard
hasbeendevelopedtofacilitatedatavisualization,analysis,andfollow-upofmpoxcases.Additionally,WHOhasdevelopedelectronicdatacollectionandreportingtoolsforaggregateddata,linelists,andanonlinecaseinvestigationform.
Coordinationandresourcemobilization
WHOhasdeployedthreehigh-levelsupportmissionstoGhana,Nigeria,andCARtoaugmentthemonkeypoxresponseefforts.Countrysupportmissionsworkcloselywiththecountriestoensuretheyhavetheresourcesandsupporttorespondeffectivelytotheoutbreak.
Laboratory
WHOprovideslaboratoriesacrosstheregionwithessentialreagentsandtrainingincollaborationwithAfricaCDCandtheWestAfricanHealthOrganization(WAHO).
Page10
Riskcommunicationandcommunityengagement(RCCE)
WHOcontinuestoconductsociallisteninginvolvingmonitoringsocialmediaandotheronlineplatformstounderstandhowpeoplearetalkingaboutcontrolmeasuresandrespondingtothekeymessagesthathavebeendeveloped.Thiswillhelpidentifygapsorareaswherethemessagingmayneedtobeadjusted.
Inadditiontodevelopingkeymessagesandmonitoringsocialmedia,thereisalsoafocusoncapacitybuilding,involvingtrainingcommunityvolunteersonhowtocommunicateaboutcontrolmeasureseffectively.Volunteersaretrainedtoidentifykeyaudiences,tailormessagestodifferentgroups,anduseavarietyofrelevantcommunicationchannels.
Readiness
WHOhasdevelopedandshareda
readinessassessmenttool
todeterminecountries'readiness.Over80%(39/47)
ofcountriesintheRegionhaveevaluatedtheirresponseabilities.Threecountries(8%)reportedadequatereadinesscapacity,18(46%)reportedmoderatecapacity,and18(46%)reportedlimitedcapacity.
Page11
Technicalguidanceandotherresources
StrategicPlanningandGlobalSupport
•WHOcommentaryonthenamingofmpoxdiseaseandmonkeypoxviruscladeshasbeenpublishedintheLancetInfectiousDiseases.
6February2023.
Newnomenclatureformpox(monkeypox)andmonkeypoxvirusclades
•WHOrecommendsnewnameformonkeypoxdisease-28November2022
/news/item/28-11-2022-who-
recommends-new-name-for-monkeypox-disease
•MonkeypoxStrategicPreparedness,ReadinessandResponsePlan(SPRP)Operationalplanningguidelines–2November2022
/publications/m/item/monkeypox-strategic-preparedness--readiness--and-response--operational-planning-
guidelines
•WHOEmergencyAppeal:Monkeypox-July2022–June2023,13October2022
/publications/m/item/who-
emergency-appeal--monkeypoxjuly-2022june-2023
•MonkeypoxStrategicPreparedness,Readiness,andResponsePlan(SPRP)-5October2022,
/publications/m/item/monkeypox-strategic-preparedness--readiness--and-response-plan-
(sprp)
InternationalHealthRegulationsEmergencycommitteeandTemporaryRecommendationsoftheDirector-General
•WHOfourthmeetingoftheInternationalHealthRegulations(2005)(IHR)EmergencyCommitteeregardingthemulti-countryoutbreakofmonkeypox,15February2023.
/news/item/15-02-2023-fourth-meeting-of-the-international-
health-regulations-(2005)-(ihr)-emergency-committee-on-the-multi-country-outbreak-of-monkeypox-(mpox
)
•WHOThirdmeetingoftheInternationalHealthRegulations(2005)(IHR)EmergencyCommitteeregardingthemulti-country
outbreakofmonkeypox,1November2022.
/news/item/01-11-2022-third-meeting-of-the-international-health-
regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox
•WHOSecondmeetingoftheInternationalHealthRegulations(2005)(IHR)EmergencyCommitteeregardingthemulti-countryoutbreakofmonkeypox,23July2022.
/news/item/23-07-2022-second-meeting-of-the-international-health-
regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox
•WHODirector-General'sstatementatthepressconferencefollowingIHREmergencyCommitteeregardingthemulti-countryoutbreakofmonkeypox,23July2022.
/director-general/speeches/detail/who-director-general-s-statement-on-
the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022
WHOInterimtechnicalguidance
•Surveillance,caseinvestigationandcontacttracingformpox(monkeypox):interimguidance,22December2022.
/publications/i/item/WHO-MPX-Surveillance-2022.4
•WHOVaccinesandimmunizationformonkeypox:Interimguidance,16November
2022.
/iris/bitstream/handle/10665/364527/WHO-MPX-Immunization-2022.3-eng.pdf
•Clinicalmanagementandinfectionpreventionandcontrolformonkeypox:Interimrapidresponseguidance,10June
2022.
/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
•Emergencyuseofunprovenclinicalinterventionsoutsideclinicaltrials:ethicalconsiderations:/publications-detail-redirect/9789240041745
•WHOTechnicalbrief(interim)andpriorityactions:enhancingreadinessformonkeypoxinWHOSouth-EastAsiaRegion,7July
2022
./media/docs/default-source/searo/whe/monkeypox/searo-mpx-tbrief22.pdf
Surveillance
•WHOGlobalclinicaldataplatformformonkeypoxcasereportform(CRF),21July2022,
/publications/i/item/WHO-MPX-Clinical_CRF-2022.3
Datamanagement
•MonkeypoxCaseandcontactinvestigationform(CIF)andminimumdatasetCasereportingform(CRF).19August2022.
/publications/m/item/monkeypox-minimum-dataset-case-reporting-form-(crf)
•TheWHOGlobalClinicalPlatformformonkeypox,14June2022.
/tools/global-clinical-platform/monkeypox
•WHOGo.Data:Managingcomplexdatainoutbreaks
./tools/godata
RiskcommunicationandcommunityengagementandPublicHealthAdvice
•Updated(V3)Publichealthadviceforgay,bisexualandothermenwhohavesexwithmenandmpox9March2023:
/publications/m/item/monkeypox-public-health-advice-for-men-who-have-sex-with-men
•Publichealthadviceonmpoxandsex-on-premisesvenuesandevents01March2023:
/publications/m/item/public-health-advice-on-mpox-(monkeypox)-and-sex-on-premises-venues-and-events
•Infographicongettingtestedf
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 临床医生个人先进事迹(5篇)
- 中秋晚会领导致辞范文(10篇)
- 中秋佳节宴会讲话稿范文(5篇)
- 春天课件大班教学课件
- 学会聆听课件教学课件
- 影响电子血压计测量准确的因素
- 价格问题课件教学课件
- 八年级上学期1月期末语文试题
- 南京航空航天大学《电力系统分析》2021-2022学年期末试卷
- 南京工业大学浦江学院《市场营销专业综合实训》2023-2024学年第一学期期末试卷
- 2023《中华人民共和国合同法》
- 悦纳自我向阳而生心理健康教育主题班会课件
- 数字经济时代“95后”新生代员工管理挑战、成因及对策分析
- 艾略特的诗 中英
- 天棚抹灰施工方案施工方案
- 新视野大学英语(第四版)读写教程1(思政智慧版) 课件 Unit 4 Social media matters Section A
- 桥式起重机培训资料
- 低碳生活与绿色文明智慧树知到课后章节答案2023年下华南农业大学
- 大学生心理健康教育智慧树知到课后章节答案2023年下安徽中医药大学
- 装配式混凝土结构连接节点构造
- 曲靖市数字经济产业餐厨垃圾资源化再利用项目(重新报批)环评报告
评论
0/150
提交评论