Friday, July 1

Guidance on monkeypox: cases should be isolated and their contacts wear a mask

People infected with the monkeypox virus (MPXV) or who are under investigation will have to isolate themselves at home and will only be able to go out to go to the doctor, while their contacts should not quarantine but should reduce interactions as much as possible and use the mask constantly.

Spain sets protocol for monkey virus while suspected cases grow

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This is stated in the Protocol for the early detection and management of cases due to the monkeypox (Monkeypox) alert in Spainprepared by the technicians of the alert presentation of the Interterritorial Council of the National Health System, which establishes a series of control measures to cut the transmission of the virus.

The document recalls that this is the first time that chains of transmission have been reported in Europe without known epidemiological links with West or Central Africa and that the majority of cases that have been detected these days in Spain and other countries have occurred in men who have maintained risky relationships with other men.

However, and “according to the information available at this time, the importance of paying special attention to the affected population without ruling out the possibility of the appearance of new cases in other population groups is clear”, assumes the technical body of the Ministry of Health and the communities, which appeals to “address the study of these cases avoiding any stigmatization of the LGTBI + collective”.

Suspected and probable cases

Those who present a vesicular rash plus one of the classic symptoms of MPX (fever, headache, muscle pain, swollen glands or fatigue) will be suspected once other pathologies have been ruled out.

The probable ones will be those who, in addition to meeting this criterion, in the 21 days before the onset of symptoms have had close contact with a confirmed case or one still under investigation, or have had sexual relations in risky sexual contexts, or have a history of travel to endemic areas of West or Central Africa. None will be a confirmed case until determined by a PCR laboratory test for MPVX.

confirmed cases

All confirmed cases or those under investigation “must remain isolated and under surveillance”, with two assumptions. First, those who are not hospitalized must remain “in a room or area separate from other people living together” until the lesions disappear and it is advised that they wear a surgical mask, especially those with respiratory symptoms. If that is not feasible – for example, in children – it is recommended that the rest of the cohabitants put it on.

All confirmed cases or those under investigation must remain isolated and under surveillance

It is advisable that they avoid contact with wild or domestic animals, “for which reason, pets must be excluded from the patient’s environment.” Nor “should you leave the home, except when you need follow-up medical care”, at which time you should wear a mask and not use public transport.

The cohabitants, for their part, will avoid contact with the cases and visits as far as possible.

Regarding hospitalized cases, they will be admitted to a room with negative pressure -never in one with positive pressure- and, if there is no availability, in a single room with a bathroom. Isolation should be prolonged until the lesions disappear.

The health workers will use adequate Personal Protection Equipment (PPE) and an FFP2 mask, but when they carry out procedures that generate aerosols or any other on the airway, they must put on the FFP3, eye protection and waterproof gloves and long-sleeved gowns. Likewise, it will be necessary to have a list of all the personnel who attend to cases under investigation or confirmed.

close contacts

“In the event of any suspicious case, the search and identification of possible close contacts will begin both between health personnel and between cohabitants, work or social, especially sexual contacts. Follow-up will not start until the case is confirmed, ”indicates the guide.

Close contacts will not be quarantined but they do have to “extreme precautions and reduce social interactions as much as possible, constantly using the mask”, which “includes the indication of refraining from sexual contact during the follow-up period”. They are instructed to self-monitor their temperature once a day for 21 days after exposure.

Close contacts will not quarantine but should reduce social interactions as much as possible by constantly wearing the mask

They will have to be locatable throughout the follow-up period and, if they present a fever or any other compatible symptom, “they must immediately self-isolate at home and urgently contact the person responsible for the follow-up.”

Close contact is considered to be someone who has been in contact with a confirmed case since the beginning of the transmissibility period, which coincides with the onset of the first symptoms, in the following circumstances:

– Contact less than 1 meter in the same room with a confirmed case and without PPE (or with incidents in its use). “The cohabitants, the health personnel who have treated the patient, contacts in the work and social sphere will have to be assessed” and “special emphasis will be placed on collecting information on people who have been able to have sexual relations in contexts of risk with the patient. case”.

— Direct contact with clothing, bedding, or fomites worn by a confirmed case during the infectious period without protective equipment.

— Percutaneous wound (for example, with a needle) or mucosal exposure to body fluids, tissues, or laboratory samples from a confirmed case.

— Handling of samples from a confirmed case by laboratory personnel without appropriate PPE.

— Contact with the corpse of a person who died from MPX or with clothing or fomites from the corpse without PPE.

Environmental control measures

Clothes should be washed at more than 60 degrees in a standard washing machine with detergent. “Bleach can be used, but it is not necessary”, and you should avoid shaking or handling dirty clothes that lead to the dispersion of infectious particles, nor should they be washed mixed with the rest of the household clothes.

Plates, cutlery and other eating utensils should not be shared and will be washed in the dishwasher or by hand with hot soapy water. Contaminated objects and surfaces should be cleaned and disinfected with a hospital-grade disinfectant or a 1:100 dilution of household bleach.

Clothes should be washed at more than 60 degrees in a standard washing machine with detergent. Dishes and cutlery should not be shared and will be washed in a dishwasher or with hot soapy water

Routes of transmission and symptoms

Before this alert, the main transmission mechanism was direct (including consumption) or indirect contact with living or dead mammals, especially rodents or primates in endemic areas.

Whereas from person to person it is given by large respiratory droplets during direct and prolonged face-to-face contact, direct contact with body fluids of an infected person or with contaminated objects and even from mother to child.

The disease is usually self-limited and most people recover in several weeks, although in some cases it can be severe, something that occurs more frequently among children, young adults and immunocompromised people.

The incubation period is 6 to 16 days, but can be as long as 21. May include fever, headache, muscle aches, swollen glands, and tiredness

The incubation period is from 6 to 16 days, but can be as long as 21; Until this outbreak, the initial clinical picture usually includes fever, headache, muscle aches, swollen glands and fatigue. Between 1 and 5 days after the fever, a rash develops, progressing sequentially from macules to papules, vesicles, pustules, and crusts that dry and fall off.

As for therapeutic options, “vaccination against smallpox has historically been shown to protect against MPX,” says the guide. In 2019, the European Medicines Agency (EMA) approved a third-generation vaccine against smallpox and in 2022 it has authorized a specific antiviral treatment that is not marketed in Spain. The availability of both is very limited.