Monkeypox (MPX)

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About monkeypox (MPX)

Monkeypox (MPX) is a viral zoonotic disease (zoonotic refers to diseases that can pass between animals to humans). There are two genetic strains of MPX virus, the West African strain and the Congo Basin (Central African) strain. Human MPX was first identified in humans in 1970 in the Democratic Republic of the Congo. MPX is largely confined to Western and Central Africa where it is endemic. MPX cases in people have occurred outside of Africa linked to international travel or imported animals.

Transmission

MPX does not easily spread between people.

Person-to-person spread may occur through:

  • sexual or intimate contact with an infected person (including kissing)
  • contact with clothing or linens (such as bedding or towels) used by an infected person
  • direct contact with MPX skin lesions or scabs
  • respiratory droplets from an individual with MPX.

In endemic areas, spread of MPX may occur when a person comes into close contact with a wild animal (such as a rodent) infected with the virus.

People with MPX are contagious from the time that they develop their first symptoms (which is usually fever, but occasionally starts with a rash) and until rash lesions crust, dry or fall off.

Symptoms

The first symptoms of MPX are usually one or more of the following:

  • Headache
  • Acute onset of fever (>38.0C),
  • Chills
  • Lymphadenopathy (swollen lymph nodes)
  • Myalgia (muscle and body aches)
  • Backache
  • Tiredness

After a few days, the characteristic rash usually appears on the place of infection and spreads to other parts of the body. It may also appear on the palms of hands and soles of the feet, inside the mouth, or on the genitalia.

The rash associated with MPX evolves typically in four stages – macular, papular, vesicular, to pustular – followed by scabbing, with lesions progressing simultaneously on any part of the body. The rash may be generalised or localised.

The symptoms usually resolve by themselves within a few weeks.

What to do if you develop symptoms of MPX

MPX is not very infectious. To get infected you need to be in close contact (usually skin to skin or shared respiratory droplets) with a case while they are infectious. Therefore, it is more likely to occur in people coming from a country with a known outbreak. Information currently available shows that in the current outbreak people at high risk of infection include persons who had multiple or anonymous sexual partners and gay, bisexual or other men who have sex with men (MSM).

Based on this, if think you may have been exposed and you develop MPX symptoms, particularly a rash, you should isolate from others and seek medical care. Wear a mask and call your doctor or nearest hospital to let them know you will be attending. If you have a rash or blisters, make sure these are covered.

Treatment for MPX is mainly supportive. The illness is usually mild and recovery usually takes a few weeks

What to do if you are a close contact of a case

If you are identified as a close contact of a MPX case, active symptom monitoring and temperature checking for 21 days since last close contact with the case will be carried out under guidance from your local Public Health Unit. As a close contact you will not be required to strictly quarantine however you are advised to avoid:

  • high risk settings such as healthcare settings[1], childcare settings and aged care facilities, as well as places of indoor gatherings where infection may spread via droplets such as bars, restaurants or places of worship.
  • high risk activities such as sexual activities and other activities that involve close physical contact such as kissing.
  • close contact with people potentially at higher risk of infection including infants, older people and immunocompromised people.

If a close contact develops initial symptoms (other than a rash) they will be required to quarantine and will be closely monitored for the next seven days. If no rash develops, they can return to temperature monitoring for the remaining days until the full 21 days are completed.

Preventing MPX transmission

Practice good hand hygiene after contact with infected animals or humans. Wash your hands with soap and water and dry thoroughly or use an alcohol-based hand sanitiser.

Avoid close contact with people with suspected or confirmed MPX and do not share clothing or bedding.

People travelling to countries where MPX is endemic (Western Africa) should avoid contact with animals that could harbour the virus (particularly animals that are sick or that have been found dead in areas where MPX occurs).

See also “What to do if you develop symptoms of MPX”

Animals and MPX

MPX is a zoonotic disease, and, despite not having been documented, there is a potential risk of spillback to susceptible animals.

The Ministry of Health and Ministry for Primary Industries are working together to provide the most current information about managing the potential risk of human to animal transmission. This will help to prevent the disease from being transmitted from humans to susceptible animals at home, in zoos and wildlife areas, and also to peri-domestic animals especially rodents, which may be susceptible to MPX virus.

People who are suspected or confirmed to be infected with MPX virus should avoid close contact with animals, including domestic animals at home (such as cats, dogs, and ferrets), livestock, and other captive animals, as well as wildlife. People should be particularly vigilant around animals know to be susceptible to the MPX virus such as rodents and non-human primates. To date, there is no documented evidence of domestic animals such as cats and dogs, or of livestock being affected by MPX.

MPX is a zoonotic disease, and as a precautionary measure, it is important to ensure that all rubbish, including medical waste, is not accessible to rodents and other scavenger animals and is disposed of in a safe manner.

For more information see the World Organisation for Animal Health website.

Infection Prevention and Control

Infection prevention measures for healthcare workers

Standard, Contact and Airborne Precautions, and routine infection prevention and control practices are required in healthcare settings.

Recommended PPE for healthcare workers includes:

  • Disposable long sleeve isolation gown
  • Disposable single use gloves
  • Eye protection (goggles or face shield)
  • P2/N95 particulate respirator (staff should have undertaken fit testing and know how to fit check their respirator)

Hand hygiene – Clean your hands thoroughly after contact with an infected patient or their environment. Follow the 5 moments of hand hygiene.

Additional infection prevention and control measures

Patients should wear a medical mask and maintain good hand hygiene practices.

Patient placement – Patients should be isolated from others and placed into either a negative pressure room or single room with good ventilation. They will need their own bathroom facilities in a hospital setting.

Patient equipment – Ensure that all used patient care equipment is handled carefully to prevent contamination to clothing and skin, and equipment is cleaned and reprocessed appropriately

Linen, waste and cleaning

Care must be taken when handling used linen, clothing and towels. Avoid shaking used/soiled linen to avoid dispersal of infectious particles. Follow healthcare facility policy and guidance for handling contaminated used linen.

Waste should be handled and disposed of as infectious waste as per healthcare facility policy.

Follow healthcare facility procedures and policies for cleaning and disinfecting environmental surfaces with approved products, and ensure the appropriate PPE is worn by cleaning staff.

Primary health and sexual health care

Clinicians are asked to look out for signs and symptoms consistent with MPX particularly in returned travellers or persons with clinically compatible rash. A telemedicine consultation is advisable where possible. Information about all recent travel, sexual history and smallpox immunization history should be collected.

If a case is suspected or under investigation contact the local medical officer of health.

[1]     unless seeking medical attention, in which case the contact should call the facility in advance and explain their status.

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