Monkeypox: Information for primary care

Background

Monkeypox is a rare infectious disease caused by the monkeypox virus (genus Ortopox). Monkeypox virus is associated with, but different from, the virus that causes smallpox (smallpox virus) and cowpox. After the global eradication of smallpox in 1977, monkeypox has become a major cause of human orthopox outbreaks, primarily in West and Central African countries. Outbreaks in these African countries usually occur in remote forest areas.

Cases of monkeypox were reported in Africa in 2018 in Cameroon, the Central African Republic, the Democratic Republic of the Congo, Liberia, and Nigeria.

September 2018, Two cases of monkeypox were imported into the United Kingdom.. Later, other cases exported from Africa were identified in other countries.

Infection; Infection

Monkeypox does not spread easily among people.

The epidemic of monkeypox has come into close contact with infected animals (which are believed to be the main animal reservoir for rodents to infect humans), infected humans, or virus-contaminated substances. It can happen at times. The virus enters the body through broken skin (even if the breaks are invisible), airways, or mucous membranes (eyes, nose, or mouth).

Human-to-human spread is extremely rare, but can occur in the following cases:

• Contact with clothing and linen (bedding, towels, etc.) used by infected persons
• Skin lesions of monkeypox or direct contact with scabs
• Closely exposed to coughing and sneezing in people with a monkeypox rash

Clinical features

The incubation period is 5 to 21 days, but usually 6 to 16 days after exposure. The early stages of a typical clinical disorder usually last 1-5 days. Patients may experience a combination of fever and / or chills, lymphadenopathy, headache, myalgia, low back pain and malaise. Fever is present in most patients, but not all. This is followed by a second stage in which the rash appears. In the meantime, some existing signs and symptoms, including fever, may alleviate or disappear. The distribution of rashes and the appearance of individual skin rashes usually change over time.

The rash can initially be patchy and papular, usually starting on the face and before spreading to the periphery, especially to the palms and soles of the feet. The first rash classically develops into vesicles, then pustules, often with acne, and eventually crusting, which peels off in the next 2-3 weeks. These characteristic smallpox lesions are usually 0.5 to 1 cm in diameter and can range from a few to thousands. Often, the involvement of the oral mucosa occurs. In some patients, lesions may also occur on the genitals, conjunctiva, and cornea.

Occasional local rashes are seen associated with the initial exposure site.

Most patients experience a mild, self-limited illness that recovers spontaneously and completely within 3 weeks of onset. However, serious illness can occur and can sometimes be fatal.

Patient evaluation

As part of a confirmed investigation Cases of monkeypox in the UK, Contact the individual identified as a potential contact in the case. These individuals are then asked to contact the health protection team (HPT) If compatible symptoms appear. However, if the patient identified as a contact person in a monkeypox case presents to you, Contact the locals HPT Seeking advice.

Other patients receiving primary care are unlikely to suffer from monkeypox.

For those who have traveled to and from Africa, fever is likely to be caused by common tropical infections such as malaria and typhoid fever and should be diagnosed and treated promptly.

Expert evaluation and laboratory research are essential. Patients of interest should first discuss with a local infectious physician. After that, a local infectious specialist may discuss the patient. Import fever service ((((IFS) (Tel: 0844 7788990). If it is agreed that monkeypox may be diagnosed HPT You need to be notified and the patient should be referred to a hospital with appropriate quarantine facilities, ideally a local infectious disease center. Details of this process and further evaluation of the patient IFS..

Patients, regardless of nationality, can be advised that a professional assessment will be free at the time of care.

Infection prevention and management when monkeypox is suspected

The main risk of infection is due to direct contact with skin lesions or contact with the patient’s clothing or linen in contact with the lesions.

Therefore, practitioners should avoid touching skin lesions with their bare hands, wear disposable gloves, and adhere to strict hand hygiene.

Patients are more likely to appear in the early stages of the disease, so the risk of environmental pollution should be low during the initial presentation to primary care or during the patient’s examination.

If the patient is referred to a hospital because of a high probability of monkeypox, do not use the room after transfer. nearest HPT You will need to contact us for cleaning and decontamination advice.