Need to know
For #TeamEEAST Last updated: 03 May 2024 at 00:49
If I am pregnant and asked to attend a Monkeypox case, am I safe to do so?
If I am severely immunosuppressed and asked to attend a Monkeypox case am I safe to do so?
How easily does Monkeypox spread?
Monkeypox does not spread easily between people.
What details can you confirm about these latest cases? Sex, age group, etc
HM Government have published details on all confirmed cases in their rolling news story here.
Current cases in the UK are from person-to-person transmission, should I worry?
As above Monkeypox does not spread easily between people. The main risk for transmission would be from direct contact with skin lesions or through contact with a patient’s clothing or linens that have been in contact with the lesions. Therefore, practitioners should avoid touching skin lesions with bare hands, wear disposable gloves and observe strict hand hygiene.
Are these the first ever cases confirmed with no travel history?
In 2018, a case of the monkeypox virus was transmitted from a patient to a healthcare worker in the UK. In May and June 2021, three monkeypox cases were reported from within the same family; the index case had recent travel history to Nigeria. Monkeypox can spread if there is close contact between people but the risk of spread of Monkeypox to the UK population remains very low.
How does it spread?
Spread of Monkeypox may occur when a person comes into close contact with an infected animal (rodents are believed to be the primary animal reservoir for transmission to humans), an infected human, or materials contaminated with the virus.
Is person to person spread common?
Person-to-person spread is very uncommon.
How can person-to-person transmission occur?
Is monkeypox spread by sexual contact?
Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during sex. As above it can also be passed on through other close contact with a person who has monkeypox or contact with clothing or linens used by a person who has monkeypox.
How does the virus enter the body?
The virus enters the body through broken skin (even if breaks are not visible), the respiratory tract, or the mucous membranes (eyes, nose, or mouth).
What is the incubation period?
The incubation period is the duration/time between contact with the infected person and the time that the first symptoms appear. The incubation period for monkeypox is between 5 and 21 days but typically 6 to 16 days following exposure.
What are the initial symptoms?
The first symptoms of monkeypox include:
What comes next?
This is followed by a second phase where a rash appears, during which time some existing signs and symptoms, including fever, may diminish or disappear. The distribution of the rash and the appearance of individual skin eruptions typically change over time.
What is the rash like & where does it start?
The rash may be maculopapular (raised) initially, typically starting on the face before spreading peripherally, particularly to the palms of the hands and the soles of the feet. The initial rash classically evolves into vesicles (fluid filled) and then pustules (pus filled), often with umbilication, which eventually crust and then desquamate (come off) during the next two to three weeks. These characteristic pox lesions are typically 0.5 to 1cm diameter and may number from a few to several thousand. Involvement of the oral mucous membranes occurs in many cases; lesions may also occur on the genitals, conjunctivae and cornea in some patients.
Is the rash always like this?
Localised rashes are seen occasionally, relating to the site of the initial exposure. The rash is sometimes confused with chickenpox. It starts as raised spots, which turn into small blisters filled with fluid. These blisters eventually form scabs which later fall off.
How ill can patients become?
Most patients experience a mild, self-limiting illness, with spontaneous and complete recovery seen within 3 weeks of onset. However, severe illness can occur and sometimes results in death.
What is the death rate for Monkeypox?
The disease caused by monkeypox is usually mild and most of those infected will recover within a few weeks without treatment. However, severe illness can occur in some individuals and those with underlying conditions such as severe immunosuppression. There are different strains of monkeypox virus in different parts of Africa. The cases confirmed recently in England have been a strain found in West Africa, which is known to be associated with less severe disease. No fatal cases occurred in an outbreak of monkeypox in the USA in 2003 which came from West Africa.
Is Monkeypox treatable?
Treatment for monkeypox is mainly supportive, but newer antivirals may be used. The illness is usually mild and most of those infected will recover within a few weeks without treatment. High quality medical and nursing supportive care will be provided to individuals to manage symptoms.
Is there a vaccine available for Monkeypox and will people be offered it?
There isn’t a specific vaccine for monkeypox, but vaccinia (smallpox) vaccine does offer some protection. Some individuals with higher level of exposures are being offered this smallpox vaccine. UK Government have pro-actively procured further doses of these vaccines.
How concerned are we about this? Is the risk to the public low?
This is a rare and unusual situation. UKHSA is rapidly investigating the source of these infections because the evidence suggests that there may be transmission of the Monkeypox virus in the community, spread by close contact. Monkeypox remains very rare in the UK and the risk to the general public remains low. UKHSA and the NHS have well established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed.
Could this have been picked up sooner?
As soon as the cases presented themselves to healthcare settings they were triaged and clinically assessed by trained healthcare staff. Due to the rare nature of the virus, monkeypox was not an immediate consideration in all cases. However, once monkeypox was suspected, each of the cases was immediately isolated and tested, and the results of those tests very quickly confirmed the diagnoses. As soon as these cases were confirmed, local Health Protection Teams were alerted and contact tracing and isolation of anyone suspected to be in recent close contact with the infected individuals quickly got underway.
Does this mean Monkeypox is circulating undetected in the population?
Monkeypox remains very rare in the UK. In the majority of previous cases, there were links to countries where the disease is more common. There are currently no known links to recent travel for these recent cases and so there is rapid investigation as to where and when transmission may have taken place. UKHSA closely monitor the prevalence of all infectious diseases and the risk of community transmission of monkeypox in the UK remains extremely low. UKHSA is rapidly investigating the source of these infections because the evidence suggests that there may be transmission of the Monkeypox virus in the community, spread by close contact. Detailed contact tracing is ongoing for follow-up of individuals who have come into contact with these cases.
How many cases could be going undetected? Is any modelling being done?
UKHSA and academic partners will be developing an assessment of potential undiagnosed cases, or cases in the community and considering a range of scenarios. They have robust contact tracing procedures in place to ensure they follow up with anyone who has been in close contact with the infected individuals they can pick up any additional cases as soon as possible.
What should someone do if they suspect they have Monkeypox?
Public Health Advice is as follows - You can help slow the spread of the outbreak. If you think you have Monkeypox symptoms – however mild:
Please contact clinics ahead of your visit and avoid close contact with others until you have been seen by a clinician. Your call or discussion will be treated sensitively and confidentially.
If I have contact with a Monkeypox case, will I have to isolate?
Dependant on contact - contact tracing will be carried out by the Covid Lead team who will assess whether the risk is HIGH, MEDIUM, LOW or NONE.
If I become symptomatic after contact with a Monkeypox case what will happen?
EEAST Covid Leads team will be actively monitoring and in daily communication with you (for up to 21 days) for any contacts/ anyone in isolation. You will be stood down if you are symptomatic following contact of a confirmed positive monkeypox case.
Do I need to tell my Manager if I'm diagnosed with Monkeypox?
Monkeypox is a notifiable disease and therefore the employee must inform the Trust if they are diagnosed through the dedicated Covid Lead T&T team.
If a staff member is at work and a household member has a positive Monkeypox diagnosis does the staff member get stood down immediately?
Stand staff down as soon as possible after a positive household diagnosis as there is the potential for them to be already infected - refer to Covid Leads T&T team for contact tracing and further advice.
Will crew be stood down if crew has contact with a confirmed monkeypox case?
Crews will only be stood down if the patient is confirmed as a Monkeypox positive case or there is unprotected direct contact or high-risk environment contact.
If you are contacted by UKHSA as a contact of a positive Monkeypox case
Immediately contact your COVID Lead or Manager for further advice. EEAST Covid Leads on 07715 494158 (7 days a week 7am to 10pm).
If I am pregnant and asked to attend a Monkeypox case, am I safe to do so?
Where possible, pregnant healthcare staff should not assess or clinically care for individuals with suspected or confirmed monkeypox. If a case is identified by AOC through pre-screening and AOC dispatches you to this call then please advise them that you are pregnant and are unable to attend this call. If you attend a job that has got through the pre-screening and there any suspicion of Monkeypox please withdraw from the situation and allow crew partner to assess and call a second crew if transport required. This guidance will be reassessed as evidence emerges.
If I am severely immunosuppressed and asked to attend a Monkeypox case am I safe to do so?
Where possible, severely immunosuppressed staff should not assess or clinically care for individuals with suspected or confirmed monkeypox. If a case is identified by AOC through pre-screening and AOC dispatches you to this call then please advise them that you are severely immunosuppressed and are unable to attend this call. If you attend a job that has got through the pre-screening and there any suspicion of Monkeypox please withdraw from the situation and allow crew partner to assess and call a second crew if transport required. This guidance will be reassessed as evidence emerges.
Published 26th May 2022