Monkeypox

CHICKEN, SMALL AND MONKEYPOX

A PROBABLE CASE IS DEFINED AS: ( IN V 1.0 MAY 2022 )

A CASE THAT MEETS THE CLINICAL CASE DEFINITION HAS AN EPIDEMIOLOGICAL LINK

NOT A

CASE

MONKEYPOX STRUCTURE

MODES OF

TRANSMISSION OF MONKEYPOX VIRUS OCCURS WHEN A PERSON COMES INTO

WITH THE VIRUS FROM

MONKEYPOX

SIGNS AND SYMPTOMS

SIGNS AND SYMPTOMS

1. THE INVASION PERIOD

• USUALLY LASTS BETWEEN 0-5 DAYS.

• CHARACTERIZED BY FEVER, INTENSE HEADACHE, LYMPHADENOPATHY, BACK PAIN, MYALGIA, AND INTENSE ASTHENIA (LACK OF ENERGY).

• LYMPHADENOPATHY IS A DISTINCTIVE FEATURE OF MONKEYPOX COMPARED TO OTHER DISEASES THAT MAY INITIALLY APPEAR SIMILAR (CHICKENPOX, MEASLES, SMALLPOX).

1. THE SKIN ERUPTION PERIOD

• USUALLY BEGINS WITHIN 1-3

OFTEN BEGINNING

OF FEVER

AND THEN SPREADING TO OTHER PARTS OF

OF THE

BODY

ORAL MUCOUS MEMBRANES,

PROCEDURE FOR COLLECTION OF SPECIMENS FOR NUCLEIC ACID TESTING

1. WEAR APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT

2. GENTLY DEROOF A VESICLE USING A SYRINGE

3. RUB THE BASE OF THE LESION FIRMLY USING A DRY SWAB WHILE ROTATING THE SWAB TO ABSORB FLUID FROM THE LESION ONTO THE SWAB AND TO GET THE CELLULAR MATERIAL FROM THE LESION BASE

4. SAMPLE AT LEAST 3 LESIONS

5. PLACE THE SWAB INTO A STERILE, LEAK-PROOF CONTAINER.

6. LABEL THE TUBES WITH PATIENT INFORMATION AND SITE OF COLLECTION, PLACE THEM IN THE ZIP-LOCK PLASTIC SPECIMEN BAG, AND SEAL THEM.

7. USE WATERPROOF DRESSING(S) TO COVER THE DEROOFED LESIONS

8. AFTER SPECIMEN COLLECTION, ALL PROTECTIVE MATERIALS (GLOVES, MASK, GOWN, ETC.) AND ALL USED COLLECTION MATERIALS MUST BE PLACED IN BIOHAZARD BAGS AND AUTOCLAVED OR INCINERATED PRIOR TO DISPOSAL. USE AN APPROPRIATE SHARPS CONTAINER TO DISPOSE OF NEEDLES AND IMMEDIATELY AUTOCLAVE.

REFERRAL OF SAMPLES TO PUBLIC HEALTH LABORATORY

THE

SPECIMENS PACKAGING AND SHIPMENT TO THE PHL LABORATORY

• ALL MATERIALS TRANSPORTED WITHIN AND BETWEEN LABORATORIES SHOULD BE PLACED IN A SECONDARY CONTAINER TO MINIMIZE THE POTENTIAL FOR BREAKAGE OR A SPILL

• PATIENT SPECIMENS FROM SUSPECTED OR CONFIRMED CASES SHOULD BE TRANSPORTED AS UN3373, “BIOLOGICAL. SUBSTANCE, CATEGORY B. ALL SPECIMENS BEING TRANSPORTED AS UN3373 SHOULD HAVE APPROPRIATE PACKAGING, LABELLING AND DOCUMENTATION

• SPECIMENS SHOULD BE PUT IN A STERILE, LEAK-PROOF CONTAINER SCREWED PROPERLY THEN SEALED WITH PARA FILM TAPE AND PLACED IN WATERPROOF SECONDARY CONTAINER E.G., ZIPLOCK BAGS AFTER WHICH THEY SHOULD BE PUT IN A THIRD CONTAINER. COOLING AGENT SHOULD BE OUTSIDE THE SECONDARY CONTAINER

• PAPER SHEETS SHOULD BE SEALED IN WATERPROOF BAGS AND KEPT SEPARATED FROM THE SPECIMENS

• SAMPLES CAN BE SHIPPED FREE OF CHARGE VIA SMSA COURIER TO PUBLIC HEALTH LABORATORY (PHL) AS PER REGULATIONS. NOTIFY THE PHL OF THE DISPATCH OF THE SPECIMEN AND COURIER OR AIRWAY BILL NUMBER AS APPROPRIATE

CONTACT TRACING

CONTACT TRACING IS CONSIDERED ONE OF THE MOST IMPORTANT PUBLIC HEALTH MEASURES TO CONTROL THE SPREAD OF COMMUNICABLE DISEASES.

A CONTACT IS DEFINED AS A PERSON WHO, IN THE PERIOD BEGINNING WITH THE ONSET OF THE SOURCE CASE’S FIRST SYMPTOMS, AND ENDING WHEN ALL SCABS HAVE FALLEN OFF, HAS HAD ONE OR MORE OF THE FOLLOWING EXPOSURES WITH A PROBABLE OR CONFIRMED CASE OF MONKEYPOX:

• FACE TO FACE EXPOSURE (INCLUDING HEALTH CARE WORKERS WITHOUT RESPIRATORY PROTECTION)

• DIRECT PHYSICAL CONTACT, INCLUDING SEXUAL CONTACT

• CONTACT WITH CONTAMINATED MATERIALS SUCH AS CLOTHING OR BEDDING

AS SOON AS A SUSPECTED CASE IS IDENTIFIED, CONTACT IDENTIFICATION, AND CONTACT TRACING SHOULD BE INITIATED AND FILL OUT THE LIST OF PATIENT’S CONTACTS FORM.

CONTACTS SHOULD BE NOTIFIED WITHIN 24 HOURS OF IDENTIFICATION.

CONTACTS SHOULD BE MONITORED AT LEAST DAILY FOR THE ONSET OF SIGNS/SYMPTOMS FOR A PERIOD OF 21 DAYS FROM THE LAST CONTACT WITH A PATIENT IN THE INFECTIOUS PERIOD.

THE PUBLIC HEALTH TEAM AT THE REGIONAL HEALTH DIRECTORATE IS RESPONSIBLE FOR LISTING, TRACING, AND FOLLOW UP LOOKING FOR SYMPTOMS OF HOUSEHOLD AND OTHER CONTACTS OF PATIENTS WITH MONKEYPOX INFECTION IN THE COMMUNITY.

REGIONAL PUBLIC HEALTH TEAMS SHOULD KEEP ALL LISTS OF CONTACTS IN AN EXCELLENT PROFESSIONAL FORMAT.

NOTE: HEALTHCARE CONTACTS SHOULD FOLLOW THE MANAGEMENT OF EXPOSED HEALTHCARE WORKERS (HCWS) TO A MONKEYPOX CASE IN HEALTHCARE FACILITIES.

MONKEYPOX

AND OTHER COMMON RASH ILLNESSES

MONKEYPOX

MONKEYPOX

MONKEYPOX VACCINES

MONKEYPOX VACCINES

VACCINE PROTECTION

➢

THE PREFERRED VACCINE TO PROTECT AGAINST MONKEYPOX IS JYNNEOS

➢ WHICH IS A TWO-DOSE VACCINE

➢ IT TAKES 14 DAYS AFTER GETTING THE SECOND DOSE OF JYNNEOS FOR ITS IMMUNE PROTECTION TO REACH ITS MAXIMUM

➢ THE ACAM2000 VACCINE MAY BE AN ALTERNATIVE TO JYNNEOS.

✓ ACAM2000 IS A SINGLE-DOSE VACCINE

✓ IT TAKES FOUR WEEKS AFTER VACCINATION FOR ITS IMMUNE PROTECTION TO REACH ITS MAXIMUM

✓ HOWEVER, IT HAS THE POTENTIAL FOR MORE SIDE EFFECTS AND ADVERSE EVENTS THAN JYNNEOS

✓ IT IS NOT RECOMMENDED FOR PEOPLE WITH SEVERELY WEAKENED IMMUNE SYSTEMS AND SEVERAL OTHER CONDITIONS.

MONKEYPOX VACCINES

VACCINE PROTECTION

➢ CDC RECOMMENDS VACCINATION FOR PEOPLE WHO HAVE BEEN EXPOSED TO MONKEYPOX AND PEOPLE WHO MAY BE MORE LIKELY TO GET MONKEYPOX

➢ PEOPLE MORE LIKELY TO GET MONKEYPOX INCLUDE:

➢ PEOPLE WHO HAVE BEEN IDENTIFIED BY PUBLIC HEALTH OFFICIALS AS A CONTACT OF SOMEONE WITH MONKEYPOX

➢

PEOPLE WHO ARE AWARE THAT ONE OF THEIR SEXUAL PARTNERS IN THE PAST 2 WEEKS HAS BEEN DIAGNOSED WITH MONKEYPOX

➢ PEOPLE WHO HAD MULTIPLE SEXUAL PARTNERS IN THE PAST 2 WEEKS IN AN AREA WITH KNOWN MONKEYPOX

➢ PEOPLE WHOSE JOBS MAY EXPOSE THEM TO ORTHOPOXVIRUSES SUCH AS:

• LABORATORY WORKERS WHO PERFORM TESTING FOR ORTHOPOXVIRUSES

• LABORATORY WORKERS WHO HANDLE CULTURES OR ANIMALS WITH ORTHOPOXVIRUSES

• SOME DESIGNATED HEALTHCARE OR PUBLIC HEALTH WORKERS

CONTACT

CLOSE CONTACT

• MONKEYPOX CAN SPREAD TO ANYONE THROUGH CLOSE, PERSONAL, OFTEN SKIN-TO-SKIN CONTACT, INCLUDING:

• DIRECT CONTACT WITH MONKEYPOX RASH, SCABS, OR BODY FLUIDS FROM A PERSON WITH MONKEYPOX.

• TOUCHING OBJECTS, FABRICS (CLOTHING, BEDDING, OR TOWELS), AND SURFACES THAT HAVE BEEN USED BY SOMEONE WITH MONKEYPOX.

• CONTACT WITH RESPIRATORY SECRETIONS.

INTIMATE CONTACT

• THIS DIRECT CONTACT CAN HAPPEN DURING INTIMATE CONTACT, INCLUDING:

• ORAL, ANAL, AND VAGINAL SEX OR TOUCHING THE GENITALS (PENIS, TESTICLES, LABIA, AND VAGINA) OR ANUS (BUTTHOLE) OF A PERSON WITH MONKEYPOX.

• HUGGING, MASSAGE, AND KISSING.

• PROLONGED FACE-TO-FACE CONTACT.

• TOUCHING FABRICS AND OBJECTS DURING SEX THAT WERE USED BY A PERSON WITH MONKEYPOX AND THAT HAVE NOT BEEN DISINFECTED, SUCH AS BEDDING, TOWELS, FETISH GEAR, AND SEX TOYS.

•

DURING MAY 17–JULY 22, 2022, A TOTAL OF 2,891 U.S. MONKEYPOX CASES WERE REPORTED BY 43 STATES, PUERTO RICO, AND DC; THE NUMBER OF REPORTED CASES INCREASED RAPIDLY DURING THIS TIME (FIGURE). CASE REPORT FORMS INCLUDING, AT MINIMUM, AGE AND GENDER IDENTITY WERE RECEIVED FOR 1,195 (41%) CASES; THESE CASES ARE DESCRIBED IN THIS REPORT. MEDIAN AGE WAS 35 YEARS (IQR = 30–41 YEARS). NEARLY ALL (99%) PERSONS WITH CASE REPORT FORMS AVAILABLE WERE MEN (CISGENDER AND TRANSGENDER) (TABLE 1). AMONG 1,054 CASES FOR WHICH RACE AND ETHNICITY WERE REPORTED, 41% OCCURRED AMONG WHITE PERSONS, 28% AMONG HISPANIC PERSONS, AND 26% AMONG BLACK PERSONS. BASED ON INFORMATION AVAILABLE IN CASE REPORT FORMS, THE PERCENTAGE OF CASES AMONG BLACK PERSONS INCREASED FROM 12% (29 OF 248) DURING MAY 17–JULY 2 TO 31% (247 OF 806) DURING JULY 3–22, AND THE PERCENTAGE AMONG HISPANIC PERSONS DECREASED FROM 33% (82 OF 248) TO 27% (214 OF 806) AND AMONG WHITE PERSONS FROM 49% (121 OF 248) TO 38% (307 OF 806).

• AMONG 241 CASES (20%) WITH REPORTED CLASSIFICATION BY HEALTH DEPARTMENTS AS BEING TRAVEL-ASSOCIATED OR LOCALLY ACQUIRED, 178 (74%) WERE CLASSIFIED AS LOCALLY ACQUIRED. THE PERCENTAGE OF LOCALLY ACQUIRED CASES INCREASED FROM 51% (33 OF 65) DURING MAY 17–JULY 2 TO 82% (145 OF 175) DURING JULY 3–22.

• AMONG 358 (30%) MEN (CISGENDER AND TRANSGENDER) WITH INFORMATION ON RECENT SEXUAL BEHAVIORS AND GENDER OF SEX PARTNERS AVAILABLE, 337 (94%) REPORTED SEX OR CLOSE INTIMATE CONTACT WITH A MAN DURING THE 3 WEEKS BEFORE SYMPTOM ONSET; 16 (4%) REPORTED NO SUCH CONTACT. AMONG 291 MEN WHO REPORTED INFORMATION ABOUT THEIR MALE SEXUAL PARTNERS DURING THE 3 WEEKS PRECEDING SYMPTOM ONSET, 80 (27%) REPORTED ONE PARTNER, 113 (40%) REPORTED TWO TO FOUR PARTNERS, 42 (14%) REPORTED FIVE TO NINE PARTNERS, AND 56 (19%) REPORTED 10 OR MORE PARTNERS. AMONG 86 MEN WITH INFORMATION REPORTED, 33 (38%) REPORTED GROUP SEX, DEFINED AS SEX WITH MORE THAN TWO PERSONS, AT A FESTIVAL, GROUP SEX EVENT, OR SEX PARTY.

• THE MOST FREQUENTLY REPORTED SIGNS AND SYMPTOMS INCLUDED RASH (100%), FEVER (63%), CHILLS (59%), AND LYMPHADENOPATHY (59%) (TABLE 2). REPORTED RECTAL SYMPTOMS INCLUDED PURULENT OR BLOODY STOOLS (21%), RECTAL PAIN (22%), AND RECTAL BLEEDING (10%). AMONG 291 PERSONS WITH AVAILABLE INFORMATION ABOUT THEIR FIRST SYMPTOMS, 58% REPORTED AT LEAST ONE PRODROMAL SYMPTOM††; FOR THE 42% OF PATIENTS WITHOUT PRODROMAL SYMPTOMS, ILLNESS BEGAN WITH A RASH.

• RASH WAS MOST FREQUENTLY REPORTED ON THE GENITALS (46%), ARMS (40%), FACE (38%), AND LEGS (37%); AMONG 718 PERSONS WITH MONKEYPOX WHO REPORTED BODY REGIONS WITH RASH, 238 (33%) REPORTED RASH IN ONE REGION, 126 (18%) IN TWO REGIONS, 98 (14%) IN THREE REGIONS, AND 256 (36%) IN FOUR OR MORE REGIONS. AMONG 104 PERSONS WITH INFORMATION ON THE NUMBER OF LESIONS, 88% OF CASES INVOLVED FEWER THAN 50 LESIONS.

• AMONG 334 PERSONS WITH DATA AVAILABLE ON HIV STATUS, 136 (41%) HAD HIV INFECTION. AMONG 954 PERSONS WITH HOSPITALIZATION DATA AVAILABLE, 77 (8%) PATIENTS WERE HOSPITALIZED BECAUSE OF THEIR ILLNESS. NO DEATHS WERE REPORTED. AMONG 339 PERSONS WITH VACCINATION STATUS AVAILABLE, 48 (14%) REPORTED PREVIOUS RECEIPT OF SMALLPOX VACCINE, INCLUDING 11 (23%) WHO RECEIVED 1 OF 2 JYNNEOS DOSES DURING THE CURRENT OUTBREAK, 11 (23%) WHO RECEIVED PRE-EXPOSURE PROPHYLAXIS AT AN UNKNOWN TIME BEFORE THE CURRENT OUTBREAK, AND 26 (54%) WHO DID NOT PROVIDE INFORMATION ABOUT WHEN VACCINE WAS ADMINISTERED. AMONG THE RECENTLY VACCINATED PERSONS WITH MONKEYPOX, AT LEAST ONE EXPERIENCED SYMPTOMS >3 WEEKS AFTER THEIR FIRST JYNNEOS DOSE.

Ever

during