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Mpox (Formerly: Monkeypox)

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September 6, 2024

Wear Gloves & Wash Your Hands!!!

There have been >100 patients identified as having Mpox in the UK during the current outbreak. Most of these cases have been amongst men who have sex with men.

Reports have suggested that although lesions occur any where including palms and soles. Genital lessons and lymphadenopathy are very common

March 2024 – UKHSA warn there is increasing cases in DRC (Democratic Republic of Congo), so stay vigilant in travellers from central Africa.

 

Trust SOP -HERE

 

Transmission

  • MPox Virus enters through mucosal membranes (Reps/GIT/Mouth/Eye), or wounds
  • Animal contact (Rodent and Bush meat) is the most common source
  • Human-Human transmission is rare but possible
    • Contact with clothing/bed linen
    • Contact with lesions
    • Cough/Sneeze if patient has lesions
    • Sexual transmission

 

Disease Course

  • Incubation 5-21 days
  • Phase 1: General viral illness (fever, headaches, myalgia, lethargy, lymphadenopathy)
  • Phase 2: Rash: initially Maculopapular starting face > extremities, turning into vesicles and pustules later. Phase 1 symptoms often deminish
  • Recovery: normally this is self limiting over 3 weeks (but deaths have occurred

monkey pox

Case Definition

Possible case

A person with a febrile prodrome compatible with monkeypox infection where there is known prior contact with a confirmed case in the 21 days before symptom onset.

Or

a person with an illness where the clinician has a high suspicion of monkeypox (for example, this may include prodrome or atypical presentations with exposure histories deemed high risk by the clinician, or classical rash without risk factors).

Febrile prodrome = fever ≥ 38°C, chills, headache, exhaustion, muscle aches (myalgia), joint pain (arthralgia), backache, and swollen lymph nodes (lymphadenopathy).

Probable case

A person with an unexplained rash on any part of their body plus one or more classical symptom or symptoms of monkeypox infection¥ since 15 March 2022 and either:

  • epidemiological link to a confirmed or probable case of monkeypox in the 21 days before symptom onset or
  • travel history to West or Central Africa in the 21 days before symptom onset or
  • is a gay, bisexual or other man who has sex with men (GBMSM)

Acute illness with fever (>38.5°C), intense headaches, myalgia, arthralgia, back pain, lymphadenopathy.

Confirmed case: A person with a laboratory confirmed monkeypox infection (monkeypox PCR positive)

Actions

NOTE: Current guidance is that where possible, pregnant and severely immunosuppressed healthcare workers (as outlined in the Green Book) should not assess or clinically care for individuals with suspected or confirmed monkeypox.

MPox Suspected:

  • Isolate patient: Negative pressure room (ideal), patient to wear surgical mask until isolated
  • Staff PPE: Gown; FFP3 mask or equiv; gloves; eye protection to be worn by all persons entering the room where a patient is being isolated.
  • Discuss with Microbiologist: If they agree they will contact the IFS (Imported Fever Service) to arrange further assessment and investigation.
  • Viral Swab from lesion:  use the Green cap viral media
  • Do not use cubicle: contact HPT (health Protection Team) for cleaning advice