Monkeypox: A local Response to a National Incident Sharon Mawdsley Nurse Consultant and Deputy Director of Infection Prevention and Control
Monkeypox • Routes of transmission include: ➢ close contact with an infected animal ➢ ingestion of infected bush meat ➢ contact with clothing or linens used by an infected person ➢ droplet spread • The incubation period is 5 - 21 days. • Symptoms begin with fever, headache, muscle pain and swollen lymph nodes followed by a rash.
Blackpool Timeline Thursday 06/09/18 • A 36 year old male was admitted to BVH after becoming unwell during a recent holiday to Nigeria. • Symptoms included fever, a scrotal lump and an itchy rash in the groin area. • Lymphadenopathy (neck, groin) was also noted. • The patient had received treatment for a scrotal abscess whilst in Nigeria and had unprotected sex. • Standard isolation precautions were implemented.
Monday September 10 th 2018 • We were made aware of a patient with a spreading pustular rash who had been to Nigeria • The patient confirmed that he had been in contact with someone with a similar rash • The patient had also eaten bush meat • Photographs and samples were taken • The patient was transferred to a HCID Unit
Contact tracing challenges • 77 staff contacts • 3 High risk exposures • Lack of a regularly updated staff record system caused logistical issues • Staff do not all regularly access the email system • Staff did not always respond to the PHE active surveillance text message
Thursday September 13 th Post Exposure Prophylaxis (PEP) • Imvanex smallpox vaccine • Unlicensed for use in monkeypox outbreaks but authorised by EMA • The vaccine had expired but the date was extended • Most effective when given within 4 days of exposure
Monday September 24 th Case number 3
Patient outcomes Case 2 Case 3 • • Isolated in Liverpool for 3 Isolated in Newcastle for 5 weeks. weeks. • • 3 negative samples obtained. Intermittent negative samples obtained. • Lesion in left groin drained, • otherwise uncomplicated Discharged home under strict recovery. instructions to self isolate. • Final clearance result obtained November 9 th . • Incident closed down November 27 th .
Discussion and Recommendations • Expect the unexpected • Monkeypox may present in Primary or Secondary Care • Clinicians need to be alert to its clinical features and possible presentations such as genital lesions • Trusts should ensure that relevant National and local guidelines are put in place so that any future cases can be rapidly detected and managed safely • Ensure full protective isolation is implemented for any suspected cases • Ensure staff contact details are kept up to date to assist in contact tracing exercises
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