Monkeypox: A local Response to a National Incident Sharon Mawdsley - - PowerPoint PPT Presentation

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 10th 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 13th

Post Exposure Prophylaxis (PEP)

• Imvanex smallpox vaccine
• Unlicensed for use in monkeypox
• utbreaks but authorised by EMA
• The vaccine had expired but the

date was extended

• Most effective when given within 4

days of exposure

Monday September 24th Case number 3

Patient outcomes

Case 2

• Isolated in Liverpool for 3

weeks.

• 3 negative samples obtained.
• Lesion in left groin drained,
• therwise uncomplicated

recovery. Case 3

• Isolated in Newcastle for 5

weeks.

• Intermittent negative samples
• btained.
• Discharged home under strict

instructions to self isolate.

• Final clearance result obtained

November 9th.

• Incident closed down

November 27th.

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