New guidelines to help healthcare professionals respond to the monkeypox outbreak have been approved by the UK’s 4 public health agencies – UK Health Security Agency (UKHSA), Public Health Scotland (PHS), Public Health Wales (PHW) and Public Health Agency Northern Ireland (PHA).
The guidelines set out new measures for healthcare professionals and the public to manage the disease and prevent further transmission now that community transmission is occurring here in the UK and in other countries.
People with possible, probable or confirmed monkeypox can now self-isolate at home, if well enough, while following the measures advised in the new guidelines to reduce the spread and while being monitored by local protection teams of health.
In addition, UKHSA purchased more than 20,000 doses of a safe smallpox vaccine called Imvanex (supplied by Bavarian Nordic) and it is offered to identified close contacts of people diagnosed with monkeypox to reduce the risk of symptomatic infection and serious illness .
The guidance released today recommends that:
People with possible, probable, or confirmed monkeypox should avoid contact with other people until their lesions have healed and the scabs have dried off. Cases can reduce the risk of transmission by following standard cleaning and disinfecting methods and washing their own clothes and linens with standard detergents in a washing machine.
Cases should also abstain from sex while symptomatic, including during the period of early symptom onset, and while lesions are present. Although there is currently no available evidence of monkeypox in genital excreta, as a precautionary measure cases are advised to use condoms for 8 weeks after infection and these guidelines will be updated as they become available. and as the evidence emerges.
If people with possible, probable or confirmed monkeypox infection need to travel for treatment, they should ensure that all lesions are covered with cloth and wear a face covering and avoid public transport. common as far as possible.
Contacts of someone with monkeypox will also be risk assessed and asked to self-isolate for 21 days if necessary.
Whenever possible, pregnant healthcare workers and severely immunocompromised people (as outlined in the green paper) should not clinically assess or care for people with suspected or confirmed monkeypox. This guidance will be reassessed as evidence emerges.
The minimum recommended personal protective equipment (EAR) for staff working with confirmed cases includes tested FFP3 respirators, aprons, goggles and gloves. For possible or probable cases minimum recommended EAR for staff includes water-repellent surgical masks (FRSM), gowns, gloves and goggles.
In non-domestic residential settings (eg, adult social services, prisons, homeless shelters, shelters), people who are clinically well should be managed in a single room with a separate toilet, if possible. Close contacts of confirmed cases should be evaluated for vaccination.
Dr Ruth Milton, Senior Medical Advisor and Director of Monkeypox Strategic Response, at UKHSA said:
These new monkeypox guidelines set out important steps for healthcare professionals and the public to manage the disease, including how to safely isolate themselves at home and reduce the risk to others.
The highest risk of transmission is direct contact with someone who has monkeypox. The risk to the UK population remains low and anyone experiencing rashes or unusual sores on any part of their body should immediately contact NHS 111 or their local sexual health service.
Dr Giri Shankar, Director of Health Protection for Public Health Wales, said:
We are working with the UK Health Safety Agency, Public Health Scotland and the Public Health Agency of Northern Ireland to develop these guidelines, which will ensure healthcare staff in Wales have the best and most knowledgeable recent updates on Monkeypox case management. .
We reassure people that monkeypox does not usually spread easily between people and the overall risk to the general public is low. Anyone with unusual rashes or sores on any part of their body should contact NHS 111 or call a sexual health service if they have concerns.
Dr Nick Phin, Director of Public Health Sciences and Medical Director of Public Health Scotland, said:
We have well-established and robust infection control procedures to deal with cases of infectious diseases, such as monkeypox, but it is important that the response is flexible and proportionate.
In addition, it is also important that our advice reflects the difference in how health services work in the UK.
The new guidelines released today ensure a clear approach for healthcare professionals to follow, which should help limit the spread of infection.
Dr Gillian Armstrong, Head of Health Protection at the Public Health Agency, Health and Social Care Northern Ireland, said:
Following the detection of monkeypox cases elsewhere in the UK, the PHA has been in regular contact with UKHSA regarding the situation. We have also worked closely with trusts and GPs to raise awareness of the disease, set up testing modalities and clinical pathways and welcome new guidance on monkeypox to ensure we are fully prepared for any potential risk to the people of Northern Ireland.
In Northern Ireland, anyone who thinks they have been exposed to rashes or unusual lesions on any part of their body should contact their Genitourinary Medicine (GUM) clinic without delay. Please telephone first.
The guiding principles highlight the shared scientific understanding between the 4 countries around disease transmission and biology – which aligns with the World Health Organization. The highest risk of transmission is considered to be through direct contact with a confirmed case, droplets or contaminated surfaces and objects. The period of highest transmission risk is understood to be from the onset of the first symptoms until the lesions have crusted over and the crusts have fallen off. There is no current evidence that individuals are contagious before the first symptoms appear.
UKHSA is working closely with colleagues at NHS England to support the resilience of the healthcare system in the period ahead.
In addition, UKHSA updated its guidance on offering the Imvanex vaccine to people before and after exposure to a confirmed case of monkeypox. The vaccine will be offered prior to exposure to healthcare workers due to the care of a patient with confirmed monkeypox and staff working in sexual health services who have been identified as assessing suspected cases. After exposure, the vaccine will continue to be offered to close contacts in the highest exposure categories, ideally within 4 days of exposure, but it may also be offered to high-risk close contacts, including homosexual and bisexual men, men who have sex with men, immunocompromised people, young children and pregnant women, up to 14 days after exposure.
Separately, a risk assessment was carried out by the Human Animal Infections and Risk Surveillance (HAIRS) group looking at pets. The risk of a case infecting a pet is low. As a precaution, cases should try to avoid contact with their pets, its litter box and its litter box for 21 days, and if possible, pets should be cared for by someone else in the same household. If this is not possible, infected people should minimize their contact with their pet as much as possible and practice good hygiene by washing their hands thoroughly before and after contact.