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MONKEYPOX
SIGNS & SYMPTOMS
TRANSMISSION IN HUMANS
TREATMENT
MONKEYPOX INFECTION CONROL WITHIN THE HEALTHCARE
SETTING
MANAGING MONKETPOX FOR NON-HOSPITALIZED INDIVIDUALS
IF YOU ARE EXPOSED TO MONKEYPOX
IF AN ANIMAL IS EXPOSED TO MONKEYPOX
MONKEYPOX INFECTION CONTROL AMONG VETERINARIANS
AND OTHER ANIMAL HANDLERS
ADDITIONAL INFORMATION
Monkeypox
- Its Origin
Recently,
a rare viral disease that occurs mostly in western Africa,
has gathered an increasing amount of media attention. This
is monkeypox, a disease which comes from the same viral family
as smallpox and cowpox. The disease was first discovered in
1958 in laboratory monkeys, but other animals were found to
have the disease through blood tests. Squirrels are thought
to be the common host, but rats, mice, and rabbits can also
get it. The first occurrence of monkeypox in humans was reported
in 1970.
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Monkeypox
was found for the first time in the United States in early
June after several people came into contact with prairie dogs
that were infected with the disease. As of June 12, a total
of 62 persons with suspected monkeypox had been reported in
Wisconsin (21), Illinois (12), Indiana (28), and New Jersey
(1). Monkeypox had been confirmed by laboratory tests in nine
persons. At least 14 of the people with suspected monkeypox
had been hospitalized for their illness, with nine cases being
confirmed by laboratory tests. These numbers of cases and
states in which the suspected cases were found will likely
change as the investigation and testing continues. As of June12,
there have been no deaths due to monkeypox within the United
States.
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Signs
& Symptoms
The signs and symptoms of monkeypox are basically the same
as those of smallpox, only milder. The only difference between
the two is the fact that monkeypox causes lymph node swelling.
Symptoms that parallel smallpox include: fever (temperature
> 100.5°F), headache, back ache, muscle aches, sore
throat, cough, and feeling of fatigue. All of these symptoms
occur about twelve days after the person is infected with
the virus. One to three days (possibly longer) after the onset
of the fever, the individual will get a rash, which will develop
into raised bumps filled with fluid. This rash often starts
on the face and spreads, but there have been cases that have
started on other parts of the body as well. The bumps will
eventually get crusty, scab over, and fall off. The entire
illness usually lasts for about 2-4 weeks.
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Transmission in Humans
People can become infected with this disease by coming into
contact with the blood, body fluids, rash of an animal already
infected with monkeypox. They can also become infected if
they are bitten by an infected animal. The disease can also
spread from person to person through large respiratory droplets
during long periods of face-to-face contact, coming into direct
contact with body fluids of infected persons, or touching
objects contaminated with their body fluids, such as bed linens
and clothing.
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Treatment
Monkeypox has no specific treatment, other than treating the
symptoms of the disease. In Africa, people that received the
smallpox vaccine had a lower incidence of contracting monkeypox.
The CDC has guidelines explaining when the smallpox vaccine
should be used to protect against monkeypox. One of the main
groups that should consider receiving vaccinations are health
care providers that could come into direct contact with infected
persons.
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Although
there are few statistics regarding human death from monkeypox
within the United States, in Africa the percent of people
who die from the disease after becoming infected is between
1 and 10 per cent. Statistics for the United States are projected
to be better than that, due to better nutrition and access
to medical care.
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Monkeypox
Infection Control Within the Healthcare Setting
If monkeypox is suspected upon admission to the hospital,
the person should be questioned about possible exposure through
contact with an infected animal, especially pet prairie dogs
and Gambian giant rats. Infection control should be notified
immediately. It is important that the patient be put into
isolation, following protocol for Standard, Contact, and Airborne
Precautions. These precautions include the following:
1.
Thorough hand washing after coming into contact with persons
suspected or positively diagnosed with monkeypox, or after
coming into contact with objects contaminated with the bodily
fluids of such persons.
2. Use of gown and gloves when treating persons suspected
to be infected with monkeypox.
3. Use of goggles if splashing fluids may be a concern.
4. Use of an approved NIOSH-certified N95 filtering disposable
respirator mask when entering the patient’s room. If
these masks are not available, surgical masks should be use.
5. The patient should be isolated in a negative pressure room.
If one is not available, the patient should be placed in a
private room until one becomes available.
6. Dispose of materials soiled with the patient’s body
fluids, such as dressings, according to the facility’s
protocol for infectious waste.
7. When handling contaminated laundry, do not shake. This
could cause infectious particles to become airborne.
8. Make sure to properly handle patient’s personal care
supplies so as not cause exposure to yourself.
9. Reusable equipment should be cleaned and sterilized thoroughly
per protocol.
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Managing
Monkeypox for Non-Hospitalized Individuals
1. Infected persons should remain in an isolated environment
until all blisters have crusted over.
2. Lesions should be attempted to be covered as much as possible
to decrease contact with other people and objects as much
as possible.
3. If it is necessary for the person to be moved from the
isolated room or if the individual is to come into contact
with others, they should cover their nose and mouth with a
mask, and cover all lesions with a sheet or a loose garment.
4. People not exposed to monkeypox should not be allowed to
enter the house unless they are health care providers. If
entering the house is absolutely necessary, a N95 respirator
mask should be worn at all times.
5. Proper and frequent hand washing is necessary for both
infected person and all others within the house.
6. Laundry used by the individual should be handled gingerly,
so as to not aerosolize infectious materials (spreading infectious
particles into the air by shaking linens). Materials should
be washed with regular detergent in warm water. Bleach can
be used but is not required.
7. Eating utensils, dishes, and drinking containers, should
be set aside for use ONLY by the infected individual for the
duration of the illness.
8. Hard surfaces that may have come into contact with infectious
material can be disinfected with regular cleaning supplies
in accordance with the manufacturer’s instructions.
9. Soiled disposable materials should be disposed properly
(bagged and put into another container).
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If
You are Exposed to Monkeypox
If you are exposed to monkey pox through someone who is infected,
or by an infected animal, you must contact your area health
department, and watch yourself for the onset of symptoms (see
above for listing) for 21 days. This includes taking and recording
your temperature twice daily and talking to health department
personnel daily. You are allowed to continue with daily activities,
including school and work, but should remain close to home.
Preschoolers that have been exposed should remain home from
school.
Health-care workers that have been exposed to monkeypox (whether
knowingly or unknowingly) should follow the above precautions,
but they should report daily to employee health to be interviewed
and examined regarding their state of health for 21 days.
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If
an Animal is Suspected of Having Monkeypox
Animals suspected of being exposed to monkeypox should be
isolated in a room with the door closed, by itself, for 30
days.
Care givers should spend as little time as possible in the
room. After feeding or caring for the animal in question,
handlers should wash their hands thoroughly and change their
clothes.
Immuno-compromised people should not have ANY contact
with the animal.
If the animal starts to display symptoms of monkeypox,
the local or state health department should be contacted as
to what to do for the animal next. DO NOT TAKE THE ANIMAL
TO THE VETERENARIAN BEFORE CALLING FIRST AND EXPLAINING THE
ANIMAL’S CONDITION AND EXPOSURE.
Symptoms in animals include fever, cough, red, itchy, watery
eyes, swollen lymph nodes, and rash.
If the veterinarian recommends seeing the ill/exposed
animal, arrangements should be made so as to not expose other
animals or people. The animal should be transported in a closed
container (put the cage in a cardboard box with a few small
air holes) and should arrive at the office when minimal exposure
can occur. After transport, the vehicle should be disinfected,
with appropriate household cleaners.
Handlers of actively sick animals need to watch themselves
particularly closely for symptoms of illness.
Should the handler choose not to keep the animal, a veterinary
clinic may have isolation facilities during the duration of
the animal’s quarantine/illness. In some cases euthanasia
may be recommended. In others, the health department may come
and pick the animal up. EXPOSED ANIMALS SHOULD NEVER
BE ABANDONED INTO THE WILD OR TAKEN TO A SHELTER.
If an infected animal dies, the health department
should be notified as to how to handle the body. DO
NOT THROW THE BODY AWAY OR BURY IT IN YOUR YARD.
Contaminated areas should be disinfected after the
deceased animal is removed. Surfaces should be cleaned with
proper cleaning materials. Soiled fabrics should be washed
with detergent in hot water and dried on the hot setting.
Chlorine bleach is recommended.
Animal waste should be bagged twice and the local health department’s
procedure’s followed. DO NOT THROW THIS vTYPE
OF WASTE AWAY IN THE REGULAR TRASH, AS IT MAY CONTAMINATE
THE LAND FILL AREA.
PEOPLE
THAT HAVE BEEN EXPOSED TO OR ARE ILL WITH MONKEYPOX SHOULD
STAY AWAY FROM ALL ANIMALS TO AVOID EXPOSING THEM UNTIL CLEARED
BY A HEALTH CARE PROVIDER TO RESUME REGULAR ACTIVITIES.
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Monkeypox
Infection Control Among Veterinarians and Other Animal Handlers
1. If the animal is being transported to the
facility, make arrangements to greatly limit the other people
and animal traffic until the animal can be isolated and the
area can be disinfected.
2.
Isolate animal in a room by itself with the door closed.
3.
Limit number of people in office/building that will be exposed
to ill animal.
4.
Use all personal protective equipment, including gown, gloves,
goggles, and approved respiratory mask.
5.
Wash hands thoroughly after each point of contact with ill
animal or its body fluids.
6.
Dispose of materials soiled with bodily fluids/waste in accordance
with local health department standards.
7.
Disinfect all non-disposable laundry, equipment, and surfaces
thoroughly with appropriate cleaners/detergents in accordance
with manufacturer and health department.
8. Currently,
euthanasia of animals suspected to be physically ill with
monkeypox is recommended. It is not recommended for animals
exposed, but not showing symptoms of illness. Local and State
health departments should be consulted regarding disposal
of euthanized animals. They should not be thrown in a land
fill or buried. Incineration is usually recommended. If the
animal is linked with a human exposure and needs to be saved
for further examination, double bag the body and freeze it.
Otherwise, no other autopsies should be performed.
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Additional Information
For more information, contact the state or local health department
or the CDC Emergency Operations Center 770-488-7100. Additional
information and recommendations will be released as they become
available. Updated information will be available at http://www.cdc.gov.
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SOURCE:
CENTERS FOR DISEASE CONTROL
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