Monkeypox

What is Monkeypox virus infection?

Monkeypox virus infection (VMPX) is a zoonotic disease, which means it can be transmitted from animals to humans. It can also be transmitted person-to-person.

The term "monkeypox" does not refer to human infection, but to infection in animals. It should be noted that this is not smallpox, a human disease that was eradicated in 1980.

What are the symptoms of human infection with Monkeypox virus?

Human infection with Monkeypox virus presents suddenly with the appearance of at least one of the following signs and symptoms:

• rash (lesions on the skin or mucous membranes)
• anogenital complaints (including ulcers)
• fever (>38.0ºC)
• headaches
• tiredness
• muscle aches and pains
• enlarged lymph nodes, a few days before the rash or at the same time

These signs and symptoms usually last between 2 to 4 weeks and go away on their own without treatment.

How does the Monkeypox virus spread from person to person?

Human transmission of Monkeypox virus can occur through incomplete skin (small abrasions of the skin and mucous membranes) and the ocular, nasal, oral, genital and anal mucous membranes.

Person-to-person transmission usually occurs by contact:

• especially face-to-face without adequate protection, and in the context of relationships involving intimate and prolonged contact
• with objects contaminated by an infected person – fomites (clothing, bed linen, towels, materials, utensils and personal objects, among others)
• direct without adequate protection with skin lesions, pus, crusting, and direct or indirect contact with infectious body fluids

Is human infection with Monkeypox virus a sexually transmitted infection?

Human infection with the Monkeypox virus can be transmitted from one person to another through close physical contact, including sexual contact. It is currently not known whether the virus can be transmitted through semen or vaginal fluids, but direct, skin-to-skin contact with lesions in sexual practices can transmit it.

What is considered a suspected case of infection?

All those who have the following conditions are considered a suspected case of infection:

• A person who has been in contact, within the last 21 days before the onset of symptoms, of a probable or confirmed case of infection with the virus and who has one or more of the following signs/symptoms: sudden-onset fever (≥38.0ºC), weakness (asthenia), muscle pain (myalgia), back pain (back pain), headache (headache)

or

• A person who presents:
  red rashes (generalised or localised macular, papular, vesicular or pustular rash) and/or anogenital complaints (including ulcers), of sudden onset, since 1 January 2022, not explained by other differential diagnoses

and

• may exist together with one or more of the following signs/symptoms: sudden-onset fever (≥38.0ºC), weakness (asthenia), muscle pain (myalgia), back pain (back pain), headache (headache), enlarged lymph nodes (adenomegaly)

What should I do if I am a suspected, probable or confirmed case?

In the event of a suspected, probable or confirmed case, the certificate of temporary incapacity for work (CIT) is issued by the doctor and the following measures are recommended:

• home isolation and physical distancing until the lesions resolve (scabs fall off) or exclude infection (if suspected or probable case)
• avoid close physical contact (cohabitants and close relatives), skin-to-skin or skin-to-mucosa, including sexual contact, until the lesions resolve (scabbing off)
• depriving oneself of staying in the same space if living with young children, pregnant women, and immunocompromised people
• frequent hand washing and/or sanitization
• Do not share objects and utensils of personal use, clothing, bed linen, towels (and other textiles) and surfaces in the domestic space
• wash clothing and textiles with hot water and usual detergents, or, when possible, in a washing machine (> 60⁰ C), using an extended wash cycle
• Clean hard surfaces with chlorinated detergents and allow to air dry
• Alert people who have been your close contacts since the onset of symptoms, to possible signs and symptoms. In the event that contacts develop symptoms, they should observe the precautions recommended above and seek health care, namely through SNS 24 – 808 24 24 24
• Avoid close contact with domestic animals and other animals, especially rodents
• If the patient needs to go to a health facility, they should wear a face mask and cover the lesions as much as possible with clothing
• Isolation measures for suspected or confirmed cases should be maintained until the scabs of all lesions fall off, which is estimated to occur between 2 and 4 weeks

How to obtain the certificate of temporary incapacity for work?

The certificate of temporary incapacity for work can be issued by any clinician in the context of a primary health care consultation or an outpatient consultation in a hospital setting.

When seen in an emergency department, the case is referred to an infectious diseases or dermatology consultation, where you will be issued with a certificate of temporary incapacity for work.

How is the disease diagnosed?

The diagnosis of the disease involves:

• clinical evaluation, with identification of signs/symptoms not explained by other causes and suggestive of infection and contact with a probable or confirmed case of human infection with the virus or history of sexual intercourse with multiple partners, or anonymously, in the 21 days prior to the onset of symptoms
• Monkeypox virus screening for laboratory confirmation by:
  • swab with wound exudate or vesicular or pustular fluid
  • oropharyngeal swab
  • Blood sample
  • if warranted, anorectal swab

What is considered close physical contact?

A close contact is considered to be an individual who reports having been directly exposed to:

• Skin lesions, mucous membranes or body fluids (blood, urine, faeces, vomiting, sputum, etc.)
• contaminated materials, utensils, or objects
• sharing the same physical space that does not guarantee physical distancing greater than 1 meter away from a suspected, probable or confirmed case, without adequate protection

What to do if I have had close physical contact with someone with the infection?

If you have no signs or symptoms, you should, for 21 days after exposure/last contact:

• be aware of the appearance of any general symptoms or skin or mucosal lesions
• avoid close physical contact, including sexual intercourse (for 21 days)
• Wash your hands more frequently and reinforce general hygiene measures
• Assess body temperature twice a day

If you have symptoms (even without skin lesions):

• call SNS 24 (808 24 24 24)
• If you have had close physical contact with someone with the infection or suspected infection, tell your healthcare professionals
• Seek health care
• not having close physical contact (mainly sexual and bed-sharing)

When are people infected with the Monkeypox virus infectious?

People with Monkeypox virus infection are infectious from one day before the onset of signs and symptoms until all lesions resolve, with natural fall of all scabs and appearance of intact skin, which usually takes between two to four weeks.

It is not yet sufficiently clear whether someone who is infected with the virus, but who has not yet developed any signs or symptoms of infection (i.e. during the incubation period), can transmit the virus, so the beginning of the transmission period of the infection is considered to be one day before the appearance of signs and symptoms.

Who is most at risk of getting infected?

Close contacts, i.e. people who interact closely with someone who is infected, are the ones who have the highest risk of acquiring the infection, namely due to the risk of exposure:

• Sexual partners
• Cohabitants: by sharing the environment and its materials, utensils and objects of personal use
• caregivers: without personal protective equipment appropriate to the level of exposure
• Healthcare Professionals:
  • without personal protective equipment appropriate to the level of exposure
  • with injury caused by sharp objects exposed to bodily fluids of an infected person
  • laboratory workers with accidental exposure to virus samples without adequate personal protective equipment

Other long-term or high-risk contacts may include close contacts by:

• Extended journeys, lasting 8 hours or more
• sharing of utensils or other personal equipment
• Sharp injuries when contact is not from a healthcare professional

Do I become immune after the disease or can I be reinfected?

To date, there is no scientific evidence on reinfection.

I am pregnant with a confirmed infection. Where am I accompanied?

After confirmation of the infection, the pregnant women are followed in a high-risk obstetrics consultation, with specific monitoring of the pregnancy and the fetus.

What is the recommended treatment in case of infection?

Appropriate treatment always depends on the individual clinical assessment of the case. However, most cases of illness require only supportive care, such as drinking plenty of fluids to stay well hydrated and, if necessary, taking medication to relieve symptoms such as pain and fever.

In the most severe cases, hospitalization may be necessary.

Is there a vaccine to prevent infection with the Monkeypox virus?

yes. The available vaccine consists of a third-generation smallpox vaccine. At this time, the following are eligible for vaccination:

• groups at increased risk of human infection by the Monkeypox virus, in the context of preventive vaccination
• people who have had close contact with a confirmed case of infection, i.e. in the context of post-exposure vaccination to the virus

For more information, see topic Monkeypox vaccine.

Source: Directorate-General for Health