Monkey Pox
What is monkey pox?
Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family (Poxviridae) of viruses as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms and monkeypox is rarely fatal. Monkeypox is not related to chickenpox. Monkeypox is less contagious than smallpox and causes less severe illness. The disease is called monkeypox because it was first identified in colonies of monkeys kept for research in 1958. It was only later detected in humans in 1970.
Who is at risk of catching monkey pox?
People who live with or have close contact (including sexual contact) with someone who has monkeypox, or who has regular contact with animals who could be infected, are most at risk.
Newborn infants, young children and people with underlying immune deficiencies may be at risk of more serious symptoms, and in rare cases, death from monkeypox.
People who were vaccinated against smallpox may have some protection against monkeypox. However, younger people are unlikely to have been vaccinated against smallpox because smallpox vaccination stopped in most settings worldwide after it was eradicated in 1980.
Mode of transmission
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Animal-to-human (zoonotic) transmission can occur from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals, bite or scratch from an infected animal, bush meat preparation.
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Human-to-human transmission can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects.
Sign & symptoms
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Fever
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Headache
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Muscle aches
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Back pain
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Low energy
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Swollen lymph nodes
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Rash: Lesions begin flat, then fill with liquid before they crust over, dry up and fall off, with a fresh layer of skin forming underneath.
Symptoms typically last two to three weeks and usually go away on their own or with supportive care, such as medication for pain or fever. People remain infectious until all of the lesions have crusted over, the scabs fallen off and a new layer of skin has formed underneath.
Management of initial monkey pox cases in malaysia
All initial suspected, probable and confirmed monkeypox cases should be hospitalised for isolation due to the following reasons:
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Malaysia has not reported any monkeypox cases and we have limited experience and knowledge on its management
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to comply with the section 14 of Act 342 in managing patients with infectious diseases
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non-compliance to the isolation order other than hospital facilities can facilitate the transmission in the community
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Monkeypox cases should be isolated and discharged upon assessment on the risk of disease transmission to others.
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Isolation precautions should be practiced until all lesions have resolved, and a fresh layer of skin has formed.
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Monitoring of a patient's health status during continuation of isolation at home can be done through Home Assessment Tool (HAT) in MySejahtera application.
Treatment based on Ministry of Health of Malaysia Guideline
Currently, there is no proven definitive treatment for monkeypox virus infection. The main
principles of management are rapid isolation to control the outbreak, as well as symptomatic
treatment for patients. CDC Atlanta has reported that monkeypox outbreak can be controlled with smallpox vaccine, antiviral cidofovir, tecovirimat and vaccinia immune globulin (VIG).
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Supportive care and symptomatic treatment, optimal nutritional support, maintain fluid and electrolytes balance, and close monitoring
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Patients should not be routinely prescribed antibiotics unless suggestive of bacterial infection.
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Therapeutic considerations
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Avoid scratching and picking the skin lesions
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Wash/bath: Use gentle cleanser or soap twice a day
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Apply calamine lotion twice a day for soothing effect and to relieve itchy
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Topical antibiotics/antiseptics can be applied onto the excoriated lesions
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Avoid using topical corticosteroid onto the skin lesions
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Prevention & Control
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Unprotected contact with wild animals, especially those that are sick or dead including their meat and blood must be avoided.
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All foods containing animal meat or parts should be cooked thoroughly before eating.
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Health workers should follow infection prevention and control measures to protect themselves while caring for monkeypox patients.
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Raise awareness of risk factors and educate people about the measures they can take to reduce exposure to the virus.
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Scientific studies are now underway to assess the feasibility and appropriateness of vaccination for the prevention and control of monkeypox.
