Principles for the control of monkeypox in the United Kingdom: a consensus statement by 4 nations

This statement has been endorsed by the UK Public Health Agencies: the UK Health Security Agency (UKHSA), Public Health in Scotland, Public Health in Wales and the Public Health Agency in Northern Ireland.

Justification for the change

Monkeypox is a viral zoonotic disease that occurs mainly in Central and West Africa. There are 2 smallpox fires – a Central African fire with a reported mortality rate of 10% and a West African fire with a reported mortality rate of 1% from epidemic clusters and outbreak reports from Africa. Prior to that, it was occasionally exported to other regions. In the United Kingdom, it is classified as a high-risk infectious disease (HCID) for the management of NHS, especially to allow early identification and prevention of the spread of health in imported cases and the recognition of the initial clinical cannot determine the specific group from monkeypox.

Given the rare imports and limited distribution, as well as the limited information available on the course and outcome of the disease, the UK’s clinical and public health response to apes was originally based on a high-impact infectious disease management system. This was extremely precautionary and intended to completely limit individual cases. It is also designed before the confirmed availability of vaccine and treatment.

The context has already changed to that of many cases in the UK and information about the spread of the community to younger age groups and the burden is accumulating rapidly. Prevention before and after exposure to Imvanex is available for implementation.

As of May 13, 2022, cases of monkeypox have been reported in many countries that do not have an endemic monkeypox virus in animal or human populations, including countries in Europe, North America and Australasia. Epidemiological research is ongoing; however, the reported cases so far have not established links to travel to an endemic area. This suggests significant community transmission in many non-endemic countries in recent weeks. In the United Kingdom, all reported cases have been identified as West African treasure by rapid molecular testing.

The transmission of the community takes place in the United Kingdom with many generations of spread. The disease appears generally mild, according to other information on the West African fire.

Too cautious a response poses a risk to public health. The exclusion of health professionals affects clinical services, especially sexual health clinics and emergency departments (ED). It is important for health management to promote engagement with health services, as well as to prevent stigma and control proliferation.

Monkeypox is an organism of hazard group 3 (ACDP / HSE). Other organisms in this category include Salmonella typhi, HIV, hepatitis B and C, and Mycobacterium tuberculosis, which are routinely managed in the community. High-impact infectious disease is not a legal classification, but has instead been approved by a UKHSA and NHS program to allow for a consistent approach to infections that meet agreed criteria.

This proposal aims to provide a proportionate response to achieve achievable strategic results. These principles do not replace the need for local dynamic risk assessments, which remain key.

Strategic goals

• to suppress the transmission of monkeypox in the community and to aim for eradication (reduction of Rt below 1) by targeting public health measures at the highest risks of transmission
• for protection against the spread of infection in hospitals and healthcare facilities and healthcare professionals assessing and managing patients
• to enable the safe operation of NHS services, including those that can diagnose and manage cases in the context of monkeypox transmission in the community

The audience

Professionals – to inform the development of operational guidelines in the UKHSA, NHS and other organizations.

Assumptions for transmission and biology

These assumptions are based on available data and expert opinion and are in line with the World Health Organization. They will be reviewed regularly, using the evidence generated in response to the incident.

1. For people with an infection that is good, outpatient, and has a prodrome or rash, the most risky routes of transmission are direct contact, droplet, or fomite. The transmission observed so far in this outbreak is consistent with close direct contact.

2. There is currently no evidence that individuals are infectious before the onset of prodromal disease.

3. For persons with an infection who has evidence of lower respiratory tract involvement or severe systemic disease requiring hospitalization, airborne transmission is not excluded.

4. It remains important to reduce the risk of fomit transmission. The risk can be significantly reduced by following agreed cleaning methods based on standard cleaning and disinfection, or by washing clothes or household equipment with standard cleaners and cleaners. In the field of health care, please consult the guide / guide for prevention and control of infections in the local country for decontamination.

5. Waste management and decontamination practices should follow best practice and be based on all available evidence of the safe handling of all waste in accordance with national law and regulations.

6. The period with the highest risk of further infection is from the beginning of the prodrome to the formation of lesions and the fall of scabs.

7. Roof and throat swabs are not considered aerosol generating (AGP) procedures, but can cause droplets. The list of AGPs is available in the National Manual of Infection Prevention and Control.

8. There is no evidence of monkeypox in genital excretions and a precautionary approach is recommended to use condoms for 8 weeks after infection (this will be updated when evidence arises), in addition to abstinence from sex while symptomatic, including during the prodromal phase and while there are lesions.

9. The disease in healthy adults is mostly self-limiting and with relatively low mortality. There is still uncertainty about potentially increased weight in children and in individuals who are highly immunocompromised or pregnant.

Consequences

Risk assessment and consideration of the hierarchy of controls will help determine the level of personal protective equipment (PPE) to be used.

For possible / probable cases the minimum PPE is:

• gloves
• FRSM Surgical Facial Mask (FRSM) should be replaced with FFP3 respirator and eye protection if the case presents with a lower respiratory tract infection with cough and / or changes in chest X-ray showing infection of the chest. lower respiratory tract)
• apron
• Eye protection is required if there is a risk of splashing on the face and eyes (eg when performing diagnostic tests)

For confirmed cases requiring ongoing clinical management (eg inpatient care or reassessment of a person who is clinically ill or deteriorating), the minimum recommended PPE for healthcare professionals is:

• tested for suitability FFP3 respirator
• eye protection
• disposable long-sleeved, liquid-repellent dress
• gloves

The above PPE will be used as a basis for contact classification.

1. Home isolation can be used for clinically well outpatient possible, probable or confirmed cases for which it is considered safe and clinically appropriate by the primary clinician and the HCID network, with ongoing clinical and public health support for clinical management and isolation.

2. For outpatient cases, limited lesions are possible, probable or confirmed, covering the lesions and wearing a face / mask reduces the risk of further transmission.

3. People with possible, probable, or confirmed monkeypox should avoid close contact with other people until all lesions have healed and the scabs have dried. This should include staying home unless medical evaluation or care or other urgent health and well-being problems are required.

4. The risk should be assessed in close household contacts and outside the household in confirmed cases. Medium risk contacts (category 2) do not need to be excluded or isolated, provided they are subject to active surveillance, but should be excluded from activities involving close contact with children, severely weakened immune systems or pregnant women. High-risk contacts (category 3) should be advised to self-insulate for 21 days.

5. Cleaning to reduce the risk to the environment in the community can be effectively achieved without the use of specialized services or equipment.

6. The risk of transmission in a home environment for possible, probable or confirmed cases can be reduced by performing regular household cleaning and washing your own clothes and bed linen in a home washing machine.

7. Transport from the community to health facilities for possible, probable or confirmed cases should be done by private transport where possible. When private transport is not available, public transport can be used, but periods of congestion should be avoided. All lesions should be covered with a cloth (eg scarves or bandages) and should be covered.

Outpatient care

1. For possible, probable or confirmed cases of outpatient care (eg outpatients, emergency departments, emergency centers, general practice, sexual health clinics), patients should be accommodated in one assessment room. The case should be equipped with a liquid-resistant surgical mask to wear as appropriate.

2. Where possible, pregnant women and people with severe immunosuppression (as outlined in the Green Paper) should not evaluate or clinically care for people with suspected or confirmed monkeypox. This will be reassessed when evidence emerges.

3. Medium risk contacts (category 2) do not need exceptions or isolation, provided they meet the active …