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Monkeypox ‘able to be contained’: Professor Michael Kidd


Jolyon Attwooll


24/05/2022 5:01:31 PM

Officials have given more detail on steps primary care clinicians should take if monkeypox is suspected.

Monkeypox in a traveller returning from Nigeria
Monkeypox in a traveller returning from Nigeria. (Image courtesy of the US Centers for Disease Control)

With community awareness and alert clinicians, containment of monkeypox transmission in Australia should be possible, Deputy Chief Medical Officer Professor Michael Kidd said this week.
 
Professor Kidd hosted a primary care webinar on Monday, arranged in response to the country’s first two cases, which were confirmed last Friday.
 
Professor Deborah Williamson, the Director of the Victorian Infectious Diseases Reference Laboratory, and Dr James McMahon, the Vice President of the Australian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), were also present.
 
The disease’s low transmissibility, with close contact with an infected person usually required for it to spread, has significant implications, Professor Kidd says.
 
‘That means with good community awareness, and with your role being vigilant as treating doctors and nurses, we are likely to be able to keep transmission localised, readily identifiable and able to be contained in Australia,’ he said.
 
As well as Australia, the disease has been detected in several European countries, along with US and Canada – all in very limited numbers so far.
 
The first recent case was confirmed in the England on 7 May. On Monday (23 May), health authorities had confirmed a total of 56 monkeypox cases in the country.
 
How it may present
Professor Kidd reiterated Department of Health (DoH) details on the illness and its symptoms.
 
According to the DoH, the illness typically has an incubation period of 6–13 days, although it can range from 5–21 days.
 
Symptoms include:  

  • fever
  • rash
  • swelling of the lymph nodes
  • a distinctive rash.
Details about the possible appearance of the rash were discussed at length during the webinar.
 
It reportedly appears from 1–3 days after fever and ‘tends to be more concentrated on the face, arms, and legs rather than on the trunk’.
 
According to the DoH, the rash shows on the face in the vast majority of cases (95%); palms of the hands and soles of the feet (75%); inside of the mouth (70%); genitalia (30%) and eyes (20%).
 
It also says the number of lesions can vary from patient to patient from a few to several thousand.
 
Professor Williamson said that images published on the UK Health Security Agency website showing the stages of rash had proved useful for clinicians seeking to verify cases (see below).

Monkeypox-update-article.jpg
 
Who is it most likely to affect?
Some, but not all of the recently identified cases, are in men who have self-reported as gay or bisexual or men who have sex with men.
 
While the illness is not currently being described as a sexually transmissible infection, human-to-human transmission is believed to be happening through close contact with skin lesions and body fluids, including respiratory droplets. Any transmission via respiratory droplets reportedly requires ‘prolonged face to face contact’, the DoH states.
 
It also says contact with contaminated materials, such as bedding, is a possible cause of transmission.
 
Professor Kidd said it is important for anyone presenting with monkeypox to feel able to have frank discussions.
 
‘Given the risk of possible sexual activity leading to the transmission of monkeypox, there is a risk of stigma and discrimination for people who experienced this infection,’ he said.
 
‘Stigma and discrimination should never occur in public health responses to communicable diseases.

‘Please make sure that any patients you see with monkeypox do feel comfortable about disclosing to you about what behaviours they may have been engaged in, as this will help in preventing further transmission.’
 
What about PPE if you are treating a suspected case?
Professor Williamson said that a gown, gloves, and an N95 mask are recommended, or a surgical mask that is what is to hand.
 
However, she described advice on PPE as ‘a live issue’ with recommendations currently being put together by health departments and subject to change.
 
How severe is the disease?
Monkeypox is described as a ‘self-limiting disease’, with symptoms typically lasting from 2–4 weeks.
 
‘However, severe cases can occur, and death has occurred in rare instances,’ Professor Kidd said.
 
Professor Williamson also gave some genomic background into the disease, saying that the recent cases have been identified as the West African clade.
 
‘Human infections so far with the West African clade appear to cause less severe disease compared to the Central African clade,’ she said.
 
Dr McMahon in the meantime said there are signs recent cases are not causing as severe illness among patients as seen previously.
 
‘There is some evidence from these reports that the severity of illness does not look as serious as we have seen with other outbreaks of monkeypox that have left Africa or been in Africa, which is very encouraging,’ he said.
 
Will previous smallpox inoculation work?
Monkeypox is related to smallpox and existing smallpox vaccines have a reported efficacy of up to 85% against the disease – with some older people likely to have been vaccinated before smallpox was eradicated.
 
Professor Williamson said there is not enough existing evidence to know if previous vaccination with the smallpox vaccine will provide any protection today.
 
‘I don’t think anybody has done robust studies yet on long-term immunogenicity,’ she said.
 
The role of general practice
Professor Kidd stressed that the role of primary care and general practice is fundamental to containing the disease.  
 
‘One of the things we’ve learned from HIV is that any GP could see someone with an initial diagnosis anywhere in Australia,’ he said.
 
‘The same could be true here. Someone could be returning from overseas into any of our major ports, and travelling home to other in urban or rural settings.
 
‘I think we’ve all got to have our wits about us in just thinking about this as a possible diagnosis
 
‘As a GP, it goes without saying that I’m very proud that the first two diagnoses in Australia were made by GP colleagues picking this up so thank you to both our colleagues.’
 
What to do if a case is suspected
Professor Williamson said health professionals should contact local health authorities in the first instance.
 
‘Prior to testing, any suspected cases should be discussed with the relevant state or territory public health units, and preferably an infectious diseases specialist as well,’ she said.
 
‘Through that pathway, there will be direct contact with jurisdictional public health laboratories to ensure the most rapid and accurate testing occurs.’
 
You can watch the webinar in full on the Department of Health website.
 
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Dr Virginia Lee Reid   25/05/2022 7:03:41 AM

RACGP webinar on Monday night 23rd, Kerry Chant asked us specifically to cal Westmead Infectious Diseases on call at 02 88905555 before any testing or management as a structured one approach to cases to prevent spread .