Smallpox of monkeys. Cases rise in Italy. Possible quarantines for close contacts. The new circular of the Ministry of Health

by LF

There are 505 cases of monkeypox in our country, 26 more than in the last survey 4 days ago. From the Ministry comes new indications on the management of case management, close contacts and tests. As regards the indications on vaccination, a new ad hoc document will have to be prepared. THE CIRCULAR

1659460037

02 AUG

Cases of monkeypox in Italy have reached 505. The infection continues to develop almost exclusively among males (501) compared to only 4 cases among women, according to the latest bulletin of the ministry of health updated to date. They are 26 more than the last survey 4 days ago. Most of the cases are recorded in Lombardy where there are 232, followed by Lazio (104), Emilia Romagna (57), Veneto (33), Piedmont (18) and Tuscany (17). There are 5 regions that have not yet reported cases: Basilicata, Calabria, Molise, Umbria and Valle d’Aosta while the remaining 7, (including the autonomous provinces of Bolzano and Trento), count less than 10 cases.

All numbers that led the Ministry of Health to launch a new circular with which information on case management, close contacts and tests was updated. As regards the indications on vaccination, a new ad hoc document will have to be prepared.

What to do if you are positive for monkeypox

Cases should be isolated until the scabs of the rash fall, which indicates the end of the infection.

In the presence of signs and symptoms that do not require hospitalization, the confirmed case – if the housing and sanitation conditions allow it – can be followed at home according to the procedures defined locally, in isolation even with respect to cohabitants and any other carers. The subject must be informed about compliance with all hygiene-behavioral measures to be implemented in order to prevent the spread of the disease to other people. A case of MPX must be monitored daily by the territorially competent Prevention Department (via telephone calls).

Cases must:

remain in isolation in a dedicated room when at home;
use dedicated household items (clothes, sheets, towels, eating utensils, plates, glasses), which should not be shared with other family members;
avoid contact with immunocompromised people until the rash heals;
avoid close or intimate contact (hugs, kisses, prolonged face-to-face contact in enclosed spaces) with other people until the rash has completely healed;
provide for thorough hand and respiratory hygiene (for the case and for all family members);
use a surgical mask in case of contact with other people;
refrain from sexual activity until the scabs fall off. Cases should be aware that condom use alone cannot provide complete protection against MPXV infection, as contact with skin lesions is required for its transmission; leave your home only temporarily (to go to medical examinations and to perform physical exercise necessary for your mental stability), provided you are wearing a surgical mask and that the rash is covered (clothes with sleeves and long pants);
avoid contact with any pet mammal, in particular with pet rodents and lagomorphs (mice, rats, hamsters, gerbils, guinea pigs, squirrels, rabbits, etc.). Any recent contact with these pets should be recorded and reported to the veterinary authorities in order to ensure the possibility of quarantining and testing animals with symptoms potentially referable to MPX (fever, lack of appetite, cough, nasal discharge or scabs, conjunctivitis, rashes such as pustules and blisters, particularly on the ears and around the lips).

For the management of urban (domestic) waste of monkeypox sick people it is recommended to stop separate collection, regardless of their nature (glass, metal, organic waste, plastic, paper, etc.), with the foresight to pack them in so as not to damage and / or contaminate the bags externally (for example by using disposable gloves).

In the presence of sharp or pointed objects or in any case capable of causing tearing of the casing (glass or metal objects or fragments), it is recommended to carry them out with particular care (e.g. by wrapping them in paper) to avoid producing tearing of the bags with consequent risk of their contents spilling.
It is also advisable to collect all personal waste (such as used handkerchiefs, bandages / gauze that has come into contact with body fluids or skin lesions) and disposable cloths used for cleaning and place them in a separate and closed bag, before being introduced into the bag. of unsorted waste. Finally, at least two bags must be used one inside the other or in a greater number depending on their mechanical resistance. This choice is indicated to limit as much as possible errors in the collection and delivery of waste to safeguard the safety in the home and the health of the ecological operators in charge of waste collection.

Close contacts
Close contacts should be identified as early as possible and informed of their exposure and the risk of developing infection. They should also be educated on the symptoms of MPX and when the symptoms may appear.

For close contacts it is recommended:

  • self-monitoring of fever (at least twice a day) or other symptoms attributable to MPX (headache, back pain, lymphadenopathy, etc.) or rash of unknown cause within 21 days of the last exposure. In this case, promptly inform the Prevention Department and the attending physician, self-isolate and avoid close contacts including sexual activity up to the exclusion of MPX;
  • refrain from sexual activities for 21 days after the last exposure or until MPX is excluded;
  • practice careful hand and respiratory hygiene (cover mouth and nose when sneezing or coughing, with disposable handkerchiefs to dispose of properly and wash your hands often);
  • avoid contact with immunocompromised people, children under 12 and pregnant women for 21 days after the last exposure;
  • avoid close direct contact with animals, including pets, for 21 days after the last exposure;
  • avoid donating blood, cells, tissues, organs, breast milk or sperm while under surveillance.

Asymptomatic contacts who properly and regularly monitor their status can continue routine daily activities such as going to work and attending school (quarantine is not required). Local health authorities can choose to exclude preschool children from daycare, preschool or other group settings.

In specific environmental and epidemiological contexts, based on the assessments of the health authorities, the application of quarantine measures may be required.

Low risk contacts

Health authorities can work with event organizers, companies or other venues to provide all attendees with information on potential exposure and guidance as needed. For contacts with low-risk exposures it is possible to adopt passive surveillance, self-check and inform your family doctor and / or local health authorities if symptoms compatible with MPX occur.

For low-risk contacts it is recommended to provide the following information:

– practice careful hand and respiratory hygiene;

– self-monitor MPX-compatible symptoms (fever, rash, lymphadenopathy) for

21 days after exposure; And

– call your doctor and / or local health services if they develop symptoms (passive surveillance).

Vaccine therapy and prophylaxis

The adoption of medical pharmacological countermeasures, including specific antivirals (Tecovirimat authorized by EMA – European Medicines Agency) can be considered in the context of experimental or compassionate use protocols, in particular for those with severe symptoms or who may be at risk of poor results, such as immunosuppressed people.

Vaccines currently available against smallpox virus may also guarantee some efficacy against monkeypox disease, although data to support this hypothesis are currently still limited. For this reason, the World Health Organization (WHO) has issued interim recommendations on their use in the current epidemic context. According to the WHO:

  • mass vaccination for monkeypox is currently neither required nor recommended;
  • for case contacts, post-exposure prophylaxis (PEP) with an appropriate second or third generation vaccine is recommended, ideally within four days of first exposure to prevent disease onset;
  • Pre-exposure prophylaxis (PrEP) is recommended for health care workers at risk, laboratory staff handling orthopoxvirus, and those performing diagnostic tests for monkeypox.

Most of the recommendations provided by the WHO relate to off-label use of vaccines. The only smallpox vaccine authorized in the EU by EMA is the modified Ankara live vaccine virus – Bavarian Nordic (MVA-BN), called IMVANEX (Bavarian Nordic A / S) 21.

Appropriate indications on the vaccination strategy in Italy against monkeypox will be provided with subsequent publication.

02 August 2022
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Smallpox of monkeys. Cases rise in Italy. Possible quarantines for close contacts. The new circular of the Ministry of Health


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