A smallpox vaccination will be offered to healthcare workers due to care for a patient with confirmed monkeypox, as well as staff working in sexual health services who have been identified as assessing suspected cases.
Updated guidance issued to support healthcare professionals to respond to the outbreak of monkeypox has been agreed by the UK’s four public health agencies: Public Health Wales (PHW), UK Health Security Agency (UKHSA), Public Health Scotland (PHS), and Public Health Agency Northern Ireland (PHA).
UKHSA has purchased more than 20,000 doses of the smallpox vaccine Imvanex, which is being offered to identified close contacts of those diagnosed with monkeypox to reduce the risk of symptomatic infection and severe illness.
Post exposure, the smallpox vaccine will continue to be offered to close contacts in the highest exposure categories, ideally within four days of exposure to monkeypox and up to 14 days after.
The guidance set out new measures for healthcare professionals for managing the disease and preventing further transmission now that community transmission is occurring in the UK. As of 5 June, 302 cases were confirmed in the UK.
Where possible, pregnant healthcare workers and severely immunosuppressed individuals should not assess or clinically care for individuals with suspected or confirmed monkeypox.
The recommended minimum personal protective equipment (PPE) for staff working with confirmed monkeypox cases includes fit tested FFP3 respirators, aprons, eye protection and gloves. For possible or probable cases, minimum recommended PPE for staff includes fluid repellent surgical facemasks, gowns, gloves and eye protection.
People who have possible, probable or confirmed monkeypox can now isolate at home, if they remain well enough, and should follow measures advised in the new guidance to reduce further spread and while being monitored by local health protection teams.
These patients should avoid contact with other people until all their lesions have healed and the scabs have dried off. The guidance says people can reduce the risk of transmission by following standard cleaning and disinfection methods and washing their own clothing and bed linen with standard detergents in a washing machine.
It also said that infected patients should abstain from sex while symptomatic, including the period of early symptom onset, and while lesions are present. While there is currently no available evidence of monkeypox in genital excretions, as a precaution, people are advised to use condoms for eight weeks after infection.
Contacts of someone with monkeypox will also be risk assessed and told to isolate for 21 days if necessary.
Dr Ruth Milton, senior medical advisor and monkeypox strategic response director at the UKHSA, said the guidance ‘set out important measures for healthcare professionals and the public for managing the disease’.
Dr Nick Phin, director of public health science and medical director at PHS, said the new guidance ‘ensured a clear approach for health professionals to follow, which should contribute towards the limiting of onward infection’; while Dr Giri Shankar, director of health protection for Public Health Wales, said the guidance provided healthcare staff with ‘the best and most up-to-date knowledge’ on the management of cases.
The highest risk of monkeypox transmission is thought to be through direct contact with a confirmed case, droplets or contaminated surfaces and objects. The highest risk period for transmission is understood to be from the onset of early symptoms until lesions have scabbed over and the scabs have fallen off.
There is no current evidence that individuals are infectious before the onset of early symptoms.
Separately, a risk assessment has been carried out by the Human Animal Infections and Risk Surveillance group (HAIRS), which found the risk of a case infecting a pet was low. However, as a precautionary measure, people should try to avoid contact with their pets, bedding and litter for 21 days, and where possible pets should be cared for by someone else in the same household. If this is not possible, then infected individuals should minimise their contact with their pet as much as possible, and practise good hygiene by washing their hands thoroughly before and after contact.
Well Pharmacy, the UK’s largest independent pharmacy chain, has issued advice on the differences between monkeypox and chickenpox after seeing uptake of the chickenpox vaccine more than double (a 146% increase) in the last six weeks.
This comes after travel nurse specialist Clare Henderson said travel health during the pandemic is ‘not all about vaccines’ and healthcare professionals need to be better at putting more emphasis onto other travel-related risks.