Monkeypox: How to manage close contact scenarios


With nine cases of Monkeypox reported in India, and some without travel history indicating they have contracted it from close contacts with the infected or been exposed to droplets or shared personal belongings, there are anxieties among people. But according to the WHO, a care protocol could keep the disease in check and aid faster recovery.

HOW CAN MONKEYPOX SPREAD FROM PERSON TO PERSON?

Monkeypox spreads from person to person through close contact with someone who has a rash, including face-to-face, skin-to-skin, mouth-to-mouth or mouth-to-skin contact, including sexual contact. People are generally considered infectious until all of their lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath.

The virus can also spread from someone who is pregnant to the foetus, after birth through skin-to-skin contact, or from a parent with Monkeypox to an infant or child during close contact.

Although asymptomatic infection has been reported, it is not clear whether people without any symptoms can spread the disease or whether it can spread through other bodily fluids. Pieces of DNA from the Monkeypox virus have been found in semen, but it is not yet known whether infection can spread through semen, vaginal fluids, amniotic fluids, breastmilk or blood. Research is underway to find out more about whether people can spread Monkeypox through the exchange of these fluids during and after symptomatic infection.

WHAT ABOUT THE ENVIRONS AND FOMITES AROUND ME?

The environment can become contaminated with the Monkeypox virus, for example, when an infectious person touches clothing, bedding, towels, objects, electronics and surfaces. Someone else who touches these items can then become infected. It is also possible to become infected from breathing in skin flakes or virus from clothing, bedding or towels. This is known as fomite transmission.

Ulcers, lesions or sores in the mouth can be infectious, meaning the virus can spread through direct contact with the mouth, respiratory droplets and possibly through short-range aerosols. Possible mechanisms of transmission through the air for Monkeypox are not yet well understood and studies are underway to learn more.

CAN MONKEYPOX SPREAD FROM HUMANS TO ANIMALS? CAN HUMANS INFECT THEIR PETS?

While instances of people with Monkeypox infecting animals have not been documented, it is a potential risk. People who have confirmed or suspected Monkeypox should avoid close contact with animals, including pets (such as cats, dogs, hamsters, gerbils etc.), livestock and wildlife. People with Monkeypox should be particularly vigilant around animals that are known to be susceptible to the Monkeypox virus, including rodents and non-human primates.

HOW CAN I PROTECT MYSELF AND OTHERS?

Reduce your risk of catching Monkeypox by limiting close contact with people who have suspected or confirmed Monkeypox, or with animals who could be infected. Clean and disinfect environments that could have been contaminated with the virus from someone who is infectious regularly. Keep yourself informed about Monkeypox in your area and have open conversations with those you come into close contact (especially sexual contact) with about any symptoms you or they may have.

If you think you might have Monkeypox, you can act to protect others by seeking medical advice and isolating from others until have been evaluated and tested. If you have probable or confirmed Monkeypox, you should isolate from others until all of your lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath. This will stop you from passing on the virus to others. Get advice from your health worker on whether you should isolate at home or in a health facility. Until more is understood about transmission through sexual fluids, use condoms as a precaution while having sexual contact for 12 weeks after you have recovered.

CAN I ISOLATE AT HOME?

If you are advised to isolate at home, you should not go out. Protect others you live with as much as possible by:

1) Isolating in a separate room

2) Using a separate bathroom, or cleaning after each use

3) Cleaning frequently touched surfaces with soap and water and a household disinfectant and avoiding sweeping/vacuuming (this might disturb virus particles and cause others to become infected)

4) Using separate utensils, towels, bedding and electronics

5) Doing your own laundry (lift bedding, clothes and towels carefully without shaking them, put materials in a plastic bag before carrying it to the washing machine and wash them with hot water > 60 degrees)

6) Opening windows for good ventilation

7) Encouraging everyone in the house to clean their hands regularly with soap and water or an alcohol-based hand sanitiser.

If you cannot avoid being in the same room as someone else or having close contact with another person while isolating at home, then do your best to limit their risk by:

1) Avoiding touching each other

2) Cleaning your hands often

3) Covering your rash with clothing or bandages

4) Opening windows throughout the home

5) Ensuring you and anyone in the room with you wear well-fitting medical masks

6) Maintaining at least one metre of distance.

If you cannot do your own laundry and someone else needs to do it for you, they should wear a well-fitting medical mask, disposable gloves and take the laundry precautions listed above.

People with Monkeypox should avoid scratching their skin and take care of their rash by cleaning their hands before and after touching lesions and keeping skin dry and uncovered (unless they are unavoidably in a room with someone else, in which case they should cover it with clothing or a bandage until they are able to isolate again). The rash can be kept clean with sterilised water or antiseptic. Saltwater rinses can be used for lesions in the mouth, and warm baths with baking soda and Epsom salts can help with lesions on the body. Lidocaine can be applied to oral and perianal lesions to relieve pain.

WHAT IS THE PRESCRIBED TREATMENT?

Symptoms normally resolve on their own without the need for treatment. If needed, medication for pain (analgesics) and fever (antipyretics) can be used to relieve some symptoms. It is important for anyone with Monkeypox to stay hydrated, eat well and get enough sleep. People who are self-isolating should take care of their mental health by doing things they find relaxing and enjoyable, staying connected to loved ones using technology, exercising if they feel well enough and can do so while isolating, and asking for support with their mental health if they need it.

An antiviral that was developed to treat smallpox (Tecovirimat) was approved in January 2022 by the European Medicines Agency for the treatment of Monkeypox. Experience with these therapeutics in the context of an outbreak of Monkeypox is limited. For this reason, their use is usually accompanied by collection of information that will improve knowledge on how best to use them in future.





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