HPSC, latest update on monkeypox in Ireland. 03/08/2022.

HPSC, latest update on monkeypox in Ireland. 03/08/2022.

HPSC has now been notified of 97 confirmed cases of monkeypox in Ireland. Read the HPSC latest update on monkeypox in Ireland http://bit.ly/3wX6OFw

For each case, Public Health is following up those who had close contact with the case while they were infectious. Public health risk assessments have been undertaken, and those who were in contact with the cases are being advised on what to do in the event that they become ill.

The cases in Ireland are part of an ongoing multi-country outbreak of monkeypox consisting of more than 25,000 confirmed cases of monkeypox in Europe, North America and many other countries worldwide (https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.htmlhttps://monkeypoxreport.ecdc.europa.eu/) . The vast majority of these cases do not have a travel link to a country where monkeypox is endemic. Many countries have reported that the cases are predominantly, but not exclusively, in men who self-identify as gay, bisexual or other men who have sex with men (gbMSM). The WHO has determined that this multi-country outbreak of monkeypox constitutes a Public Health Emergency of International Concern. This declaration comes with recommendations for countries with cases of monkeypox, like Ireland, to strengthen their public health and clinical responses to stop transmission and emphasises the importance of engagement with affected communities. (https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox)

In addition to the multi-country outbreak that is affecting Ireland, there are ongoing monkeypox outbreaks in endemic areas https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396.

A multidisciplinary Incident Management Team was established by the HSE when the international alert was first raised and commenced activities to prepare for cases in Ireland. The IMT will continue to actively monitor this evolving international situation. To assist in Ireland’s response, monkeypox has been made a notifiable disease [ADD LINK TO ND SECTION]. This means that medical practitioners (and laboratories) are required to notify the local Medical Officer of Health/Director of Public Health of monkeypox cases in Ireland.

About monkeypox
Monkeypox is an uncommon disease that is caused by infection with monkeypox virus. The virus is found in some animal populations in remote parts of Central and West Africa, and in the past has caused occasional limited outbreaks in local communities and travellers. The cases being reported across multiple countries now are unusual because most of the cases do not have a link to travel to these parts of Africa.

There are two types of monkeypox: West African monkeypox and Congo Basin monkeypox. It is the milder, West African, type that is causing the current outbreak.

Monkeypox spreads through close contact, including contact with the skin rash of someone with monkeypox. People who closely interact with someone who is infectious are at greater risk for infection: this includes household members, sexual partners and healthcare workers. The risk of spread within the community in general, is very low.

Symptoms of monkeypox
Symptoms of monkeypox virus infection include:

  • itchy rash (see below),
  • fever (>38.50C),
  • headache,
  • muscle aches,
  • backache,
  • swollen lymph nodes,
  • chills,
  • exhaustion.

The rash starts as raised red spots that quickly change into little blisters. It usually develops within 1 to 3 days of the start of the fever or other symptoms, but some people may only have a rash. Sometimes the rash first appears on the face and spreads to the mouth, palms of the hands and soles of the feet. However, following sexual contact, the rash may be found initially in the anogenital areas. Not everyone will experience all the symptoms of monkeypox. Rash in the anogenital area, or complications of the rash such as rectal pain, may be the main symptom.

The rash goes through different stages before finally forming scabs which later fall off.

Images of the different stages of the rash can be found on the HPSC website at the following link: www.hpsc.ie/a-z/zoonotic/monkeypox/factsheets 

Treating Monkeypox:
Monkeypox infection is usually a self-limiting illness and most people recover within weeks, although it can occasionally cause severe complications including death. In endemic Monkeypox infection, severe illness has been seen in people with very weak immune systems, pregnant women and in very small babies.

There is no medicine that can cure monkeypox. Treatment of monkeypox is mainly supportive. This involves treating any uncomfortable symptoms, such as pain or itch, that occur, keeping the patient warm, comfortable and relaxed, and making sure they get plenty of fluids. This allows the person’s own body defences to fight the infection.

Vaccination:
Ireland’s National Immunisation Advisory Committee (NIAC) has recommended that smallpox vaccine can be used to provide protection against monkeypox. The European Medicines Agency has also recently approved the use of this vaccine for the prevention of monkeypox disease.

Since the multi-country monkeypox outbreak began, the HSE has received limited supplies of smallpox vaccine, and has been using this to respond to cases of monkeypox. The vaccine is being offered to close contacts after a risk assessment, and also to some healthcare workers who may be at risk of exposure through their work.

NIAC has made further recommendations to the Minister for Health, in relation to the groups of people who would benefit from vaccination to protect against monkeypox. NIAC has recommended pre-exposure prophylactic vaccination should be offered to those at high risk of infection, including gay, bisexual and other men who have sex with men (gbMSM) and others at high risk of unprotected exposure.  

At this time, supplies of vaccine in Ireland and in the EU are low and limited. The HSE is now working to review the NIAC advice, in consultation with stakeholders, and is putting plans in place to identify those most at risk and the best way to use our supply of vaccines. Our aim is to ensure people at risk offered a vaccine at the earliest opportunity, and that we provide the best public health protection with the supplies available.

Ireland, along with other EU countries, is actively exploring options to increase our medium to long-term supply of vaccines.

Gay, bisexual and men who have sex with men (gbMSM):
Anyone, regardless of their sexuality, can get monkeypox if in close physical contact with a case. However, many of the cases in this multi-country outbreak are in men who self-identify as gay, bisexual or other men who have sex with men (gbMSM).

A community engagement response is underway to create awareness within the gbMSM community about monkeypox and its symptoms, including the development of key messaging that is informative but does not stigmatise. This has been designed by representatives from man2man.ie and MPOWER in collaboration with the HSE and has been recognised as best practice in Europe.

As the virus spreads through close contact, the HSE is advising those who self-identify as gbMSM to be alert to any unusual rashes or vesicular lesions on any part of their (or their partner’s) body, especially their genitalia. If they do notice any such changes, they should contact their local STI Clinic or their General Practitioner (GP) for advice.

A list of public STI services is available on the HSE’s Sexual Wellbeing website https://www.sexualwellbeing.ie/sexual-health/hse-sti-services-in-ireland.html.

Further information on monkeypox infection can be found on the HPSC website: https://www.hpsc.ie/a-z/zoonotic/monkeypox/ 

HPSC will continue to closely monitor this situation and provide relevant updates to the public as appropriate.