The Aga Khan University Hospital, Karachi

Department of Infection Prevention and Hospital Epidemiology (DIPHE)

Emerging Infection Alert: Monkeypox
23rd May 2022
Name of organism: Monkeypox virus

Endemic regions: West Africa especially the Democratic Republic of Congo

Current areas with outbreak: Multiple countries around the world.

Transmission:
• Historically from animals (such as rodents) to humans with limited human to human transmission.
• This current outbreak is unusual as the patients do not have a history of contact with animals or travel to
endemic regions.
• Human to human transmission occurs by:
o Face-to-face exposure (including health care workers without appropriate PPE).
o Direct physical contact.
o Contact with contaminated materials such as clothing or bedding.

Presenting complaints:
• Initially fever, headache, muscle pain, and enlarged lymph nodes
• After 1 to 2 days rash starting from mouth to face then trunk and arms
o Rash evolves from macular to papular to vesicular and finally pustular and then crust
o All the lesions evolve at the same time (unlike chickenpox) and last 2 to 4 weeks

Incubation period: 5 to 14 days (up to 21 days)

Contagious period: From the start of a day of symptoms till all the crusts fall off

Infection Control Measures:

• Initiate Airborne and contact precautions till chickenpox is ruled out.
• Once chickenpox is ruled out, shift the patient to droplet with contact precautions.
o A single room with adequate ventilation with a dedicated bathroom and staff is recommended.
o Cohorting is allowed if enough single rooms are not available.
o Recommended personal protective equipment (PPE) includes gloves, gown, medical mask, and
eye protection.
o Cover lesions with a dressing, sheet, or clothing to reduce potential contact.
o PPE should be disposed of prior to leaving the isolation area where the patient is admitted.
o For Aerosol Generating Procedures wear an N95 mask.
o Ensure cleaning and disinfection of the equipment in between patients.

In case of a suspected case, inform Infectious Diseases and DIPHE immediately

Reference:
1 https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385 (last accessed 23rd May 2022).