Monkeypox Outbreak 2022.pptx

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Monkeypox
outbreak
by/ Kholoud Mohamed
Family Medicine Resident
Under supervision of
Dr/ Samar Osama
Assistant lecturer
at...

The Causative Agent:
Monkeypox is an infectious disease caused by the
Monkeypox virus which is a double-stranded
DNA, zoon...

• The virus is found mainly in tropical rainforest regions of
Central and West Africa.
• The virus is split into Congo Bas...

Epidemiology:

2003 U.S. outbreak:
 It was the first outbreak of monkeypox outside of
Africa.
 In May 2003, a young child became ill wi...

2017 Nigeria outbreak:
In 2017, Nigeria has experienced a large outbreak, with over 500
suspected cases and over 200 confi...

2018 Israel case:
In October 2018, one case occurred in a man who traveled from
Nigeria to Israel.
2019 Singapore case:
On...

Countries reporting confirmed human cases of
monkeypox 1970 – 2021, WHO

2022 UK outbreak:
The index case:
 In late April 2022, the case was reported of a British
resident who travelled to Niger...

 Extensive contact tracing of people who had been in contact with the
index case both on the international flight from Ni...

on 12 May, two new cases of monkeypox were
confirmed by the UKHSA in London. There was no
known link between either of the...

Europe, North America and Australia:
On May 18
Portugal: 14 confirmed cases
20 suspected cases
Spain: 7 confirmed cases
23...

On May 19 On May 20
Sweden : the first confirmed case
Belgium: the first confirmed case
Italy: the first confirmed case
Fr...

 On May 20, the World Health Organization held
an emergency meeting to discuss the outbreak.
 The WHO European chief exp...

Cases of monkeypox in
non-endemic countries
reported to WHO
between 13 to 21 May
2022

Geographical distribution of confirmed and suspected cases of monkeypox in
non-endemic between 13 to 21 May 2022

Cases of monkeypox in
endemic countries
between 15 December
2021 to 1 May 2022

Cases of monkeypox in
non-endemic countries till
27 May 2022

The current situation in Egypt:
On May 20, Dr. Hossam Abdel Ghaffar, the
spokesman of the Egyptian Ministry of Health
and ...

Animal Reservoir:
• Monkeys
•Dormice
•Gambian pouched
rats
•African squirrels
Monkeys
dormouse
Gambian pouched rat African...

Mode of Transmission:
The virus enters the body through:
 Broken skin (even if not visible).
 The mucous membranes (eyes...

Human-to-human transmission occurs through:
 Large respiratory droplets.
 Direct contact with body fluids or lesion
mate...

Is it a sexually
transmitted
disease??!
Almost all of the case clusters include men
aged 20–50, many of whom are gay, bise...

Is the virus
genetically
mutated??!
In Portugal, the first draft genome sequence of
the monkeypox virus was obtained from ...

The incubation
period:
usually 6-13 days but
can range from 5-21
days.

History taking:
Important clues:
 Recent travel to endemic areas.
 Interaction with wild animals imported
from endemic a...

Clinical picture:
Initial symptoms :
Fever.
Headache.
Myalgia.
Fatigue.
Lymphadenopathy.
(a key differentiating
featu...

Within 1 to 3 days after the fever, the patient
develops a rash:
• Begins on the face and extremities (including palms
and...

Monkeypox lesions

Differential Diagnosis:
Smallpox
Chickenpox
Disseminated zoster
Eczema herpeticum
Disseminated herpes simplex
Syphilis
Sca...

Diagnosis:
Clinically.
Laboratory testing:
• Polymerase chain reaction (PCR) testing of
samples from skin lesions.
• Speci...

Prevention:
 Avoid contact with animals that could harbor the virus
 Avoid contact with any materials of a sick animal.
...

Vaccination:
Smallpox vaccine (ACAM2000):
• It contains live vaccinia virus, and it was approved by
the Food and Drug Admi...

The vaccine is not routinely available for public.
It is licensed for immunization in people who are at
least 18 years old...

JYNNEOS (also known as Imvamune or Imvanex)
 JYNNEOS is a live, attenuated vaccinia virus, incapable of replicating.
 On...

People who receive JYNNEOS are not considered
vaccinated until they receive both doses of the
vaccine.
It is indicated for...

When to take the vaccine?
• Vaccines are effective at protecting people against monkeypox
when given before exposure to mo...

Monkeypox Disease vs Vaccine Risks.
 In Central Africa—where
people live in remote
areas and are medically
underserved—sh...

Ring Vaccination
This would vaccinate the
close contacts of people
who have been infected
with monkeypox to cut off
any ro...

Treatment:
Supportive care:
• Antipyretic.
• Treatment of fluid & electrolytes
disturbance.
• Oxygenation if needed.
• Emp...

Tecovirimat (ST-246):
• On 13 July 2018, it was approved the U.S. Food and Drug
Administration (FDA) and was approved for ...

Brincidofovir & Cidofovir:
• Cidofovir was approved for medical use in 1996.
• Brincidofovir was approved for medical use ...

Vaccinia Immune Globulin (VIG)
• It has no proven benefit in the treatment of smallpox
complications.
• IVIG can be consid...

Complications:
 Bacterial superinfection of skin
 Permanent skin scarring
 Hyperpigmentation or
hypopigmentation
 Perm...

Complications among Pregnant
Women With Human Monkeypox:
In 2017, Mbala et al.
reported the fetal
outcomes of 4 pregnant
w...

Pathologic findings for the stillborn fetus from
case 4:
 Diffuse cutaneous maculopapular lesions.
 Hydrops fetalis
 Ma...

 Monkeypox is usually self-limiting.
 The condition resolves around 3 to
4 weeks after symptom onset in
most cases.
 Pa...

The role of
Family
Physicians:

Case and Contact Definitions:

CASE INVESTIGATIONS:
• Once a suspected case is detected, the physician should notify health
care authority to start inten...

During hospitalization:
• The patients should be isolated in a negative air
pressure room as soon as possible.
• If it is ...

Personal protective measures :
• PPE should be donned before entering the patient’s room.
• All PPE should be disposed pri...

In case of home isolation:
• The patient should be isolated in a room or area separate from other
family members when poss...

• The patients should wear a surgical mask & if this is not feasible, other
household members should wear a surgical mask ...

Duration of Isolation Procedures
Isolation should be continued until all lesions have resolved
and a fresh layer of skin h...

Contact tracing:
• Identification of all contacts of every suspected case during case
investigation .
• All contacts shoul...

Case investigation form - U.S. Centers for Disease Control
and Prevention

Contacts should be instructed to monitor their temperature twice
daily. If fever or rash develop, contacts should self-iso...

• Contacts who remain asymptomatic can be
permitted to continue routine daily activities (e.g.,
go to work, school).
• Con...

Monitoring of the exposed
healthcare workers:
 All healthcare worker should be alert to the symptoms and
should notify th...

Could it be a new
pandemic ??!
• Unlike SARS-CoV-2, It is related to the
smallpox virus, there are already
treatments and ...

• Unlike SARS-CoV-2, RNA virus, monkeypox virus is a
relatively large DNA virus. DNA viruses are better
at detecting and r...

References:
• CDC. About Monkeypox | Monkeypox| Poxvirus | CDC [Internet]. 2018 [cited 2019 Oct
19]. Available from: https...

• "Epidemiological update: Monkeypox outbreak," European Centre for Disease Prevention
and Control, 20 May 2022. [Online]
...

Monkeypox Outbreak 2022.pptx

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