#Monkeypox #treatment #recos
The title, Quick Answers: Monkeypox Virus Infection: Primary Care Healthcare, sounds a bit techno. On the objective side, the document is inspired by the Rapid Responses published by the HAS with the occurrence of Covid-19 in case management. The new card is intended, in fact, to allow front-line health professionals to be up to the task in “the care of patients who present symptoms of monkeypox”. [Monkeypox, ndlr] or patients who have been in contact with a person infected with this virus.” Numerous structures participated in its development: Spilf (Society of infectious pathology in the French language), SFLS (French Society for the fight against AIDS), National Council for AIDS and viral hepatitis, HAS, ANRS ǀ MIE, the TRT-5 CHV, College of General Medicine, SFM (French Society of Microbiology), CMIT (National Professional Council for Infectious and Tropical Infectious Diseases) and the French Society of Dermatology.
The idea is to present the essential recommendations and advice in the form of key information. Apart from what health professionals and people who are infected or think they are, they should know as a priority. The HAS document lists fifteen of them. We have only retained a few of them here; for completeness, it is necessary to refer directly to the HAS document (see references below).
First clue: “Monkeypox virus (MPXV) infection is transmissible primarily by direct mucocutaneous contact (most often during sexual contact), more occasionally by respiratory droplets and/or through an object (clothing, dishes, etc.). etc.).
Who cares-? “Without being exclusive to this population, the majority of reported cases in Europe concern men who have sex with men (MSM) with multiple partners. [ayant plus de deux partenaires, selon le critère retenu]. In France, 95% of the cases occurred in MSM”, recalls the document.
Regarding care, the “doctor asks the patient about his serological status. If you are a person living with HIV (PLHIV), he asks about your treatment and your CD4 count. In this case, he refers you to an HIV specialist.” In addition, the “sexual contact mode of transmission requires a systematic assessment of STIs from the beginning: blood tests (HIV, HBV, HCV, syphilis serology) and PCR for gonococcus and chlamydia in the first urine stream.” The document confirms that the “incubation period is between 5 and 21 days”. “The diagnosis is clinical (polymorphic symptomatology, possibility of help by teleexpertise); the removal of lesions for biological diagnosis (search for viral DNA) is indicated in case of clinical doubt (unclear symptoms or unidentified context of exposure or search for differential diagnosis)”, explains the file.
Treatment is generally outpatient. [prise en charge à domicile, au maximum, ndlr] : the evolution is usually favorable in two to four weeks. Some forms can be hyperalgesic. [extrêmement douloureuses, ndlr] and there are some visceral complications. In France since the beginning of the epidemic, 3% of patients have required hospitalization (…). No deaths have been reported.” The sheet recalls that “there is no specific treatment for simple forms, but symptomatic treatments, particularly for sometimes intense pain. The start of treatment with anti-inflammatory drugs or corticosteroids should be avoided.” pay special attention to populations at risk of severe forms: immunocompromised people, pregnant women and young children. In these cases, referral to the advice of a specialist is indicated”, explains the HAS. Finally, two key points are recalled in terms of screening and vaccination. “To date, there is no indication for screening in asymptomatic people, even in contact persons at risk of being contaminated,” the sheet explains. “There is vaccination against this disease in pre-exposure in people at very high risk of exposure and post-exposure for people who are risk contacts”.
Preventive or post-exposure vaccination
On the occasion of these Rapid Responses, HAS reiterates the need for pre-exposure vaccination (as a preventive measure) for people with a very high risk of exposure and post-exposure for contact people with risk of contamination. It complements its previous recommendations by stating that pre-exposure vaccination of minors who are within the vaccine targets may be considered on a case-by-case basis.
HAS also specifies that the 3rd generation vaccines (Imvanex/Jynneos) can be administered simultaneously with any other vaccine in the vaccination schedule, without risk to patients. If the vaccine in the schedule in question is a live attenuated vaccine, it should be given on the same day as the monkeypox vaccine, or four weeks (28 days) apart. HAS also insists on the need to immediately report any adverse effect suspected to be due to one of the vaccines to a regional pharmacovigilance center or on the dedicated portal.