Monkeypox Back In The News
- Details
- Published: Tuesday, 25 October 2022 07:35
- Written by Peter Ingle
- Hits: 1441
Jeremy Hunt found himself in trouble recently for starting a Twitter thread with, “Whilst I have one or two other things in my in-tray today,” as an introduction to his thoughts on a serious healthcare issue.
Dentists, at least on this occasion, may have some sympathy with him as they read the latest paper in the British Dental Journal on Monkeypox.
Available on open access at https://www.nature.com/articles/s41415-022-5079-8 it comes at a time of political paralysis, rampant inflation, workforce shortages and an end of days feeling amongst NHS contractors. Monkeypox adds to dentist’s in-trays the threat of a serious viral disease that might be transmitted in clinical situations, as well as its implications for infection control.
Historically, Monkeypox was mostly seen following contact with infected animals in Central and West Africa. Since May 2022 sustained human to human transmission has been seen globally. Monkeypox can be transmitted through close contact with an infected person, contaminated objects and surfaces, or by droplets and possibly aerosols.
There is no question that UK case numbers are rising. Between 2018 and 2021 seven cases were identified in the UK. Following the report of a case in May 2022, by August 11th there were 3,023 cases confirmed. 71% of these lived in London. In July 2022 the World Health Organisation declared the Monkeypox outbreak to be a public health emergency of international concern.
Despite the figure of 91% of recent UK cases being transmitted by sexual contact, the precise route is not clear. Direct contact with skin lesions, bodily fluids including saliva, as well as respiratory secretions have been suggested. Infection via droplets, surface contamination and aerosols cannot be excluded.
Incubation ranges from 5 to 21 days with two distinct phases to the disease. The initial prodromal illness comprises, fever, lymphadenopathy, fatigue, headache and back pain as well as a variety of lesions. The oral mucosa is affected in about 70% of cases with the extremities and face also likely to be involved. Most cases are self-limiting but complications include encephalitis, pneumonitis and secondary bacterial infections.
The virus has been shown to remain infective in aerosols for several hours and the risk of airborne transmission will depend upon factors including the presence of respirator equipment, and temperature, humidity and ventilation.
The chances of dental teams encountering an infectious patient overall are low, although this will vary depending on practice location and patient base. United Kingdom Health Security Agency (UKHSA) guidance has Monkeypox as a possible cause that should be considered for patients who present with an unexplained rash on any part of their body, and one or more symptoms typical of Monkeypox, if they also fall into one of the following groups:
They have been in contact with a probable or confirmed case in the last 21 days before symptom onset.
Have travelled to Central or West Africa in the 21 days before onset.
Are, gay, bisexual, or men who have sex with men. Men accounted for 98% of the recent UK cases.
In this case the patient should be provided with a surgical mask and asked to return home to isolate and await further advice. The dental professional should then contact their local health protection team for guidance.
The implications for infection control will be familiar to dentists who have worked through the pandemic. Given the possibility of droplet transmission, aerosol generating procedures (AGPs) would increase the risk of transmission. Standard infection control precautions would be below the recommended level of protection for carrying out an AGP on a patient with Monkeypox. Elective treatment in patients with or suspected of having Monkeypox should be avoided until Monkeypox has been excluded, or they are no longer infectious.
GDPUK readers will be familiar with papers that end with words to the effect that “more research is necessary”. They may not be surprised, but they are unlikely to be reassured, reading a similar conclusion here.
You need to be logged in to leave comments.
Report