The title: Quick Responses: Monkeypox Virus Infection – Primary Care Physician Care sounds a bit like techno. On the objective side, the document is inspired by the Rapid Responses published by the HAS with the emergence of Covid-19 on case management. Indeed, the new fact sheet aims to enable first-line healthcare professionals to be at the “care of patients with monkeypox symptoms” level [Monkeypox, ndlr] or patients who have had contact with a person infected with this virus”. Many structures have been involved in its development: Spilf (French-speaking Society of Infectious Pathology), SFLS (French Society for the Fight against AIDS), National Council of AIDS and Viral Hepatitis, HAS, ANRS ǀ MIE, TRT-5 CHV, College of General Medicine , SFM (French Society of Microbiology), CMIT (National Professional Council of 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 is a priority for healthcare professionals and people who are or think they are infected to know. The HAS document lists fifteen of them. We have only recorded a few of them here – the entirety must be referenced directly in the HAS document (see references below).
First key point: “Infection with the monkeypox virus (MPXV) is transmissible, mainly through direct mucosal contact (most commonly during sexual contact), more rarely through droplet infection and/or through an object (linen, dishes, etc.).
Who is affected-? “Without excluding this population, the majority of cases reported in Europe involve men who have sex with men (MSM) with multiple partners. [ayant plus de deux partenaires, selon le critère retenu]. In France, 95% of cases occurred in MSM,” the document recalls.
In terms of care, “the doctor will ask the patient about their HIV status. If it is a person living with HIV (PLHIV), he will ask them about their treatment and their CD4 count. In this case, he will forward it to an HIV specialist.” In addition, the “path of transmission through sexual contact requires systematic STI clarification right from the start: blood tests (HIV, HBV, HCV, syphilis serology) as well as gonococcal and chlamydia PCR during the first flow of urine”. The document confirms that the “incubation period is between 5 and 21 days.” “The diagnosis is clinical (polymorphic symptomatology, possibility of receiving help via tele-expertise); the removal of lesions for biological diagnostics (search for viral DNA) is indicated in clinical doubts (unclear symptoms or unclear exposure context or search for a differential diagnosis),” explains the paper.
Treatment is usually on an outpatient basis. [prise en charge à domicile, au maximum, ndlr] : Development is most commonly favorable in two to four weeks. Some forms may be hyperalgesic [extrêmement douloureuses, ndlr] and there are some visceral complications. In France, 3% of patients have had to be hospitalized since the epidemic began (…). No deaths have been reported.” The journal recalls that “there is no specific treatment for the simple forms, but symptomatic treatments, particularly for the sometimes severe pain. Initiating treatment with anti-inflammatory drugs or corticosteroids should be avoided.” Particular attention must be paid to population groups at risk of severe forms: immunocompromised people, pregnant women and young children. In these cases, referral to specialist advice is indicated,” explains the HAS. Finally, there are two key points relating to screening and vaccination “So far there is no indication for screening in asymptomatic people, not even in contact people at risk of contamination,” explains the paper. “There is a vaccination against this disease in pre-exposure in people with a very high risk of exposure and in post-exposure. Exposure for people who are vulnerable contacts.”
Preventive or post-exposure vaccination
On the occasion of these emergency measures, HAS reiterates the need for pre-exposure vaccination (as a preventive measure) for those at very high risk of exposure and post-exposure vaccination for contacts at risk of contamination. She complements her previous recommendations by noting that pre-exposure vaccination of minors who fall under vaccination targets can be considered on a case-by-case basis.
HAS also states that 3rd generation vaccines (Imvanex / Jynneos) can be given concurrently with any other vaccine in the vaccination schedule without risk to patients. If the vaccine in the vaccination schedule in question is a live attenuated vaccine, it must be given either on the same day as the monkeypox vaccine or four weeks (28 days) apart. HAS also insists on the need to promptly report any side effects suspected of being related to any of the vaccines to a regional pharmacovigilance center or through the dedicated portal.
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