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The COVID-19 pandemic has shown us that with the interconnectedness of our world, it is inevitable that at some point, infections emerging overseas may make their way to our community. One of the few viruses that has reached Australia since COVID is the mpox (previously known as monkeypox) virus, with the World Health Organization (WHO) recently meeting for the fourth time to update on the efforts to combat the May 2022 outbreak.
Thankfully, a vaccine has been developed for mpox through the very successful smallpox vaccine and has been distributed to many eligible Australians. At the Australian College of Nursing (ACN), the Nurse Immuniser team has continued to keep a close eye on the mpox situation and the distribution of the vaccine to groups identified as vulnerable to transmission by the government.
The ACN Immunisation team joins us to discuss mpox, what it means, and what processes nurses need to be aware of.
What is mpox?
On 28 July 2022, Australia’s Chief Medical Officer declared mpox to be a Communicable Disease Incident of National Significance. Mpox is a viral infection that initially originated in the Democratic Republic of Congo in 1970 (WHO, 2022). There have been small periodic outbreaks since 1970, but this is the first time there has been a global increase. At last report, there have been 141 confirmed cases reported in Australia (NSW Health, 2022).
The Communicable Disease Incident of National Significance was lowered in Australia in November 2022. However, eligible communities are still recommended to get the vaccination when returning from or going to countries with confirmed cases, as cases continue to spread overseas.
There are two different strains of mpox: The Central African (Congo Basin) and the West African strain. The current strain found in Australia is the West African strain and this strain is believed to be less severe and transmissible than the Central African strain (WHO, 2022).
The viral infection is related to the one that causes smallpox, but is usually milder (Johns Hopkins Medicine, 2022). Mpox causes a rash or lesion that can be transmitted via close contact with an infected person, animal, or contaminated item (WHO,2022). Most people who become infected recover within a few weeks. However, it can be fatal up to 10 per cent (Johns Hopkins Medicine, 2022).
What are the symptoms of mpox?
Symptoms of mpox are similar to its more infectious but eliminated cousin, smallpox and typically show around 7-14 days after exposure (NSW Health, 2022).
Symptoms can be present across the entire body or clustered in specific locations and include:
- Rashes, lesions or sores on skin
- Ulcers and lesions in the mouth
- Body aches
- Swollen lymph nodes
- General exhaustion prior to appearance of rashes
The Australian Government Department of Health and Aged Care states that symptoms tend to clear after two to four weeks. Symptoms can become more serious and may require hospital treatment.
How is mpox transmitted?
Mpox is a viral disease that spreads from one person to another, mainly by direct skin-to-skin contact. It can also be transmitted through contact with contaminated items such as clothes or bedding, as well as contact with infected bodily fluids.
Mpox can be sexually transmitted, but it is unknown how long the virus remains present in semen and other genital excretions. People should abstain from sex for the duration of their infection, and it is recommended that a condom be used for eight weeks after recovery.
Anyone can get mpox; people are considered infectious from the first-time symptoms appear until all lesions have formed a crust and the scabs have fallen off (NSW Health, 2022).
What options are there for prevention?
Vaccines for smallpox can be effective against mpox and are currently the best prevention method for transmission. For optimal protection the vaccine is recommended prior to the exposure to the virus. However, people who have been exposed to the virus can also obtain the vaccine, as receiving the vaccine within four days of being exposed to mpox will increase the chance of avoiding the disease and its symptoms.
There are currently two approved vaccine brands used in Australia, both of which can be safely used by all age groups and have fewer side effects than previous smallpox vaccines. The vaccine can provide up to 80 per cent protection against mpox; two doses of the vaccine are required, given at least 28 days apart.
What do nurses need to know about managing mpox?
The Clinical Excellence Commission recommends that individuals with mpox in both inpatient and outpatient settings should be managed by applying standard and transmission-based precautions (contact and droplet) at a minimum. This includes isolating the individual and the use of PPE (Personal Protective Equipment) (gown, gloves, eye protection, respiratory protection, surgical mask or P2/N95 respirator including fit checking (based on risk assessment) for healthcare staff. Strict hand hygiene should also be maintained during contact, including environmental contact.
People with suspected or confirmed mpox should be isolated in a negative pressure room (with an anteroom and ensuite). If a negative pressure room is unavailable, they should be isolated in a negative flow or 100% exhaust room (with ensuite) or a single room with ensuite and with the door closed (designated bathroom if ensuite facilities unavailable).
What do nurses need to do if they suspect mpox exposure?
In the first instance, refer to your healthcare facility’s infection policy.
Any nurse who has cared for an individual with mpox should be alert to the development of symptoms that could suggest mpox infection, especially within the 21-day period after the last date of care, and should notify their manager, work health and safety representative and follow the guidelines of the Infection Prevention and Control Service within their Health District.
If you have had unprotected exposures (i.e., not wearing PPE) to individuals with mpox you do not need to be excluded from work, but should undergo active surveillance for symptoms (headache, fever, chills, sore throat, malaise, fatigue, rash, and swelling in the lymph nodes), which includes measurement of temperature at least twice daily for 21 days following the exposure. You should not work with high-risk people during this period.
Nurses who have cared for or otherwise been in direct or indirect contact with people with mpox while adhering to recommended PPE may undergo self-monitoring or active monitoring for symptoms.
Please refer to your state Health Department for updates on health worker exposure management.