Measures for Preventing Monkeypox: Procedures for Referred Suspected Cases of Monkeypox in HIV/AIDS Treatment Facilities
Measures to Prevent Monkeypox?
According to Chapter IV of the Guidelines issued with Decision 2265/QD-BYT in 2022, the measures to prevent monkeypox are clearly outlined as follows:
Non-specific disease prevention measures:
- Avoid close contact with individuals who have or are suspected of having monkeypox, avoid direct contact with open wounds, body fluids, droplets, and contaminated items.
- Cover mouth and nose when coughing or sneezing, preferably with a cloth, handkerchief, disposable tissue, or sleeve to reduce the spread of respiratory secretions; wash hands with soap and clean water or hand sanitizer immediately after coughing or sneezing. Do not spit indiscriminately in public places.
- Regularly wash hands with soap and clean water or hand sanitizer.
- Individuals with acute unexplained rashes accompanied by one or more suspicious symptoms should proactively contact medical facilities for monitoring and promptly advice. Additionally, self-isolate and avoid close contact with others, including sexual contact.
- People traveling to countries/regions with monkeypox outbreaks (Central and West Africa) should avoid contact with mammals (dead or alive) such as rodents, marsupials, primates that may carry the monkeypox virus. Upon returning to Vietnam, they should proactively report to local health authorities for advice.
- Ensure food safety; lead a healthy lifestyle, increase physical activity, and improve health.
- Healthcare workers taking care of or treating suspected or confirmed monkeypox patients should use appropriate personal protective equipment (PPE).
Specific disease prevention measures:
Up to now, results from some studies have shown that prior smallpox vaccines have certain efficacy in preventing monkeypox. Currently, a few countries have approved the use of new generation smallpox/monkeypox vaccines (generation 2, 3) for the prevention and control of monkeypox 5,6,7.
As of July 18, 2022, WHO does not recommend wide-scale vaccination against monkeypox, but it suggested vaccination for high-risk individuals such as healthcare workers and those in direct contact with cases, with vaccination considered and decided on an individual basis upon exposure and after exposure. Research on the efficacy of monkeypox vaccines continues.
Border health quarantine:
Implemented according to the provisions of Decree 89/2018/ND-CP by the Government of Vietnam, which details the implementation of certain provisions of the Law on Prevention and Control of Infectious Diseases on border health quarantine and directives of the Government of Vietnam and guidance from the Ministry of Health.
Isolation and medical handling at border crossings follow the regulations in Decree 101/2010/ND-CP by the Government of Vietnam, detailing the implementation of certain provisions of the Law on Prevention and Control of Infectious Diseases on applying medical isolation measures, enforced medical isolation, and specific epidemic control during an epidemic and directives of the Government of Vietnam and guidance from the Ministry of Health.
Passengers are advised to monitor their health for 21 days after entry, limit contact, avoid crowded places8. If they develop symptoms such as rash, headache, fever, chills, sore throat, discomfort, fatigue, and lymphadenopathy, they should limit contact with others and go to the nearest medical facility for advice, diagnosis, and treatment.
Measures to Prevent Monkeypox? The process of transferring suspected monkeypox cases at HIV/AIDS treatment facilities? (Image from the Internet)
Guidelines for Treating Monkeypox in Humans?
Pursuant to the provisions in Section 3 of the Guidelines issued with Decision 2099/QD-BYT in 2022 on treating monkeypox in humans, as follows:
Principles of treating monkeypox:
- Monitor and isolate suspected/confirmed cases;
- Symptomatic treatment is the main approach;
- Ensure nutrition, water-electrolyte balance, and psychological support;
- Use specific antiviral drugs in severe cases and special conditions (newborns, elderly, immunocompromised individuals, etc.) according to recommendations from the World Health Organization and Vietnamese regulations.
- Monitor, detect, and promptly manage severe conditions and complications.
Specific treatment measures for monkeypox:
- General treatment measures
+ Isolate suspected/confirmed cases at medical facilities following the temporary surveillance and prevention guidelines for monkeypox by the Ministry of Health.
+ Individualize treatment for each patient.
- Mild cases:
Symptomatic treatment, such as:
+ Reducing fever and pain.
+ Care for skin, eye, and mouth lesions.
+ Ensure nutrition and electrolyte balance.
+ Monitor and detect early complications such as pneumonia, skin infections, sepsis, encephalitis, etc., to treat in isolation rooms at the intensive care unit.
+ Follow regulations for infection prevention and control.
- Severe cases:
Treat in isolation rooms at the intensive care unit, managing complications (if any) according to issued protocols.
- Specific antiviral drugs:
+ Indications
++ Individuals with severe complications (sepsis, pneumonia, encephalitis...).
++ Immunocompromised individuals (HIV, cancer, on immunosuppressive or high-dose corticosteroid therapy...).
++ Children, especially those under 8 years old.
++ Pregnant or breastfeeding women.
++ Individuals with acute progressive illnesses.
+ Treatment drugs as per World Health Organization recommendations (see Appendix 2)
++ Tecovirimat
++ Cidofovir
++ Brincidofovir
++ Intravenous Immunoglobulin
Process of Transferring Suspected Monkeypox Cases at HIV/AIDS Treatment Facilities?
Based on sub-clause 3.3.2 of sub-clause 3.3 of Section 3 Chapter VI of the Guidelines issued with Official Dispatch 1289/AIDS-DP in 2023, the process of transferring suspected monkeypox cases at HIV/AIDS treatment and PrEP facilities includes the following steps:
Step 1: Reception and Triage
- Preparation:
+ Training to provide knowledge, awareness, and procedural guidelines for healthcare staff,
+ Prepare facilities, temporary isolation areas, personal protective equipment, staff, and assign tasks.
- Reception and triage of customers
+ List customer groups needing monkeypox screening
+ Triage method, remote temperature measurement, and healthcare declaration
- Conduct temporary isolation: for those with one or more suspicious symptoms.
Step 2: Screening and Risk Assessment (using the questionnaire as per Decision 2265/QD-BYT 2022)
- Questionnaire aims
+ Screen for symptoms, risk factors, and epidemiological data faced by the customer
+ Screen for urgent issues needing immediate handling
+ Assess the customer's monkeypox risk (low, medium, high)
- Screening examination
- Those with one or more suspicious symptoms: conduct temporary isolation.
Step 3: Managing Urgent Issues (if any)
Address urgent issues related to mental and physical health services for cases needing immediate rescue as they threaten the customer's life or safety.
Step 4: Counseling on current risk behaviors and solutions to prevent and control monkeypox
- General counseling principles
- Counseling aims to explore and discuss the issues faced by the customer without excluding risk behaviors not yet encountered by the customer
- Choose appropriate services, items, and messages to provide to the customer.
Step 5: Transferring Customer to Healthcare Facilities for Diagnosis and Treatment
- Guide customers on the use of referral cards when visiting diagnostic and treatment facilities.
- Assist customers in accessing services (Provide detailed information about monkeypox service providers).
- If the diagnostic and treatment facility accepts the customer, fill in the patient code on the referral card, sign, clearly write name and seal; it is only recognized as a successful referral case when validated.
- Retrieve the referral card from the customer; it should be signed and sealed.
Step 6: Continuous Monitoring and Support
- Record contact information, main issues, and support provided in the outpatient record.
- Continue to monitor and support treatment compliance, assisting customers in revisiting on time as per the healthcare staff's instructions.
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