Health Minister Carolina Darias.
The Ministry of Health published its new roadmap for the care of patients infected with monkeypox (monkey pox). The Carolina Darias team has developed three protocols in collaboration with learned societies to improve diagnosis, treatment and prevention among different groups of patients: ambulatory, hospital and pediatric.
The objective is to guide physicians in their way of acting, once the objectives have already been achieved. 5,000 infections in Spain and the first two people died from the disease. “Most cases of monkeypox are mildly affected and do not require hospitalization, but some complications or risk factors may require hospitalization”presented Health.
Experts have highlighted several keys that begin with a series of precautions to avoid contagion, such as the use of FPP2 masks to prevent possible airborne transmission, as well as Individual protection equipment (PPE) in case of close contact. At the same time, it was also recommended a exhaustive disinfection areas in which health center patients are cared for. “Wet cleaning methods should be used with approved disinfectants such as sodium hypochlorite (bleach) at a concentration of 0.1% or quaternary ammonium,” the protocol states.
The bone protocols They also influenced safety measures when performing take samples from patients to confirm your diagnosis. There should be no other patients in the room, while healthcare staff should be essential and always equipped accordingly. “It is recommended to carry out a specific PCR study for monkeypox suspicious lesions to confirm the diagnosis”they pointed.
Health has also asked doctors to take, as far as possible, samples from skin lesions or mucosal localizations. While in patients who report risky sexual practices, it is important to “consider” carrying out tests to analyze a possible STI infection.
Treatment: from paracetamol to antivirals
The Ministry of Health has also laid the foundations for the most effective treatments which must be adapted to the “individual characteristics of each patient”. The range of drugs ranges from Paracetamol for the fever loratadine for itching. It is also recommended to cut the nails to avoid scratching, to keep the wounds dry and clean, as well as sitz baths with salt water for ulcerated genital lesions. “In case of advanced crusty adherent lesions, it can be applied Thin layer of petroleum jelly after hygiene to help decrust,” reads the protocol.
The protocol also exposes the possibility of using topical and oral antibiotics in case of bacterial superinfection of the conjunctiva or cornea, while opening the door to marketed eye antiseptics but remember that “there is no clinical experience”.
For conditions such as inflammation of the rectal mucosa, it is recommended symptomatic treatment: oral anti-inflammatories, topical or systemic corticosteroids, topical or oral antibiotics for bacterial superinfection of perianal lesions and topical solution based on zinc and copper sulphates for perianal skin lesions. “SIf complications are suspected, the patient will require surgical evaluation”reads the text.
The roadmap also considers the possibility of using specific antiviral treatments, fundamentally in hospitalized patients, even if he recalls that they have limited availability and little clinical experience: “In some cases, these are indications outside the recommendations and with a risk of specific adverse effects. For this reason, will be reserved for patients with certain specific risk conditions and will be administered in hospital.
Tecovirimat It has been established as “first priority” as long as there is stock available and there are no contraindications. The protocol also includes the role of the brincidofovir, currently unavailable or Cidofovir for patients who have not yet experienced the “onset of the rash”, as this can prevent mortality. Finally the door opens Smallpox immunoglobulinalthough only in severe first priority cases that do not respond to treatment, with life-threatening or permanent injury.
Monkeypox in children
The Ministry of Health has also devoted a specific chapter to the situation of children infected with monkeypox. Although it is considered that the iinfections are less common Among this group, a higher risk of hospitalization and admission to intensive care units has also been reported, due to the occurrence of more injuries. “In the cases reported in Africa the greatest severity is associated with pediatric age,” the protocol says.
Given this situation, the document recommends the hospitalization of high-risk patients such as immunocompromisedin those with cserious pictures vomiting, gastrointestinal intolerance, dehydration, neck pain due to extensive lymphadenopathy, dysphagia, suspected bacterial superinfection, respiratory distress, pneumonia, elevated transaminases, thrombocytopenia or significant decline. Or in those who have complications in the analytical results. It will also apply in newborns or infants under 3 months old in a generalized way.
In case of contagion, experts have not recommended to continue breastfeeding because it is not known whether “the infection can be transmitted” by this route. Although it is specified that there are no contraindications for children in Imvanex vaccine. “You can see if there are enough doses to give to all close contacts,” they explained.
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