The title: Quick Responses: Monkeypox Virus Infection – Primary Care Physician Care, sounds a bit techno. On the objective side, the document is inspired by the Rapid Responses published by the HAS with the occurrence of Covid-19 on case management. The new sheet aims, in fact, to allow first-line health professionals to be at the level in “the care of patients presenting with symptoms of monkeypox [Monkeypox, ndlr] or patients who have been in contact with a person infected with this virus”. Many structures participated in its development: Spilf (French-language infectious pathology society), SFLS (French society for the fight once morest AIDS), National Council for AIDS and viral hepatitis, HAS, ANRS ǀ MIE, the TRT- 5 CHV, College of General Medicine, SFM (French Society of Microbiology), CMIT (National Professional Council for Infectious and Tropical Infectious Diseases) and the French Society of Dermatology.
Quick replies
The idea is to present the essential recommendations and advice in the form of key information. Other than what health professionals and people who are infected or who think they are should know as a matter of priority. The HAS document lists fifteen of them. We have only retained a few of them here – for the entirety, it is necessary to refer directly to the HAS document (see references below).
First key point: “infection with the Monkeypox virus (MPXV) is transmissible, mainly by direct mucocutaneous contact (most frequently during sexual contact), more occasionally by respiratory droplets and/or through an object ( laundry, dishes, etc.).
Who is concerned- ? “Without being exclusive of this population, the majority of cases reported in Europe concern 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,” recalls the document.
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In terms of care, the “doctor asks the patient regarding his HIV status. If it is a person living with HIV (PLHIV), he asks him regarding his treatment and his CD4 count. In this case, he directs him to an HIV specialist”. In addition, the “mode of transmission through sexual contact requires a systematic STI assessment from the outset: blood tests (HIV, HBV, HCV, syphilis serology) and gonococcal and chlamydia PCR on first urine flow”. The document confirms that the “incubation period is between 5 and 21 days”. “The diagnosis is clinical (polymorphic symptomatology, possibility of getting help by tele-expertise); the removal of lesions for biological diagnosis (search for viral DNA), is indicated in the event of clinical doubt (non-clear symptoms or unidentified context of exposure or search for a differential diagnosis)”, explains the sheet.
The treatment is generally outpatient. [prise en charge à domicile, au maximum, ndlr] : the evolution is most often favorable in two to four weeks. Some forms may be hyperalgesic [extrêmement douloureuses, ndlr] and there are some visceral complications. In France since the start of the epidemic, 3% of patients have required hospitalization (…). There have been no reported deaths.” The sheet recalls that “there is no specific treatment for the simple forms, but symptomatic treatments, in particular for the sometimes intense pain. The initiation of treatment with anti-inflammatories or corticosteroids should be avoided”. “Particular attention must be paid to populations at risk of severe forms: immunocompromised individuals, pregnant women and young children. In these cases, referral to specialist advice is indicated,” explains the HAS. Finally, two key points are recalled in terms of screening and vaccination. “To date, there is no indication for screening in asymptomatic people, including in contact persons at risk of being contaminated”, explains the sheet. “There is a vaccination once morest this disease in pre-exposure in people at very high risk of exposure and in post-exposure for people who are contacts at risk”.
Preventive or post-exposure vaccination
On the occasion of these Rapid Responses, HAS reiterates the need for pre-exposure vaccination (as a preventive measure) for people at very high risk of exposure and post-exposure for contact people at risk of contamination. It supplements its previous recommendations by indicating that pre-exposure vaccination of minors falling within the vaccine targets can be considered on a case-by-case basis.
HAS also specifies that 3rd generation vaccines (Imvanex / Jynneos) can be administered simultaneously with any other vaccine in the vaccination schedule, without risk to patients. If the vaccine in the vaccine schedule in question is a live attenuated vaccine, it must be administered either on the same day as the vaccine once morest Monkeypox, or four weeks apart (28 days). HAS also insists on the need to immediately report any adverse effect suspected of being due to one of the vaccines to a regional pharmacovigilance center or to the dedicated portal.
