There are Type I and Type II contact persons, which is defined according to the intensity of the contact.
Type I are high-risk contacts, “who have had direct contact with skin lesions (all stages, including crusts) or mucous membranes of a symptomatic case of monkeypox, its bodily fluids, or potentially infectious material,” according to the recommendations. This is defined in more detail below. According to this, type I contacts are sexual partners, people who run the risk of inhaling droplets of respiratory secretion or whirled up, virus-contaminated dust when cleaning contaminated rooms, household contacts or the like – for example spending the night in the same room – skin contact with shared clothing, bed linen or shared utility items, including workplace items, people with skin injuries from shared sharp objects (for example, needles or blades), and passengers on airplanes, buses, and trains with journeys of eight or more hours or more.
Type II contacts are brief social contacts, work colleagues who do not share an office, short stays in the fitness studio, sauna, bath or similar without sexual contact and people with adequate personal protective equipment. This includes FFP2 or higher quality masks, long-sleeved protective coats, safety goggles and gloves.
In the case of type I contacts, the experts from the health department recommend first of all that the responsible health authority register by name with the collection of telephone number, e-mail address, place of work, occupation and living conditions – in short, contact tracing.
The contact persons should also be actively informed by the competent health authority about the symptoms and progression of the disease, and their state of health should also be monitored by the authority for a period of 21 days after the last exposure in the form of daily telephone contact. If symptoms such as fever, rash, etc. appear within 21 days of last exposure, the competent authority should initiate a laboratory diagnostic test. The person should immediately self-isolate until monkeypox infection can be ruled out. Contact with immunosuppressed and pregnant people as well as children under the age of twelve should also be avoided at the workplace, as should close physical contact and contact with pets. In addition, attention must be paid to hand hygiene and hygiene when coughing, sneezing and blowing your nose. Three points – contact tracing, information and self-monitoring – are also recommended for Type II contacts.
Contagious for two to four weeks
The Ministry of Health reiterated that people infected with monkeypox are themselves contagious for the entire two to four week period of the illness. There is a pre-eruptive (or prodromal) and an eruptive stage. The first is caused by an initially sudden high fever (38.5 – 40.5 degrees Celsius), headache and muscle pain, exhaustion and very often swelling of the lymph nodes – especially in the throat and neck as well as in the groin area – possibly also by coughing, feeling unwell and sometimes marked by diarrhea.
The eruptive stage occurs after one to three days, skin changes form. First there are rashes in the mouth and throat, face, hands and forearms, followed by spreading towards the center of the body. This then proceeds with the smallpox-typical so-called efflorescence stages from limited color changes of the skin to blisters and pustules to the crusts. The genital area can also be affected. Eventually the scabs will heal. Only when these have completely disappeared is the patient no longer contagious.
In addition to the clinical criteria just described, there are other parameters in the case definition, such as epidemiological ones: This concerns, for example, contact with potentially infected animals, species endemic to Africa, travelers returning from West or Central African countries and/or contact with a probable or confirmed human Monkey Pox Case. And there are laboratory diagnostic criteria: These are evidence of the presence of an orthopoxvirus infection (e.g. orthopoxvirus-specific positive PCR without sequencing) or evidence of monkeypox virus-specific nucleic acids in a clinical sample using PCR3 or sequencing.
Suspected, probable and confirmed cases
A distinction is also made between suspected, probable and confirmed cases. Suspected cases are people who meet at least one of the epidemiological criteria, have a fever or a rash of unknown origin and show two or more non-specific symptoms within 21 days of the last contact (in relation to the epidemiological criteria).
Probable cases are patients with a rash of unknown cause, one or more other monkeypox symptoms, and one of the following additional items: These include a positive laboratory test result for orthopoxvirus infection, a relevant travel history, an epidemiological link to a confirmed or probable case, or multiple or anonymous sexual contacts within the past 21 days. Probable cases are also people with a corresponding rash. Finally, confirmed cases are those detected in a laboratory by either a monkeypox PCR test or by an orthopoxvirus-specific PCR test and confirmation by nucleotide sequencing.
Source: Nachrichten
