Appendix 1: MPX Case and Contact Management Chart adapted from the Monkeypox (MPX) Communicable Disease Manual Chapter

Appendix 1: MPX Case and Contact Management Chart adapted from the Monkeypox (MPX) Communicable Disease Manual Chapter

Note: • MPX is now a notifiable disease on the list of infectious diseases in New Zealand. • The Monkeypox Communicable Disease Manual chapter can be found here: https://www.health.govt.nz/our-work/diseases-andconditions/communicable-disease-control-manual/monkeypox

Category Description

Under investigati on/ Suspected case

A clinically compatible illness characterised by the presence of acute unexplained8 skin and/or mucosal lesions or proctitis (for example anorectal pain, bleeding)

and

• an acute unexplained and compatible rash (evolving typically in four stages – macular, papular, vesicular, to pustular – followed by scabbing, with lesions progressing simultaneously on any part of the body). The rash may be generalised or localised. • Advise the case to self-isolate while under investigation until it is determined whether or not they meet the case definition. Health workers to practice Standard, Airborne and Contact infection control precautions to prevent transmission via droplets. This includes eye protection, P2/N95 mask, fluid repellent gown and gloves.

Collect standard information to enable contact tracing including recent travel and sexual history and smallpox vaccination status.

Notify Communicable Diseases (notifycommdiseases@heal

Actions for the Case or Contact Actions/Advice for Public Health/DHB

8 More common causes of acute rashes with similar appearances should be considered and excluded where possible; varicella zoster, herpes simplex, syphilis, molluscum contagiosum.

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th.govt.nz) or call 0800 GET MOH for any out of hours enquiries.

Probable or confirmed case

A person meeting the case definition for a suspected case. AND at least one of the following: • exposure9 to a confirmed or probable case in the 21 days before symptom onset • history of travel to an area where MPX is endemic or where there is a current outbreak in the 21 days before symptom onset10 • is a priority group for testing.

At this time priority groups for testing include the following: • persons who had multiple (two or more) or anonymous sexual partners in the 21 days before symptom onset • gay, bisexual or other men who have sex with men (MSM).

Confirmed case: A case meeting the definition of either a suspected or probable case and is laboratory confirmed for MPX virus by detection of unique sequences of viral DNA either by real-time polymerase chain reaction (PCR) and/or sequencing. • Ensure the case self-isolates until their lesions have crusted, the scab has fallen off and a fresh layer of skin has formed underneath (symptoms normally last 14 –28 days). • Self-isolate means that cases should not go out to public places or venues, or attend places of worship.

Cases must avoid physical contact, particularly sexual contact over this period (including kissing, intimate touching). Cases are able to walk by themselves while keeping a 2-metre distance from other and must wear a mask when leaving the house. Due to some evidence

MPX virus in semen and uncertainty around whether transmitted this way condom use for 8 weeks after infection; this information can be provided to cases as they may be motivated to use condoms for a period of time. • Probable or confirmed cases should avoid close direct contact with animals, including domestic animals (such as cats and dogs), livestock, and other captive animals, as well as wildlife. People should be particularly vigilant around animals known to be susceptible, such as rodents and non-human primates. • Ensure that all waste, including medical waste, is disposed of in a safe manner and that it is not accessible to rodents and other scavenger animals. • Complete Case

Investigation

Questionnaire form11 • Arrange laboratory testing if required • Inform the local Sexual

Health Service • Provide Case

Information Sheet (found in G:drive). • Twice weekly welfare checks via phone or email, to identify and address any welfare concerns while the case is isolating and check on compliance with isolation advice. See

Appendix 4:

Welfare/isolation form.

9 Exposure: direct physical contact with skin or skin lesions, including sexual contact; or contact with contaminated materials such as clothing, bedding or utensils; or prolonged face-to-face contact, including health care workers without appropriate PPE. 10 Refer to: https://www.who.int/emergencies/emergency-events/item/2022-e000121 11 Found here: G:\Toi Te Ora\Z_E_FINALS\CD Notifiable\Monkeypox (MPX)\MPX Case Investigation Questionnaire

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High risk contacts

A high risk contact is defined as a person with one or more of the following exposures to a probable or confirmed MPX case without appropriate PPE: • prolonged face to face respiratory exposure in close proximity12 • direct physical skin-to-skin contact, including sexual contact • contact with crusts, bodily fluids or contaminated materials such as clothing or bedding • any health worker or household member who has cared for a person with probable or confirmed MPX, including management of potentially contaminated materials even without direct patient contact, without appropriate PPE. All high risk contacts are advised: • to undergo active monitoring13 for symptoms for 21 days following last exposure. • if any MPX symptom appears, contacts are to immediately isolate and contact PHU • post-exposure (PEP) vaccination may be considered when available • to always wear masks when around others • hand hygiene and respiratory etiquette • for 21 days after last exposure to a case: o do not need to be excluded from work duty if asymptomatic as long as symptoms are not present however are encouraged to work from home if possible. o If working in a high-risk setting, should be managed on a case-by-case basis in consultation with local National Public Health Service. As a minimum, ensure symptom free and wear a mask. o to wear a mask in high-risk settings including healthcare settings14, childcare settings and aged care facilities, as well as places of indoor gatherings where infection may spread via droplets such as bars, restaurants or places of worship • Complete Contact

Investigation

Questionnaire15 • Provide Active

Monitoring Contact

Information Sheet (found in G:drive) • HPO or CD nurse to provide thermometers as needed for daily temperature checks (asking the contact to record temperature readings). • Daily phone call from the HPO or CD nurse to review recorded temperatures and symptom check (see

Clinical criteria and

Appendix 3).

12 Currently defined as being within 2 metres of a monkeypox case in the same poorly-ventilated indoor physical space for 3 hours or more. 13 Active monitoring for symptoms is when public health officials are responsible for contacting (i.e. by phone, email, text) periodically to see if a person under monitoring has signs/symptoms. The individual under monitoring must take their temperature daily, watch for signs/symptoms compatible with MPX, and immediately isolate and report to public health officials if they have signs/symptoms. If initial symptoms (other than a rash) they should be quarantined and watched closely over the following seven days. If no rash develops, they can return to temperature monitoring for the remaining days. Completion of monitoring will be based on a high trust model. If a contact reports no presentation of rash for 21 days since last close contact exposure to the case (while infectious), they will be released from follow-up. 14 unless seeking medical attention, in which case the contact should call the facility in advance and explain their status. 15 Found here: G:\Toi Te Ora\Z_E_FINALS\CD Notifiable\Monkeypox (MPX)\MPX Contact Investigation Questionnaire

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Medium risk contacts

A medium risk contact is defined as a person with one or more of the following exposures to a probable or confirmed MPX case: • prolonged indirect contact16 with an unmasked MPX case without wearing, at a minimum, a surgical mask • passengers seated either side of a MPX case during a flight of 8 hours or more • participated in activities resulting in contact between sleeves and other parts of an individual’s clothing and the patient’s skin lesions or bodily fluids, or their soiled linens or dressings (for example, turning, bathing, or assisting with transfer) while wearing gloves but not wearing a gown) • exposure that, at the discretion of public health authorities, is recategorized to this risk level because

o to avoid high-risk activities including sexual activities and other activities that involve close physical contact such as kissing o to wear a mask when in close contact with people potentially at higher risk of infection including infants, older people and immunocompromised people o not to donate blood, cells, tissue, breast milk, semen, or organs while they are under symptom surveillance. All medium risk contacts are advised to: • Self-monitoring17 for symptoms for 21 days following last exposure • if any MPX symptom appears, contacts are to immediately isolate and contact local National Public Health Service. • PEP (if available)– to be considered on a case-by-case basis only for those at high risk of severe illness eg, immunocompromised. • Intermediate testing priority if compatible prodromal symptoms develop, high if a clinically compatible rash develops. • For 21 days after last exposure to a case: o If working in a high-risk setting or people at higher risk of severe infection (incl. • Complete Contact

Investigation

Questionnaire18 • HPO or CD nurse to provide thermometers as needed for daily temperature checks (asking the contact to record temperature readings), and contact information for public health officials if they develop signs/symptoms. • Provide Self Monitoring

Contact Information

16 Currently defined as being within 2 metres of a monkeypox case in the same poorly-ventilated indoor physical space for 3 hours or more. 17 Self-monitoring for symptoms may be advised for low-risk contacts. Self-monitoring is when the person being monitored is responsible for taking their temperature once daily and watching for signs/symptoms compatible with MPX. The individual should immediately isolate and report to public health officials if they have such signs/symptoms within 21 days of last exposure. If initial symptoms (other than a rash) they should be quarantined and watched closely over the following seven days. If no rash develops, they can return to temperature monitoring for the remaining days. Completion of monitoring will be based on a high trust model. If a contact reports no presentation of rash for 21 days since last close contact exposure to the case (while infectious), they will be released from followup. 18 Found here: G:\Toi Te Ora\Z_E_FINALS\CD Notifiable\Monkeypox (MPX)\MPX Case Questionnaire

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Low/ uncertain risk contact

of unique circumstances (for example, if the potential for aerosol exposure is low when Airborne Precautions are meant to be applied, public health authorities may choose to decrease risk level from high to intermediate) A low/uncertain risk contact is defined as a person with one or more of the following exposures to a probable or confirmed MPX case: • people involved in brief in-direct contact with a case (for example, passengers on a plane seated outside of either side of the case, flight crew who provided service to a case, people sharing the same lift as the case, drivers and passengers in the same vehicle as the case for less than 3 hours, colleagues in the same area of an office as the case, brief faceto-face, and unmasked conversations with a case) • people who have had direct contact with a case or its environment while wearing personal protective equipment (PPE) in accordance with transmissionbased precautions are considered to be at low risk of transmission and do not require follow up (for example, cleaners of a case’s hotel room, health worker or household member caring for a MPX case, laboratory workers working with case material). • all interactions between a health worker or household member caring for a person with probable or confirmed MPX conducted using appropriate PPE in accordance with transmission-based precautions are low risk. • exposure that, at the discretion of public health authorities, was recategorized to this risk level based on unique circumstances (for example, uncertainty about whether MPX was • On a case-by-case basis local National Public Health

Service may wish to advise such low-risk contacts to self- monitor17 • if any MPX symptom appears, contacts are to immediately isolate and contact PHU • generally, do not warrant PEP (should it be available) or active follow-up by the PHU • No action required unless deemed necessary on a case-bycase basis.

infant, pregnant women, immunocompromised people), ensure symptom free and wear a mask. o Should not donate blood, cells, tissue, breast milk, semen, or organs. Sheet (found in G:drive).

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present on a surface and/or whether a person touched that surface)

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