Public health

Dermatology clinics urged to be on high alert for monkeypox

Dermatology clinics have been advised by the World Health Organization to have high vigilance for patients presenting with possible symptoms of monkeypox.

With more than 100 cases globally and two cases already identified among returning travellers to Australia, the WHO is advising that additional cases and further onward spread in the countries currently reporting cases is likely.

“Countries should be on the alert for signals related to patients presenting with an atypical rash that progresses in sequential stages – macules, papules, vesicles, pustules, scabs, at the same stage of development over all affected areas of the body – that may be associated with fever, enlarged lymph nodes, back pain, and muscle aches,” a WHO statement advised.

“These individuals may present to various community and healthcare settings including but not limited to primary care, fever clinics, sexual health services, infectious disease units, obstetrics and gynaecology, urology, emergency departments and dermatology clinics. Increasing awareness among potentially affected communities, as well as health care providers and laboratory workers, is essential,” it said.

WHO recommends that any patient with suspected monkeypox should be investigated and if confirmed, isolated until their lesions have crusted, the scab has fallen off and a fresh layer of skin has formed underneath.

The federal Department of Health says the National Incident Centre has been activated to support the national response after Victoria and New South Wales both confirmed a case on 20 May. The confirmed cases are both in returned travellers – one travelled to the UK and the other through Europe.

The Department said monkeypox virus is not currently a nationally notifiable disease in Australia, but the Victorian Department of Health and NSW Health are responding to the cases and working to rapidly identify contacts. The monkeypox situation is also being monitored and discussed by the Communicable Diseases Network Australia (CDNA) and the Australian Health Protection Principal Committee (AHPPC).

“States and territories are alerting clinicians to be on the lookout for potential cases and to report any cases to their relevant state and territory authorities urgently so that a public health response can be activated. Post exposure prophylaxis can be effective in preventing or modifying disease contacts if provided soon after exposure,” said acting Chief Medical Officer, Dr Sonya Bennett.

“Signs of infection include fever, a distinctive vesicular rash which can occur on any part of the body including the face, and swollen lymph nodes. People who have recently returned from overseas, or who have been in contact with a case in Australia, and who develop any of these symptoms should seek medical advice immediately,” she advised.

“Human-to-human transmission of monkeypox can occur through close contact with lesions on the skin, body fluids including respiratory droplets, and contaminated materials such as bedding. Transmission via respiratory droplets usually requires prolonged face-to-face contact. Transmission can occur between sexual partners, through intimate contact during sex, with infectious skin lesions being the likely mode of transmission,” the department said.

NSW Chief Health Officer Dr Kerry Chant told a media briefing that the case of monkeypox identified in a patient by a NSW GP did not have classical symptoms.

“The presentation was actually quite unusual and not the classic [symptoms] that we’ve learned and read about this rare disease, so I pass on my appreciation to that astute clinician for considering monkeypox as part of the differential diagnosis,” she said.

She said the incubation period was usually one to two weeks after exposure and was characterised by a chickenpox-like rash that might develop on the face after a period of fever, muscle ached and lethargy.

Dr Chant said a high proportion of cases had been reported in gay and bisexual men and other men who have sex with men and she urged particular vigilance for monkeypox in these groups.

However the federal Department of Health emphasised that monkeypox was not described as a sexually transmitted disease, though it can spread through direct intimate contact during sex.

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