What to do if you suspect you have caught monkeypox
Please contact your family physician. If you are unable to do so, please get in touch with the Estonian Family Physicians Association’s helpline on 1220. If you develop any additional symptoms, please call the Emergency Response Centre on 112.
Get yourself tested for monkeypox.
Self-isolate and avoid coming into close contact with anyone else.
If possible, reach out to your sexual partners and close contacts to see if they are experiencing similar symptoms.
What to do if you're infected with monkeypox
Stay at home and follow the advice given by health professionals. If you develop any additional symptoms, please contact the Emergency Response Centre on 112.
Avoid contact with other people, especially pregnant women, children, and people with weakened immune systems.
Avoid sexual contact until the last scab has fallen off from the ulcer.
Inform your close contacts about the illness.
As information on the transmission of the disease is scarce, use a condom for at least twelve weeks after recovery.
GENERAL INFORMATION AND INSTRUCTIONS
HOW TO PROTECT YOURSELF
Be familiar with the symptoms of monkeypox and know how the virus spreads.
- SAFE SEX
Practice safe sex and limit your number of sexual partners.
Keep hands clean by washing with soap and water or disinfecting with alcohol-based products.
- GET ADVICE FROM A SPECIALIST
If you are at risk of catching monkeypox, ask your family physician or specialist for advice on how to avoid infection.
- BUILD ON RELIABLE INFORMATION
Do not trust everything you read on the internet. Rely on the information which is provided by the National Health Board, the European Centre for Disease Prevention and Control (ECDC), and the World Health Organisation (WHO).
MONKEYPOX SYMPTOMS AND DISTRIBUTION
The main symptoms of MONKEYPOX are as follows:
- muscle pain,
- swollen lymp nodes,
- a rash.
The rash may appear at the same time as, or soon after, the first symptoms appear. It may be painful and itchy. The rash may appear on the mouth, hands, or feet or anywhere else on the body. In this outbreak, the rash has also appeared around the groin and anus.
The main ways of contracting MONKEYPOX:
- skin-to-skin contact with a person who has monkeypox;
- mouth-to-mouth or mouth-to-skin contact with someone who has monkeypox;
- sharing bed linen, towels, clothes, or sex toys with someone who has monkeypox.
CAN MONKEYPOX BE VACCINATED AGAINST AND WHICH MEDICINES ARE AVAILABLE?
Estonia procures monkeypox centrally through the European Commission's HERA Working Group in collaboration with Latvia and Lithuania.
The Health Board will procure seventy-two doses of Tecovirim to be shared with Latvia and Lithuania. This medicine is only used in very serious cases, which are very rare.
The vaccine will be procured centrally through HERA on similar principles (for Estonian use only). A total of 1,400 doses of Jynneos vaccine have been ordered. As part of preventative procedures which are aimed at monkeypox, it is recommended that vaccination be supplied to those persons who have come into close contact with a case of monkeypox during an infectious period, especially where this concerns household members and sexual partners.
Time of delivery: August.
WHAT IS THE JYNNEOS VACCINE?
There is no separate vaccine for monkeypox, but the smallpox vaccine, Jynneos, is used for vaccination purposes.
Jynneos/Imvanex prepares the body to protect itself against the smallpox and monkeypox viruses. The vaccine contains a live modified form of the vaccine virus called ‘vaccinia Ankara’, which is closely related to the smallpox and monkeypox viruses.
The vaccine does not cause smallpox and cannot replicate itself. Since smallpox and monkeypox are similar viruses, antibodies which are produced by the vaccine also protect against monkeypox. Once the vaccine is injected, the immune system recognises the fact that the protein is foreign to the body so it begins to mount a natural defence against it. If a person is later exposed to monkeypox or a similar virus, the antibodies which have already been produced will work with the immune system to fight and defend against the virus cells.
STATISTICS AND INFORMATION
> Cases of infection identified in Estonia: 11
The risk of infection in Estonia is very low.
> As of 6 September a total of 18 844 cases of monkeypox have been detected in EU/EEA countries
> Monkeypox has been identified the greatest number of times in the following countries:
Spain - 6 749
France - 3 645
Germany - 3 505
More information is available via the ECDC website!
WHO IS MOST AT RISK FROM MONKEYPOX?
Monkeypox can strike anyone. The virus doesn't care about your gender or sexual orientation.
Men who have sex with men are most affected by monkeypox.
Pregnant women, young children, and people with weakened immune systems, who may have severe forms of monkeypox, are most at risk from the virus. Therefore, if you suspect you have monkeypox and have developed symptoms, you should avoid contact with people in at-risk groups.
Monkeypox is a painful and unpleasant experience, but most people recover from the illness within a few weeks.
NEWS AND INTERVIEWS
How is the testing of monkeypox samples carried out in the Health Board’s Communicable Diseases Laboratory?
A person goes to their family physician complaining of itchy bumps. The doctor looks at it and says it's like chicken pox, but maybe it's monkeypox. What next? Who will take the sample, and how will it get to the Health Board’s Communicable Diseases Laboratory?
The WHO has provided guidelines to follow when taking a sample. The symptoms of monkeypox are similar to those of smallpox, but milder: they include a fever, severe headache, muscle aches, backache, a swelling of the lymph nodes, and fatigue as the initial symptoms. The characteristic skin rash occurs between 1-3 days after the onset of fever. Initial experience shows that family physicians tend to confuse the signs of chickenpox with those of monkeypox. In general, adults suffer more severely from chickenpox than children, and cases so far have mainly been chickenpox. In collaboration with the Communicable Diseases Department, instructions were prepared in good time, to which we added instructions from the laboratory both for taking samples and for sending them to the laboratory. In cases of suspected infection, patient sampling is carried out either by the family nurse or by a hospital-based sampler. A very specific sampling device is used, which is described in detail in the instructions and is accompanied by a photograph.
So a sample is taken at your family physician or hospital and is sent to the Health Board's laboratory. What does the laboratory do with this sample?
This is in fact a common second biohazard class assay which extracts nucleic acid, or DNA. And then a PCR reaction mixture is mixed together (PCR being a polymerase chain reaction, ie. the synthesis of copies of the viral DNA in large replicates), and then a real-time PCR (RT-PCR) is carried out. The entire procedure takes a total of three hours before a response can be issued.
What is included in the RT-PCR reagent kit which is ordered by the laboratory and how many samples can be tested with one kit?
It depends on the kit. If there are commercial kits available, they usually have all this information contained within them. We have a test kit which can handle fifty test analyses. It includes a buffer for the PCR reaction, as well as primers which allow a specific target region of viral DNA to be copied during PCR, and an enzyme which carries out the synthesis reaction. The reagent kit also includes fluorescent molecules, which allow the RT-PCR reaction to be monitored in real time to see whether or not a positive signal is forming. For example, if the DNA of the virus which causes monkeypox is present in the sample, the signal will fluoresce and be visible, and if it is not, there is no signal.
In the laboratory, we prefer to use a ready-to-use reagent kit, which eliminates the need for labour-intensive and resource-intensive reaction optimisation and subsequent validation to implement the method there.
Are all the necessary liquids already inside?
They certainly are. And the test also comes with precise method instructions, so that we simply open the box and mix. It also includes all the necessary checks. For example, it includes an additional control which amplifies a small region of the human genome. If this human gene signal is positive, we know that the reaction most certainly contains material from a human sample.
So if somebody sends a sample containing apple juice, for example, no human genome will be detected?
Yes, there will be no positive response.
Now that you've carried out all your procedures in terms of the monkeypox test, will the answer appear on the computer screen?
Yes. The equipment software provides visualised results. The same is true for coronavirus, so it's pretty similar. But while coronavirus is an RNA-based virus, the monkeypox virus is a DNA-based virus.
Is the laboratory organised in such a way, if a sample arrives with a suspected case of monkeypox, so that it will ensure that there will not be a long queue and that we can tell within three hours whether the sample is positive or not?
Yes. Everything you need has already been organised. The Communicable Diseases Department has sent instructions to Estonian Family Physicians Association along with a referral form. All of the necessary information has also been published on the Health Board’s website. Precisely the same information has been provided to hospitals.
The answers were provided by Janne Pullat, head of the Infectious Diseases Laboratory at the National Health Board, and Irina Eero, senior laboratory specialist.
REQUESTING MORE INFORMATION
In case your health should deteriorate, please call the emergency number ☎️ 112.
If you have any other questions, please contact the Health Board via email: [email protected]