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Singapore - WHO disease outbreak news report on Monkeypox - May 16, 2019

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  • Singapore - WHO disease outbreak news report on Monkeypox - May 16, 2019

    Monkeypox – Singapore

    Disease outbreak news
    16 May 2019

    On 9 May 2019, the Ministry of Health (MOH) in Singapore notified WHO of one laboratory-confirmed case of monkeypox. The case-patient is a 38 year old Nigerian man who arrived in Singapore on 28 April 2019 and attended a workshop from 29-30 April. Prior to his travel to Singapore, he had worked in the Delta state in Nigeria, and had attended a wedding on 21 April 2019 in a village in Ebonyi State, Nigeria.
    The patient developed fever, muscle aches, chills and skin rash on 30 April. He reported that he had remained in his hotel room most of the time between 1 and 7 May. He was transferred to a public hospital by ambulance on 7 May and referred to the National Centre for Infectious Diseases (NCID) on the same day, where he was isolated for further management. Skin lesion samples were taken on 8 May and tested positive for monkeypox virus by the National Public Health Laboratory on the same day. He is currently in a stable condition.
    Public health response

    Based on investigations thus far, authorities in Singapore have traced and contacted a total of 23 close contacts, including 18 participants and trainers who attended the same workshop, one staff at the workshop venue, and four hotel staff who had close contact with the affected individual. Healthcare workers who were in contact with the patient had used personal protection equipment. MOH’s investigation and contact tracing operations are ongoing.
    One of the 18 workshop participants had left Singapore before the patient was diagnosed. This contact is a Nigerian national who travelled by air to Nigeria on 5 May. The Nigerian national IHR focal point has been provided with details of the contact for follow up action, as necessary. Potential sources of exposure and possible epidemiological links within Nigeria are currently being investigated.
    Close contacts of the affected individual were referred to NCID for further assessment and offered post-exposure prophylaxis with smallpox vaccination, which can prevent disease or reduce the severity of symptoms. As of 15 May 2019, 14 persons were vaccinated. As a precautionary measure, close contacts have been quarantined either at home or designated government quarantine facility and monitored for 21 days from their date of exposure to the confirmed case. If anyone develops symptoms, they will be treated at NCID. All other contacts, who have a low risk of being infected, have been placed under active surveillance, and will be contacted twice daily to monitor their health status.
    Singapore MOH released a press statement on 9 May 2019, providing information about the situation, advice for the public, and measures being taken to minimize the risk of any potential onward transmission of the disease.
    WHO risk assessment

    Monkeypox is a sylvatic zoonosis with incidental human infections that occur sporadically in parts of Central and West Africa. It is caused by the monkeypox virus (MPXV) and belongs to the Orthopoxvirus family. The disease is self-limiting, with symptoms usually resolving spontaneously within 14-21 days. There is currently no vaccine specifically for monkeypox. The animal reservoir remains unknown, although it is likely to include rodents. Direct contact with affected live or dead animals through hunting and consumption of bush meat are presumed drivers of human infection.
    This is the first diagnosed case of monkeypox infection in Singapore. The patient was a traveller arriving from Nigeria, where a multistate monkeypox outbreak has been ongoing since September 2017.
    Given that authorities in Singapore have promptly initiated appropriate public health measures, including isolation of the primary case, contact tracing and quarantine, surveillance and risk communication, the risk of onward spread in the country is low.
    WHO advice

    Residents and travelers to endemic areas/countries should avoid contact with sick, dead or live animals that could harbor MPXV (rodents, marsupials, and primates) and should refrain from eating or handling bush meat. Hand hygiene using soap and water, or alcohol-based sanitizer should be emphasized. Any illness during travel or upon return should be reported to a health professional, including information about all recent travel and immunization history. There is no specific treatment or vaccine for the MPXV infection.
    Timely contact tracing, surveillance measures and raising awareness of imported emerging diseases among health care providers are essential to prevent secondary cases and effectively manage monkeypox cases and outbreaks.
    Health-care workers caring for patients with suspected or confirmed MPXV infection should implement standard, contact and droplet infection control precautions. Samples taken from people and animals with suspected MPXV infection should be handled by trained staff working in suitably equipped laboratories.
    WHO does not recommend any restriction for travel to, or trade with, Singapore or Nigeria based on available information at this time.
    For more information on Monkeypox: