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Clinical Update: MPOX

When to suspect mpox
One or more of:

  • Unexplained recent onset rash (single or multiple lesions)
  • Mucosal lesions (single or multiple lesions which may be oral, conjunctival, urethral, penile, vaginal or anorectal)
  • Proctitis (tenesmus; rectal pain or bleeding)
  • Acute illness with fever (38.5C or greater), headache, myalgia, back pain, arthralgia, lymphadenopathy, asthenia, fatigue

AND EITHER

1.    Travel history to countries where clade I mpox is endemic [country list here]
OR
2.    Close contact with a confirmed or suspected case of clade I mpox

When mpox is suspected, the immediate actions required include:

  • Try to manage the case over the phone if possible – advise the person to confine themselves to one room, ideally with an ensuite bathroom, pending further instruction
  • For face-to-face consultations with suspected mpox, don PPE (including a gown, FFP2/3 mask, gloves and if there is a risk of splashing fluids to the face, a visor/goggles)
  • The patient should be moved away from other staff and patients and occupy a room alone.  It may be possible to be assessed in a car
  • Assess the clinical status of the person (by phone or face-to-face)
  • Contact the local infectious disease (ID) physician or clinical microbiologist for advice about transfer to the hospital for testing.  ID or microbiology can arrange scheduled ambulance transport to the hospital.  Whilst GPs can’t arrange scheduled transfers, if there is clinical urgency, GPs can request an emergency ambulance.  In these circumstances, pre-notify the National Ambulance Service and the receiving hospital of possible mpox clade I status

Subsequent steps 

  • Collect names of the people present in the building and the nature of their contact with the suspected case for future contact tracing (proximity, duration of contact)
  • The rooms in which the patient was present in the practice should not be used until they have had environmental cleaning and disinfection

Clinical Topic: Infection Control

Infection prevention and control aims to improve awareness and knowledge; enhance surveillance of antibiotic resistance and antibiotic use; reduce the spread of infection and disease; and optimise the use of antimicrobials in human health.

Clinical Update: Parvovirus B19

In 2024, there has been an increase in detected cases of parvovirus B19 both in Ireland and internationally.

View Occupational advice for non-immune pregnant women who are contacts of one or more highly suspected or confirmed case of parvovirus B19 infection (B19).

Non-immune women under 22/40 should not work in settings where there is a current outbreak of B19.

Non-immune women under 22/40 exposed to a single case of known or highly suspected B19 may need to stay off work – details are available in the guidance linked above.

Clinical Update: Norovirus

Unseasonal Increase in Norovirus Activity
  • Maintain a high index of suspicion for Norovirus - assume all vomitus is infectious
  • When two or more people in the same building/area/group develop vomiting within a day or so, it is likely to be norovirus
  • Clean and decontaminate soiled areas immediately
    Strict attention to routine hygiene/precautions and implementation of heightened cleaning/disinfection during outbreaks
  • Exclude ill staff from work until 48 hours after the last episode of vomiting/diarrhoea
  • Cohort ill patients to prevent further transmission
  • Advise facilities to involve IPC colleagues at the earliest stage
Background

The HPSC have identified a period of moderately increased norovirus activity that has the potential to impact acute and residential facilities.  This period of heightened activity could continue for some weeks.  A similar increase in Noroviral illness has been seen in the UK, in some European countries and in the USA.

Clinical

Norovirus usually presents with sudden onset nausea and vomiting (often projectile), concurrent watery diarrhoea, and abdominal cramps.  Low grade fever, headache, myalgia, and chills are commonly reported.  Although generally mild, the elderly and immunocompromised are at increased risk of severe illness and dehydration.

When two or more people in the same building/area/group develop vomiting within a day or so, there is a high likelihood that it is norovirus

Duration of illness tends to be between one and three days. Patients should not return to work/school for 48 hours after resolution of all symptoms.  Patients may continue to shed virus for some days, so careful hand hygiene is necessary on return to work/school. 

In primary care, diagnosis of norovirus is primarily clinical; the characteristic nature of symptoms means that testing/virological confirmation is not required, except in community congregate settings.  Further guidance is available in Infectious Intestinal Disease: Public Health & Clinical Guidance (page 12).

Diagnosis can be confirmed by faecal PCR analysis.  Testing for norovirus is normally only performed in the context of a known/suspected outbreak (in an acute or residential health care setting, or in a community setting e.g. a hotel or school).  This will then guide public health management.  

During outbreaks, strict attention to routine hygiene/precautions and implementation of heightened cleaning/disinfection during outbreaks in facilities is necessary.

Noroviral illness is a notifiable disease.  Notify your local department of public health

Health Protection

View further guidance, including Interim Guidance Note on the Management of Norovirus in Residential Care Settings