While the first monkeypox case has already been recorded in the Philippines, the public should not panic too much as the Department of Health (DOH) has already issued a memorandum as early as May of this year on how to respond to this new public health emergency of international concern (PHEIC).
During the webinar titled “Monkeypox, nandito na. Are we ready?” by the University of the Philippines in partnership with UP Manila NIH National Telehealth Center and in cooperation with UP Philippine General Hospital, Dr. Regina Berba, Chair, Infection Control Unit, UP Philippine General Hospital, said there is a need for an up-to-date and relevant response to monkeypox.
“There is a need for all the countries in the world to be involved and have that global solidarity to stop this from evolving into something far worse,” she said.
She said that if the country is to identify the objectives of the response, it should be to identify cases efficiently, reduce new cases, reduce confusion, reduce the stigma, and protect the health-care workers (HCWs).
“It’s important for our responses on an institutional level, collectively and individually, because we don’t want to lose our patients. We want them to come to us and be diagnosed as efficiently as possible and hope to achieve all the identified objectives,” she said.
How to deal with suspect patients?
Dr. Berba said there should be a pathway on how suspect patients can be brought to specific areas in a hospital where they can be treated. She cited that at the PGH, they have already posted information posters on monkeypox and where the clinics are, and informed their large infectious disease community of HCWs, all of whom may be asked to manage patients who are suspect or probable cases.
The patients with a rash may also be brought to the PGH’s SAGIP clinic, the dermatology clinic or even the emergency room. There is also the need to create a pathway and make the facility safe and efficient for patients like setting up the facility first before the first patient arrives, get all the needs for diagnostics like kits and PPEs, plus set up a courier network that will bring diagnostic samples to the Research Institute for Tropical Medicine (RITM), and network with the local Epidemiology Bureau (EB) and the Regional Epidemiology Surveillance Unit (RESU).
In terms of facility response, Dr. Berba said it boils down to two areas: identifying an isolation area for suspected monkeypox cases, which should be a stand-alone, dedicated facility where monkeypox cases should not be mixed with other patients; and have a process in place for referral of suspected cases for monkeypox testing or transfer to designated referral centers.
“Even before a suspect case is identified in the facility, the infection prevention and control unit [IPCU] should already coordinate with the local epidemiology surveillance units, whether municipal, city or regional, to determine the procedures to be followed in the event a monkeypox case is identified in the facility. This process should be worked on, written, and modified accordingly,” she said.
At the UP-PGH, Dr. Berba said they have created an interim pathway for monkeypox cases, sort of a flowchart or more of a checklist where there are questions with a corresponding action depending on the answer to the questions.
Initially, Dr. Berba said that they will admit patients who will answer “Yes” to the questions, but she learned from Dr. Franco Felizarta, Infectious Disease Specialist and is part of the UP Medical Alumni Association in America (UPMASA), that not all monkeypox cases may have to be admitted because they may not be sick so they would be discharged.
“The pathway should be fluid, people should know what to do, what to expect and how to take care of themselves once the patient arrives,” she added.
Screening the rash
This involves determining whether the suspect is monkeypox or not like the appearance of a rash, the other links like travel history in the past 21 days, were there multiple sex partners in the last 21 days, and other epidemiologic links. A checklist should also be handy, a fully accomplished Monkeypox Case Investigation Form (CIF) that is like the Covid-19 tracking form, then collection of specimens and instructions on proper collection of specimens.
However, Dr. Berba reiterated that not all rashes are monkeypox so there’s dengue, syphilis, chickenpox, herpes, measles, other skin lesions or even non-infectious hypersensitivity reactions.