Memo for Persons Who Had a High-Risk Contact with an Identified Case of Monkeypox

This is to inform you that you had a high-risk contact with a person who has been diagnosed with monkeypox and must adhere to the requirements specified in this memo.
Monkeypox (MP) is a zoonosis caused by the monkeypox virus (MPV) belonging to Orthopoxvirus genus in the  family Poxviridae.
MPV enters the body through lesions (even if the lesion is not visible), the respiratory tract or mucous membranes (eyes, nose or mouth). MP transmission can occur from a direct contact with the blood, bodily fluids or cutaneous or mucosal lesions of infected animals. Transmission may occur from a contact with an infected person, but such transmission is extremely rare. Human-to-human transmission can occur via:
•    Air droplets in prolonged face-to-face interaction with an infected individual;
•    Direct contact with infected skin or scabs;
•    Contact with the clothes, bedding, towels etc. Of an infected individual;
•    Close and intimate contact during sexual intercourse.

Individuals living with an infected person are exposed to the greatest risk of infection when using the same bedding, towels, etc.

The incubation period of the disease is 5-21 days (usually 6-13 days). MP is manifested by fever (the temperature is usually high >38.5 °C), fatigue, headaches, myalgia, and enlarged lymph nodes. Within three days after the onset of symptoms of the disease, a rash develops, which progresses from flat reddish spots to vesicles filled with clear liquid or pus, until finally scabs form.
Most of the infected develop mild to moderate symptoms which tend to go away naturally and recovery takes from 2 to 4 weeks.
Although MP is not a disease that spreads from person to person very easily, individuals who had a high-risk contact with the infected should observe the state of their health for  21 days after exposure and follow the established requirements:
1. Watch out for MP symptoms such as:
•    Fever;
•    Enlarged lymph nodes (lymphadenopathy);
•    Rashes;
•    Other nonspecific symptoms: fatigue, headaches, myalgia, etc.
2. Measure your body temperature twice a day;

3. Only asymptomatic people exposed to MPV can continue with their normal daily activities, such as going to work and school (i.e., isolation is not necessary).
During the observation, these persons should not leave their place of residence, e.g. go to another region of Lithuania, another country.

4. With the development of MP symptoms, consult a doctor and isolate:
    If during symptom observation period only non-specific symptoms of the disease develop (fever, enlarged lymph nodes, fatigue, headache, myalgia, but there is no rash), you need to isolate on a separate floor or in a separate room for 7 days and watch out for development of a rash (during this period, if necessary, the doctor may issue you an electronic sick leave). If a rash does not develop within 7 days and the fever passes, the isolation is no longer obligatory, but you need to continue observing your state of health and measuring the temperature until the 21-day period ends;
    If a rash of unknown origin and other MP symptoms appear, you must contact your doctor for diagnosis and isolate on a separate floor or in a separate room until the diagnosis is confirmed. If the diagnosis of MP has not been confirmed, the isolation is no longer obligatory, but individuals must continue to observe their state of health until the 21-day period ends.

5. Observe hand hygiene, cough and sneeze etiquette;
6. Avoid physical contact (e.g. hugging, kissing, handshaking), especially with young children, pregnant women, persons with weakened immune systems;
7. Avoid sexual intercourse (even „safe sex“) and close physical contact with other persons (the use of condoms cannot provide complete protection against MPV transmission);
8. Avoid any contacts with domestic and other animals (mammals) for 21 days from the last contact with an infected individual;
9. At least 21 days after exposure to MP, individuals should not donate blood, organs or bone marrow.

If you do not develop MP symptoms within 21 days after the contact, you can maintain a normal life.

During symptom observation period, you can be contacted by National Public Health specialists, therefore you should be available by phone and/or e-mail for the entire period.

For more information on MP and high-risk contacts see websites of the Ministry of Health and the National Public Health Centre:
https://nvsc.lrv.lt/bezdzioniu-raupai
https://sam.lrv.lt/lt/veiklos-sritys/visuomenes-sveikatos-prieziura/uzkreciamuju-ligu-valdymas