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    Adriane Bevervanso
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    - A man in his 40s presented with a rash and other symptoms after having unprotected sex with a new male partner. He was initially assessed by a family physician and then an infectious disease physician. - Clinical challenges included identifying an appropriate isolation room, ruling out other STIs given diagnostic delays, and addressing patient concerns about paying rent during isolation. - Health system challenges involved educating providers, limited isolation capacity, challenges transporting specimens, and the need to establish pathways for assessing and testing patients at sites with clinical capacity. - Community meetings discussed concerns around stigmatizing imagery, risk of stigma in media, ensuring barrier-free access to vaccines and advocacy.

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    MPox - Early Experience

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    Mpox-EarlyExperience

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    - A man in his 40s presented with a rash and other symptoms after having unprotected sex with a new male partner. He was initially assessed by a family physician and then an infectious disease physician. - Clinical challenges included identifying an appropriate isolation room, ruling out other STIs given diagnostic delays, and addressing patient concerns about paying rent during isolation. - Health system challenges involved educating providers, limited isolation capacity, challenges transporting specimens, and the need to establish pathways for assessing and testing patients at sites with clinical capacity. - Community meetings discussed concerns around stigmatizing imagery, risk of stigma in media, ensuring barrier-free access to vaccines and advocacy.

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    6 views15 pages

    Mpox EarlyExperience

    Uploaded by

    Adriane Bevervanso
    - A man in his 40s presented with a rash and other symptoms after having unprotected sex with a new male partner. He was initially assessed by a family physician and then an infectious disease physician. - Clinical challenges included identifying an appropriate isolation room, ruling out other STIs given diagnostic delays, and addressing patient concerns about paying rent during isolation. - Health system challenges involved educating providers, limited isolation capacity, challenges transporting specimens, and the need to establish pathways for assessing and testing patients at sites with clinical capacity. - Community meetings discussed concerns around stigmatizing imagery, risk of stigma in media, ensuring barrier-free access to vaccines and advocacy.

    Copyright:

    © All Rights Reserved
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    of 15

    Early Experience with

    Monkeypox
    Darrell H. S. Tan MD FRCPC PhD
    June 21, 2020
    I live and work on the traditional
    territories of the Mississaugas of
    the Credit, Anishnabeg,
    Chippewa, Haudenosaunee and
    Wendat peoples.
    Outline
    • Clinical challenges

    • Health system challenges

    • Community concerns
    Traditional teaching on natural history
    Stage Incubation Fever stage Rash stage Recovery
    period

    Timeline 5-21 days 1-4 days 2-4 weeks Days to weeks

    Clinical Enanthem, Macule → Crusted and


    findings Lymphadenop Papule → healing
    athy near end Vesicule →
    Pustule
    Infectivity Nil Low High Nil
    Case: Man in his 40s
    Sex w new M Sex again “Bumps” Headache, malaise, fever,
    partner (give & w same on penis, chills, myalgias, cervical LN,
    receive oral, rim, partner pubic “Bump”
    insertive anal) area on lip Sees Family Physician

    DAY 0 8 12 14 16 19 20

    Seen by ID
    Family Physician assessment day 19

    • Differential diagnosis: HSV-1 or 2, syphilis


    • Diagnostic specimens collected but held back in microbiology lab
    Photos courtesy of Dr S Jaeranny
    ID physician assessment day 20
    • Challenges identifying negative pressure isolation room for assessment

    • Clinical evolution atypical: new lesions at multiple stages of evolution

    • Diagnostic delay due to biosafety considerations in lab: challenges in


    ruling out other STIs, role of empiric therapy (eg. benzathine penicillin)

    • Patient voiced concerns about paying rent given need for isolation
    Evolution of rash
    Clinical challenges
    • Specimen dilution: send in minimal
    (1mL) viral transport medium

    • Diagnostic delays

    • Serology not available

    • Analgesia eg. proctitis


    Health system capacity
    Education / awareness Infection Prevention & Specimen transport
    Control limitations limitations

    Sexual health/PrEP clinics

    Airborne transmission ? Category A → B


    Emergency departments pathogen Limited
    Airborne / droplet / capacity
    contact precautions Transportation of In
    Infectious diseases dangerous goods Healthcare
    Negative pressure rooms training system

    Primary care providers


    Health system challenges
    • Referral pathways
    • Rapid dissemination of information about which sites have clinical capacity to
    assess and test

    • Stewardship of scarce interventions


    • Antivirals (tecovirimat)
    • Vaccine (3rd generation smallpox vaccine)
    Community mobilization meetings since wk
    1
    Concerns Responses
    • Meaningful engagement • Municipal, provincial, federal
    policy-makers as guests
    • Image atlas in development
    • Stigmatizing imagery • Community spokespeople
    • Risk of stigma in media • Walk-in access at vaccine clinics
    • Barrier-free access • Advocacy
    • Financial support during
    isolation
    www.optionslab.ca
    darrell.tan@gmail.com

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