Updates on Monkeypox

Disease
 Origin
1958 – first identified in laboratory cynomolgus
monkeys in Denmark by Preven von Magnus

1970 - when smallpox was nearly eradicated

- orthopoxvirus named monkeypox was
identified in humans.

The first known human case occurred in the

Equateur province of Zaire (now known as the
Democratic Republic of Congo [DRC])

A 9-year-old boy developed a small poxlike illness,

which was eventually confirmed as human
monkeypox by the World Health Organization
Topic Outline

1. Risk Factors, Signs & Symptoms, and Transmission

2. Diagnosis and Treatment
3. Epidemiology, Case Definition, Global Situation, and
Surveillance - Sample Coordination
4. Sample Collection
5. PDITR Measures
6. Border Surveillance and Control
7. Immigration Reminders for Filipinos Traveling to Monkeypox
Affected Countries
8. Monkeypox in Animal
Risk Factors, Signs & Symptoms,
and Transmission
DR. MARK PASAYAN
Philippine Society for Microbiology & Infectious
Diseases (PSMID)
Diagnosis and Treatment
DR. ARTHUR DESSI ROMAN
Philippine Society for Microbiology & Infectious Diseases (PSMID)
Diagnosis
• Laboratory confirmation is necessary.
• Rule out other rash illnesses
• Chickenpox – Varicella IgM/IgG
• Measles – Measles IgM/IgG
• Bacterial skin infections – GS CS
• Scabies – characteristic ”burrows”
• Syphilis – palms and soles involvement, RPR/VDRL, TPPA
• Medication-associated allergies
Diagnosis: What specimens to
send?
• Vesicular or pustular fluid aspirate
• Crust or roof of skin lesion
• Skin or tissue
 What is the preferred test to
diagnose monkeypox infection?
PCR is the preferred test to indicate the
presence of the virus in the skin
lesions
 Diagnostic Tests Used for Monkeypox
Polymerase Chain Reaction Viral Isolation by Cell Enzyme-linked
(PCR) assay Culture Immune Sorbent
Advantages • Preferred test Indicate the presence of • Detect exposure to the
• Indicate the presence of the virus the virus virus
• Can be used alone, or in • IgM-based serology to
combination with sequencing determine recent
• GeneXpert MPX/OPX assay is exposure
highly sensitive and specific • Paired sera analysis to
compared to real-time quantitative determine recent
MPX PCR assays (gold standard) infection

Disadvantages • No commercial PCR kits available • Limited to high-level • Cross-reactivity

• Cartridge, primers and probes not facilities with expertise between orthopoxvirus
• yet available locally and equipment (e.g. species
US CDC) • Not yet available
• Not yet available locally locally

https://www.who.int/news-room/fact-sheets/detail/monkeypox
Diagnostic Tests Used for Monkeypox
• Other diagnostic assays:
• Whole Genome Sequencing
• Electron microscopy: Brick-shaped poxvirus
• Histopathology: ballooning degeneration of
keratinocytes, prominent spongiosis, dermal edema, and
acute inflammation🡪 non-specific
Ancillary Diagnostic Tests
Ancillary test results are non-specific abnormalities (AST, ALT,
leukocytosis, mild thrombocytopenia, and hypoalbuminemia)

• Recommended: CBC, crea, AST, ALT

• If with significant GI losses: Na, K
• Other differentials: Varicella IgM/IgG, HSV PCR as needed
Treatment
• Supportive care – antipyretics, hydration if with losses
• Keep skin clean, dry with lesions covered with sterile wound
dressing.
• Change bed linens at regular intervals.
• Antibacterial treatment – if with superimposed bacterial
infection
• Cloxacillin or clindamycin
 RITM Management Protocol for Monkeypox 23 May 2022
[DRAFT]

Use of Antivirals
• No proven antiviral therapy.
• Use of current Antivirals based on animal models and dose
studies in healthy humans
• Data not available on effectiveness of antivirals for human monkeypox
and its complications
• Can be used for control of outbreak or for severe cases
• Could only be used under Investigational New Drug (IND)
or Emergency Use Authorization (EUA) protocol
• Currently, no strong recommendation for use from any
international guidance.
 Antivirals against Monkeypox
Tecovirimat (US FDA, July 2018) Cidofovir Brincidofovir (US FDA June 2021) Vaccinia immune globulin
(VIG)
Potent inhibitor of an orthopoxvirus viral competitive inhibitor Analog of cidofovir, inhibits viral Provides passive immunity,
protein p37 required for the formation of an and an alternate DNA polymerase exact MOA not formally
infectious virus particle substrate for CMV DNA known
Treatment of choice in patients with severe polymerase
disease, With or without brincidofovir
Adult: 5 mg/kg weekly x 2 <10 kg: 6 mg/kg on Days 1 and 8 6000 U/kg IV
40 to <120 kg: 600 mg BID for 14 d weeks then 5 mg/kg (oral solution)
≥120 kg: Oral: 600 mg TID for 14 days every other week 10-48kg: 4 mg/kg on Days 1 and 8
(oral solution)
Pediatric: >= 48 kg: 200 mg on Days 1 and 8
13 to <25 kg: 200 mg twice daily for 14 d (solution and capsule)
25 to <40 kg: 400 mg twice daily for 14 d
40 to <120 kg: same as adult
≥120 kg: same as adult
Active in monkey models, likely effective in Active in vitro an in Limited published data, some Treatment of monkeypox
humans mouse models animal models show that it is likely under IND
an effective treatment of FDA-approved for treatment
orthopoxvirus infections of adverse reaction to
smallpox (vaccinia) vaccine
headache, nausea, and abdominal pain Dose dependent Inc AST, ALT. GI upset
proximal tubular injury Blackbox warning; increased
mortlity at higher, prolonged doses,
fetal harm, potential carcinogen
Epidemiology, Case Definition, Global
Situation and Surveillance - Sample
Coordination
ALETHEA R. DE GUZMAN, MD, MCHM, PHSAE
Director IV
Epidemiology Bureau- DOH
Epidemiology: Monkeypox
Outbreak
Monkeypox Cases from Endemic Countries reported to the Monkeypox Cases from Non-Endemic Countries reported to the
WHO (N=1,315) WHO (N=120)
(May 13 - 21, 2022)
No. of No. of No. of
Country No. of Deaths Country
Confirmed Confirmed Suspect
Cases Cases Cases
Cameroon 25 <5 Australia 1-5 -
Central 6 <5 Belgium 1-5 1-5
African
Republic Canada 1-5 11-20
Democratic 1238 57 France 1-5 1-5
Republic of Germany 1-5 -
Congo
Nigeria 46 0 Italy 1-5 -
Netherlands 1-5 -
Portugal 21-30 -
Spain 21-30 6-10
Sweden 1 -5 -
Reference: WHO (2022). Multi-country monkeypox outbreak in United Kingdom 21-30 -
non-endemic countries.
https://www.who.int/emergencies/disease-outbreak-news/item/2022- United States 1 -5 -
DON385#:~:text=During%20human%20monkeypox%20outbreaks%2 C
%20close,factor%20for%20monkeypox%20virus%20infection. Total 92 28
Multi-country Monkeypox Outbreak in Non-endemic
Countries
● Previous cases in non-endemic areas are associated with travel
● From May 13 – 21, 2022, 92 laboratory confirmed and 28 suspect Monkeypox cases
were reported from 12 non-endemic countries to the WHO
● No death reported.
● Majority have been reported amongst men who have sex with men (MSM) seeking care
in primary care and sexual health clinics.
● All laboratory confirmed cases were detected with West African clade.
● No established travel links to an endemic area and have presented through primary
care, secondary care or sexual health services
● The identification of confirmed and suspect cases with no direct travel links to an
endemic area is atypical
WHO Risk
Assessment
Actions taken:
● Ongoing epidemiologic investigation and genomic sequencing to confirm the particular monkeypox virus clade(s)
● Vaccination, where available, provided to manage close contacts

WHO Risk assessment:

● Infection in non-endemic countries seems to have been locally acquired with circulation occurring amongst MSM.
● The extent of local transmission is unclear at this stage and there is the high likelihood of identification of further
cases with unidentified chains of transmission.
● With three countries reporting cases of monkeypox in this population group within a few days, it is therefore highly
likely that other countries may find similar situations.

WHO Advice:
● Intensive public health measures should continue in countries reporting cases.
● Further spread in other Member States is likely, thus, any patient with suspected monkeypox should be investigated
and isolated during the presumed and known infectious periods, that is during the prodromal and rash stages of the
illness, respectively.
Aligning with the Four-Door
Strategy
Aligning with the Four-Door
Strategy
Case Definition: Monkeypox in Non-endemic
Countries
A person of any age presenting with an unexplained acute rash
AND
One or more of the following signs or symptoms:
● Headache;
● Acute onset of fever (>38.5°C);
● Myalgia;
● Back pain;
Suspected ● Asthenia;
Case ● Lymphadenopathy; AND
For which the following common causes of acute rash do not explain the clinical picture: varicella zoster,
herpes zoster, measles, herpes simplex, bacterial skin infections, disseminated gonococcal infection, primary
or secondary syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, molluscum
contagiosum, allergic reaction (e.g., to plants); and any other locally relevant common causes of papular or
vesicular rash.

As per WHO, it is not necessary to obtain negative laboratory results for listed common causes
of rash illness in order to classify a case as suspected.

World Health Organization. (21 May 2022). Multi-country monkeypox outbreak in non-endemic countries.
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
Case Definition: Monkeypox in Non-endemic
Countries
A person meeting the case definition for a suspected case AND
One or more of the following:
● has an epidemiological link (face-to-face exposure, including health care workers without respiratory protection;
Probable Case direct physical contact with skin or skin lesions, including sexual contact; or contact with contaminated materials such
as clothing, bedding or utensils) to a probable or confirmed case of monkeypox in the 21 days before symptom
onset;
● reported travel history to a monkeypox endemic country in the 21 days before symptom onset;
● has had multiple sexual partners in the 21 days before symptom onset.

A case meeting the definition of either a suspected or probable case and is laboratory confirmed for monkeypox virus
Confirmed Case by detection of unique sequences of viral DNA either by real-time polymerase chain reaction (PCR) and/or whole
genome sequencing (WGS).

A contact is defined as a person who, in the period beginning with the onset of the source case’s first symptoms, and
ending when all scabs have fallen off, has had one or more of the following exposures with a probable or confirmed case
of monkeypox:
Close Contact
● face-to-face exposure (including health care workers without appropriate PPE);
● direct physical contact, including sexual contact;
● contact with contaminated materials such as clothing or bedding.

A case meeting the definition of either a suspected or a probable case but tested negative for monkeypox virus
Discarded Case
through RT-PCR or WGS.

Monkeypox Case Investigation Form (CIF) (ICD 10 –CM Code: B04)

Guidelines for Public Health Surveillance
For Human ● Monkeypox shall be classified as a Notifiable Disease
● All primary care providers, clinicians, public health authorities, points of entry, and
institutions/offices shall notify the DOH of any suspect, probable, or confirmed case within
24 hours of detection;
● Reporting of cases or contacts shall utilize the Case Investigation Form (CIF)
● Case investigation shall focus on:
i. Exposure investigation (back tracing) within 21 days prior to symptom
onset;
ii. Characterization of clinical presentation; and
iii. Tracing and profiling of identified contacts.
● Contacts shall be quarantined and closely monitored at least a period of 21 days from
the last contact with a patient or their contaminated materials during the infectious period.

For Animals ● Shipments of rats and primates shall be strictly monitored by the Department of
Agriculture (DA), Department of Environment and Natural Resources (DENR),
and Bureau of Customs (BOC) for animals with monkeypox symptoms.
Laboratory Testing
● Laboratory confirmation of monkeypox shall be done through Reverse Transcription
Polymerase Chain Reaction (RT-PCR) and/or whole-genome sequencing of skin lesion
samples and other samples, as may be included in future policies.
a. Two samples shall be collected and shall need to have sufficient volume to be able
to accommodate parallel testing for differential diagnosis and whole-genome
sequencing (WGS);
b. Sample collection guidelines can be found in Annex C of the Department
Memorandum
c. Samples for WGS must be coordinated with the EB through the Regional
Epidemiology and Surveillance Unit (RESU) for processing either at RITM or
the University of the Philippines-Philippine Genome Center (UP-PGC);
d. The second sample shall be sent to RITM for confirmatory testing through RT-
PCR;
e. The RITM may opt to send out samples for PCR confirmation by its partner facility
in Australia.
Sample Collection
MS. GLAZEL NOROÑA
Science Research Specialist
Research Institute for Tropical Medicine (RITM)
WHO_MOOC_Monkeypox_Module2_Unit_B_EN-6.pdf
 BIOSAFETY MEASURES
• Use of adequate standard operating procedures (SOPs)
• Properly trained laboratory personnel
• All specimens collected for laboratory investigations
-potentially infectious
-handled with caution
• Minimize the risk of laboratory transmission based on risk
assessment
 Any individual meeting the
definition for a suspected case
should be offered testing
SPECIMEN
COLLECTION

WHO_MOOC_Monkeypox_Module2_Unit_B_EN-6.p
df
WHO_MOOC_Monkeypox_Module2_Unit_B_EN-6.pdf
WHO_MOOC_Monkeypox_Module2_Unit_B_EN-6.pdf
WHO_MOOC_Monkeypox_Module2_Unit_B_EN-6.pdf
WHO_MOOC_Monkeypox_Module2_Unit_B_EN-6.pdf
WHO_MOOC_Monkeypox_Module2_Unit_B_EN-6.pdf
SPECIMEN
PACKAGING

WHO_MOOC_Monkeypox_Module2_Unit_B_EN-6.pdf
 SAMPLE REFERRAL TO
DETAILS NEEDED:
RITM
a. Date of Request
b. Region
c. Referring institution/ESU
d. Requesting physician/health worker
e. Outbreak details: Number of cases, location
f. Suspected pathogen
g. Test requested
h. Purpose (i.e. confirmatory testing for outbreak investigation)
i. Specimen type and total number sent
j. Expected date of arrival in testing laboratory
k. Courier (if applicable) including tracking number
l. Shipper’s name, signature, position, institution/agency and contact information
 DOCUMENTS
REQUIRED
a. Completely filled-out
Case Investigation Form
(CIF)/ Case Report Form
(CRF)

b. Linelist of referred
samples
WHEN SENDING SHIPMENT TO
RITM…
For Monkeypox Sample, address shipment to:

MS. JUNE C. CARANDANG

Surveillance and Response Unit
Research Institute for Tropical Medicine
9002 Research Drive Filinvest Corporate City
Alabang Muntinlupa
SCHEDULES FOR PICKUP OF
SAMPLES

Outbreak Samples/EREID Samples

Daily (Monday-Sunday)
Cut off: 3:00 PM PST
 Specimen Quality
(Non-Compliance with Specimen Requirements)
● Inappropriate specimen type for the requested test
● Insufficient quantity
● Leaking/broken container
● Suspicion of contamination or tampering
● Inappropriate transport or storage
● Unknown time delay
● Sample deterioration e.g. hemolysis for serologic samples; bacterial
overgrowth or contamination)
● Unlabeled or illegibly labeled specimen
 Specimen Information
(Non-Compliance with Document Requirements)

●Incomplete documents
●Missing information in documents
 Specimen Coordination
(Non-Compliance with communication/
Coordination Requirements)

● Testing laboratory is not notified of the shipment

● There is no documented by the
acknowledgement laboratory of acceptance of testing
the specimen
RITM SURVEILLANCE AND RESPONSE UNIT

• RITM LANDLINE - (02) 8807-2631 local 412

• SMART – 0919-9279197
• GLOBE – 09153578603
LABORATORY
TESTING
1. PCR Testing
2. Metagenomic Sequencing
PCR WORKFLOW IN
SPL
RELEASING AND REPORTING OF RESULTS

RITM SRU

• shall forward the results to the RESU and EB as soon as

available.

• The RESU shall provide the result to the

referring institution.
 REFERENCES
1. World Health Organization (21 May 2022). Disease Outbreak News; Multi-country
monkeypox outbreak in non-endemic countries. Available at:
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
2. Monkeypox WHO factsheet.
https://www.who.int/news-room/fact-sheets/detail/monkeypox
3. Monkeypox testing. https://cnphi.canada.ca/gts/reference-diagnostic-test/5030?
labId=1021
4. WHO Online course on Monkeypox. https://openwho.org/courses/monkeypox-
intermediate
5. Specimen collection procedures for monkeypox.
https://www.cdc.gov/smallpox/lab-personnel/specimen-collection/specimen-collection-proc

edures.html#tonsillar
6. Specimen transport procedures for monkeypox.
https://www.cdc.gov/smallpox/lab-personnel/specimen-collection/specimen-collection-tran

sport.html
7.Specimen submission procedures for monkeypox.
PDITR Measures
DR. JOSE GERARD B. BELIMAC
Medical Officer V, Division
Chief Adult Health Division
and
Evidence Generation and Management
Division Disease Prevention and Control
Bureau- DOH
PDITR Measures
PREVENT DETECT ISOLATE TREA REINTEGRATE
T
● Avoid contact with: Contact Tracing Infection Control: ● Supportive ● Observe infection
- animals that Case-patients should be Hospital Management control
could harbor the interviewed to elicit - Negative Air ● Antivirals ● Issuance of
virus names and contact Pressure
- - Private Room
Clearance to
any materials, information of all such
such as bedding, persons. Contacts should - minimize exposure to work
that has been in be notified within 24 surrounding persons ● Constant
contact with a sick hours of identification Infection Control: Home implementation of
animal - Isolate in a room or the MPHS
● Isolate infected Testing area separate from
patients from others ● PCR Testing other family members
who could be at ● Metagenomic - should not leave the
risk for infection Sequencing home except as
● Practice good hand ● Differential required for follow-up
hygiene after contact Testing medical care
with infected Processing of specimen - Pets should be
animals or humans. collected shall be through excluded from the ill
● Use personal RITM or Philippine person’s
protective equipment Genome Center (PGC) environment
(PPE) when caring
for patients
● Vaccination

https://www.cdc.gov/poxvirus/monkeypox/prevention.html
Border Surveillance
and Control
DR. CARLOS DELA REYNA, JR.
International Health Surveillance
Division Bureau of Quarantine
Border Surveillance and Border Control
BOQ’s OneHealthPass
• An online registration platform for arriving
traveler
• Electronic Health Declaration Checklist
(eHDC)
• Prior to arrival, we are able to know:
• Passenger’s information
• Medical Status
• Travel History
• Declaration of possible exposure

www.onehealthpass.com.ph
Border Surveillance and Border Control
Heightened Alert at All Points-of-Entry
• Last May 20, 2022, DOH Sec.
Duque instructed BOQ Dir.
Salcedo to heighten the alert
level at POEs for
Monkeypox.
• Dir. Salcedo ordered all BOQ
Stations to conduct stringent
screening for Monkeypox.
• BOQ issued guides to all
stations.
• Assessment of Risk of
Importation was conducted
through Flight Mapping.
Border Surveillance and Border Control
Immigration Reminders for Filipinos Traveling
to Monkeypox Affected Countries
MR. MARLON LIMJAP
Deputy for Operations NAIA
Terminal 1 Bureau of Immigration
Reminders:
1. Refrain from traveling to the abovementioned affected countries if
possible;
2. If passenger cannot refrain from traveling to said affected countries,
then health protocols must be observed such as:
● Proper wearing of masks;
● Frequent handwashing; and
● Social Distancing;

3. Continuous coordination with Bureau of Quarantine and other

related government agencies.
• The Bureau of Immigration is an implementing agency of
DOH-IATF issuances. The Bureau adheres to IATF
Resolutions and issuances in crafting its policies during
this time of pandemic.
• The decision-making of the Bureau of Immigration in the
airport setting is guided by agencies such as the Bureau
of Quarantine (BOQ), who has expertise in the medical
field.
• Travel
protocol and policies are screened by B O Q before
Immigration assessment commences.
The Philippine Strategy on fight
against diseases
• The Bureau of Immigration shall incoporate in our present
policy the Department of Health (DOH) instructions on
monkeypox.
• At present, the Philippines has adopted a four-door
strategy in
intensifying border control to prevent the entry of monkeypox
virus into the country.
• The Bureau of Immigration is the implementing arm which
provides travel restrictions and bans as a separate and
primary level of defense to supplement the currently
implemented health protocols.
Monkeypox in Animal
DR. FEDELINO MALBAS, JR.
Head, Veterinary Research Department
Research Institute for Tropical Medicine
(RITM)
 Etiology
• Monkeypox is a pox diseases of nonhuman primates
similar to variola in man
• MP is a zoonotic disease
• Belongs to Genus Orthopoxvirus related to variola
(smallpox) vaccinia,cowpox,bu ffalo pox and
viruses
camelpox .
• Old , new world monkeys and arthropod apes can
a
beff ecte
d

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 Etiology

• It was also isolated from wild squirrel

(Funisciurus anerythrus )Zaire/ Congo in 1986
• The natural reservoir of monkeypox remains
unknown;however,African rodents and
primates may harbor the virus and
infect people

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 Monkeypox

• 1959- the first known outbreak in

monkeys was reported at the Statens
Seruminstitut Copenhagen/Denmark
• 1976- additional outbreaks in
captive primates have occurred in
Paris

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 Virus
• It is rectangular virus of typical pox virus
structure and of 200 to 250 nano meter
size
• Resistant to ether and relatively resistant
to cold

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 • Monkeypox is endemic in the African
tropical rain forest particularly in
Congo,Zaire ,West and Central Africa
• The virus has repeatedly caused
human infections

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 Transmission
• The monkeypox virus can be transmitted
to humans in bites from animals
,aerosols or by
direct contact with lesions ,blood or
body fluids from an infected persons or
animals .
• Most cases are zoonotic and occur
after contact with infected animal
• Can be spread on fomites

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 Transmission
• Aerogenous transmission is considered to be the main
route of transmission between nonhuman primates and
probably also to other species like man or as in one case
in ant eaters (Myrmecophaga tridactyla)
• The route of transmission in animals is less well
understood . The virus maybe transmitted through
aerosols through skin abrasions or by the ingestions
of infected tissues /meat

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 Pathogenicity
• Initial multiplication of the monkey pox
virus occurs in local cellular
components ,most probably in fixed or
wandering connective tissue cells
• In experimentally infected Macacca
fascicularis a constant viremia appeared
between the 23 rd and 4 th day P.I.

RESEARCH INSTITUTE FOR TROPICAL 7575

 Clinical symptoms
NHP : Differences exist in the susceptibility of
the di ff erent host species. Anthropod apes
are usually more severely a ff ected than
monkeys , while cynomolgus monkeys su ff er
more than rhesus monkeys.
• After an incubation period of usually 3 to 4
days a sharp temperature rise heralds the
onset of the disease .

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 Clinical symptoms
• Animals become anxious with older
ones
• Aggressive
• Anorexia
• With behavioral abnormalities such:
- sucking on fingers
- inflammation of the lips

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 Clinical symptoms
As to development of the pocks (sores)
two types of lesions can be
distinguished:
1st type of lesion
• Acute marked facial edema
• Ulceration in mucous membranes
and papule formation

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 Clinical symptoms

1st type of lesion

• General lymphadenopathy ,respiratory distress
• Death from asphyxia
• Arthropod apes are especially prone to
such severe infection (chimps,gorilla
orangutan,bonobo)

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 Clinical symptoms
2 nd type of lesion
• Infection occurs as a benign cutaneous eruption
• 7-8 days after experimental infection itching
and vesicular exanthema are
common
• Occasional coughing and mucopurulent nasal
discharge indicate the presence of early
lesions in the respiratory tract

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 Clinical symptoms
2nd type of lesion
• Ist typical pocks appears as papules of 1 to 4
mm.in diameter
• Develop into pustules containing thick
purulent material
• Vesicles become umbilicated & covered by crusts
or scabs
• Desquamation of scabs or crusts within 7 to 10
days & small scars remain

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 Clinical Symptoms
Most common sites of pocks/sore formation in monkeys
• Buttocks
• Hands
• Feet
• Mucous membrane of the tongue
• Oral cavity
• Pharynx ,larynx,trachea
• Spleen,tonsils, lymph nodes testes and ovaries

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 Infection in other Animals
Rabbits Rodents and Prarie Dogs initial signs
• Fever
• Conjunctivitis
• Nasal discharge
• Cough
• Lymphadenopathy
• Anorexia
• Lethargy

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 Infection
…
Animals may then develop the following:
• Nodular rash
• Pustules
• Patchy alopecia
• Presence of pneumonia

The veterinarians should consider those signs.

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 Treatment
• Treatment is mainly supportive
• Antiretroviral drug cidofovir is effectiv e in
vitro animal studies
• Prevention of secondary infection
using antibiotics in NHP
• Endangered animals can be protected/useful
by variola –vaccination

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 Way Forward
• Avoiding contact with infected animals ( dead or sick animals).
• Avoiding contact with bedding and other materials
contaminated with the virus.
• Washing your hands with soap and water after coming
into contact with an infected animal.
• Cook foods thoroughly that contains animal meat or
parts .
• Avoid contact with people who may be infected with the
virus.
• PPE when caring for people or animals infected with
the virus.
• Shipment of rats and NHP shall be strictly monitored
by DA-BAI,DENR and BOC for animals with MP
symptoms.
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 References
• Manfred Brack.Agents Transmissible from Simians to Man .Springer –Verlag
Berlin Heidelberg New York London Paris Tokyo;Spring 1987 pp.10-17
• Interim case definition for Animal Cases of Monkeypox . ‘’Centers for Disease Control
a n d Prevention (CDC)June 2003 ,30 June 2003
• Baskin, G.B. “Pathology of nonhuman primates.” Primate Info Net. Feb 2002 Wisconsin
Primate Research Center. 27 June 2003
<http://www.primate.wisc.edu/pin/pola6-99.html>
• Baxby, D. “Poxviruses.” In Medical Microbiology. 4 th ed.Edited by Samuel Baron .
New York; Churchill Livingstone, 1996. 27 June 2003
<http://www.gsbs.utmb.edu/microbook/ch069.htm>
• Schoeb, T.R. “Diseases of laboratory primates.” 27 June
2003
<http://netvet.wustl.edu/species/primates/primate1.txt>.

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Link to the Facebook Town
Hall Session
https://www.facebook.com/230411089125671/videos/280086930926077
 Announcement!!!!!

Philhealth Accreditation
Marilao Local Health System
Thank You!!