The Ministry of Health updated its action protocol for early detection and case management before the health alert of monkeypox. A review in which the department headed by Carolina Darias has included definition from serious clinical pictures and how to retrieve and ship the samples.
The document approved by the Conference on Warnings and Preparedness and Response Plans ensures that in the event of severe clinical picture It is recommended that you send samples to the National Center for Microbiology (ISCIII) for complete microbiological investigation of the case and sequencing of the viral genomeif deemed appropriate.
For this purpose, the recommended samples will be determined based on the observed clinical picture. Thus, before a neurological manifestationThe Ministry decrees that it must be collected cerebrospinal fluid (CSF). While in case of pneumonia respiratory samples (isputum, bronchoalveolar lavage, nasopharyngeal exudate, etc.). In addition, if possible, a skin lesion sampledamn whey
In case of “fatal evolution”Health finds that the necropsies must be sent freshnever embedded in paraffin or in formalin, as these processes compromise the viability of the virus and therefore the cost-effectiveness of subsequent culture for virological characterization.
“Shipment must be made in triple pack and chilled (2-8ºC). If samples have already been frozen, they will be shipped on dry ice to avoid consecutive thaw-freeze processes,” Health explains.
Reporting of severe cases
Once the investigated cases are considered cases of particular gravity, Health establishes it must be notified urgently of the public health services of the autonomous community. They will in turn notify the Coordination Center for Health Alerts and Emergencies (CCAES) for follow-up action.
“The cases considered would be pneumonia, encephalitis or meningoencephalitis, pharyngeal lesions which prevent the absorption of liquids and/or represent a complete or partial compromise of the respiratory tract or other complications which, according to clinical judgment, are particularly serious”, the ministry specifies.
How to retrieve the samples?
Health had already established this before case under investigation, sampling indicated must be derived from skin injury. Specifically, you should take a sample of vesicular fluid, patches of vesicular lesions, exudates, or crusts. In addition, they must be sent in a virus transport medium and stored cold.
“If it shows was not available or other further studies are needed, they may be use others samples such as buccal or pharyngeal mucosal swabs or anal swabs,” Health explains in its monkeypox action protocol.
Who analyzes the samples?
The health agency has established that the samples will be sent to those laboratories with diagnostic capacity for monkeypox that the autonomous community indicates or, if this is not possible, to the National Center of Microbiology (CNM).
“The the first ten samples were analyzed in the laboratories of the autonomous communities will be sent to CNM to confirm the result. It is recommended that you contact the CNM before sending the samples,” Health clarifies.
In addition, the request to send a sample to a reference laboratory by the doctors must be validated by public health services of the autonomous communities.
How are monkeypox samples sent?
The portfolio, led by Carolina Darias, yielded a range of third class agent to monkeypox. To be able to be performed in laboratories with a level of BSL2 biosafety using more stringent type 3 precautions.
“The samples will be sent, in accordance with the established in transport of dangerous goods by road in Spanish territory, such as category A goods compliance with the prescriptions of the regulation for UN number 2814″, specify the health agency.
These samples will be saved and sent in a viral transport medium. Although they can also be shipped in a dry tube. In the event that they need to be stored for some time before being shipped, they will be stored, according to the particular health department, at four degrees Celsius.
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