Monkeypox and dentistry
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- Published: Tuesday, 31 May 2022 07:57
- Written by Peter Ingle
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The daily reports on Monkeypox show a steady increase in case numbers both in the UK and worldwide. Will this affect UK dentistry? Must colleagues be on the lookout?
It is clearly too early to know how widely it will spread and how severely it will affect our lives. Despite this, the experiences of the last 30 months have left many uneasy about where this particular virus will take us. Recent published guidance raises some difficult questions for dental practices.
Dental practices are still recovering from the effects of Covid 19. There is an acceptance that there may not be a complete return to all of the ways that teams were working in January 2020. Knowledge of Monkeypox, including its transmission, is still developing, though there seems to be agreement on some aspects. It has a long incubation time, as much as 21 days. It can be spread in a variety of ways, according to the American Centre for Disease Control, ‘the virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes’. It adds that, ‘human-to-human transmission is thought to occur primarily through large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.’
The possibility of spread in clinical settings has already affected some parts of the health service. Dr Claire Dewsnap, a consultant in genitourinary medicine and president of the British Association for Sexual Health and HIV, said staff in sexual health clinics were "already under significant pressure" and monkeypox was making that situation worse. "It is already stretching the workforce and will have a massive impact if staff have to isolate if they are in close contact with someone who’s infected," Dr Dewsnap said.
Case definitions for the UK have recently been provided: Monkeypox: case definitions - GOV.UK (www.gov.uk)
More information at this site, too https://www.gov.uk/guidance/monkeypox
In summary these are divided into three groups:
Possible cases, these would include, an individual with a febrile prodrome, that is fever ≥ 38°C, chills, headache, exhaustion, muscle aches, joint pain, backache, and swollen lymph nodes. This is where there is known prior contact with a confirmed case in the 21 days before symptom onset. Alternatively clinical suspicion based upon factors such as the Monkeypox rash.
Probable cases include those with a Monkeypox compatible rash plus at least one of a further three epidemiological criteria.
Confirmed cases will be on the basis of a positive PCR test for the virus.
Also recently published is Monkeypox contact tracing classification and vaccination matrix. V6.1 20 May 2022 Monkeypox contact tracing guidance: classification of contacts and advice for vaccination and follow up (publishing.service.gov.uk)
The matrix could make worrying reading for dental practices. An example of the highest risk exposure, at level 3 is given as ‘Contact in room during aerosolgenerating procedure without appropriate respiratory PPE.’ Appropriate PPE is set out in a footnote as ‘a minimum: FFP3 respirator, long sleeved gown, gloves and eye protection.’
So to consider just one possibility. Tomorrow, a patient seen last week phones the practice to say that they have just tested positive for Monkeypox. They had a session of ultrasonic scaling with the clinician and assistant, wearing as per current guidelines, fluid resistant masks. Since then the clinician and assistant have carried out another 20 AGP’s with similar PPE. Reading the matrix it would seem that a case can be made for 21 day isolation of the dental team, and potentially, tracing of their subsequent AGP patients. The effect this would have on a practice, particularly those struggling to achieve the 95% UDA target, would be dramatic. It would also add to the access crisis.
After a day playing the email equivalent of snakes and ladders, GDPUK did get a response from the United Kingdom Health Security Agency, (UKHSA) regarding the situation described above:
“Thanks for getting in contact. I’m afraid we aren’t able to speculate on potential scenarios, contacts are categorised by tracing teams following verbal assessment based on their level of contact with the infected individual and the likelihood that they may have contracted the infection.”
GDPUK, hopes that this remains a hypothetical problem for practices, and will keep readers updated.
UKHSA refusal to comment upon typical scenario?
The reply in this article from UKHSA is somewhat worrying, that they can't/won't comment upon such theoretical scenarios like a patient calling a Practice a week after an AGP saying they have MonkeyPox infection etc.This is likely to be an increasingly likely scenario, especially with international travel and visitors going exponential in the coming Summer months :o
Almost everything imposed upon Dentistry for covid-prevention was based upon 'hypothetical' risks not actual, as exemplified from our dental colleagues in many many other Countries able to work without additional PPE requirements and NO outbreaks associated with dental practices basically!
Apparently although low numbers at this early stage, I was somewhat surprised to hear on the news that of all the cases diagnosed, half were in the UK.
It won't take much to have more 'hypothetical' impositions placed upon our Profession if cases increase, along with public fear!
Yours keeping the PAPR preventively,
Tony.
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