The Ministry of Health has updated his action protocol for the early detection and management of cases before the health alert of the monkey pox. A review in which the department led by Carolina Darias has included the definition of the serious clinical pictures and how to extract and send the samples.
In the document agreed by the Conference on Alerts and Preparedness and Response Plans, it is ensured that in the event of a severe clinical picture It is recommended to send samples to the National Center for Microbiology (ISCIII) for the complete microbiological study of the case and sequencing of the viral genomeif deemed appropriate.
For this, the recommended samples will be determined based on the clinical picture observed. Thus, before a neurological manifestationthe Ministry stipulates that it must be collected cerebrospinal fluid (CSF). While in case of pneumonia, respiratory samples (andsputum, bronchoalveolar lavage, nasopharyngeal exudate, etc.). In addition, if possible, a skin lesion samplewoe whey
In case of “fatal evolution”Health establishes that the necropsies must be sent freshnever paraffin-embedded or in formalin, since these processes compromise viral viability and thus the profitability of subsequent culture for virological characterization.
“The shipment must be made in triple packaging and refrigerated (2-8ºC). If the samples were already frozen, they would be sent on dry ice to avoid successive thawing-freezing processes”, explains Health.
Severe Case Reporting
Once the cases under investigation that are considered cases of special gravity, Health establishes that must be notified urgently to the public health services of the autonomous community. These in turn will notify the Coordination Center for Health Alerts and Emergencies (CCAES) for follow-up.
“The cases considered would be pneumonia, encephalitis or meningoencephalitis, pharyngeal lesions that prevent the swallowing of liquids and/or present total or partial compromise of the airway or other complications that, in clinical judgment, are especially serious”, details the Ministry.
How to extract the samples?
Health had already established that before a case under investigation, sampling is indicated must be extracted from skin injury. Specifically, you have to take the sample of vesicular fluid, smears of vesicular lesions, exudates or crusts. In addition, these must be shipped in virus transport medium and kept cold.
“If this shows was not available or other additional studies are required, they could be use others samples such as buccal or pharyngeal mucosal smears or anal smears”, clarifies Health in its action protocol against monkeypox.
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 designates or, failing that, to the National Center for Microbiology (CNM).
“The first ten samples analyzed in the laboratories of the autonomous communities will be sent to the CNM to confirm the result. It is recommended to contact the CNM prior to sending the samples”, details Health.
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 shipped?
The portfolio led by Carolina Darias has given a range of class three agent to monkeypox. So that it can be carried out in laboratories with a level of BSL2 biosafety using stricter type 3 precautions.
“The samples will be sent, in accordance with what is established in the dangerous goods transport operations by road in Spanish territory, such as category A merchandise complying with the prescriptions of the regulations for UN number 2814 ”, details the health agency.
These samples will be kept and sent in virus transport medium. Although they can also be sent in a dry tube. In the event that they have to be kept for a period of time before they are sent, they will be stored, according to the specific Health Department, at four degrees Celsius.
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