Updated 5.12pm with details on EU plan for vaccine

People with monkeypox are being ordered to isolate at home for 21 days and those with symptoms must also quarantine and seek medical advice.

Superintendent of Public Health Charmaine Gauci issued the guidance as cases of the virus increase in Europe, even though she stressed the virus remains mild.

Malta still has only one confirmed case of monkeypox, after a 38-year-old man, who had recently been abroad in a country hit by the outbreak, tested positive.

Gauci said any positive cases must stay in mandatory isolation for 21 days from when the swab test is carried out. 

"Close contacts are not required to isolate as long as they do not have any symptoms," she told Times of Malta.

"Should they develop symptoms, they are required to isolate at once and seek immediate medical advice."

Monkeypox is now a statutory notifiable disease in Malta, meaning that doctors and laboratories are obliged to inform the public health authorities if they suspect or confirm a case of the virus.

'Avoid risk of spread'

Symptoms of the virus include fever, chills, headache swollen glands, muscle aches, back pain and low energy. This is followed by a rash, that breaks out within one to three days. 

The number of these lesions can range from a few to several thousand, Gauci explained and tend to be concentrated on the face, palms of the hands and soles of the feet. 

A sample is taken from the rash leisons and sent to a laboratory for testing to confirm if it is the virus. 

Gauci also advised anyone with symptoms to take action to avoid the risk of spreading the virus.

"It would be sensible to call ahead and let them know your concerns and not to go to the clinic to avoid risk of spread," she said.

"One should avoid using public transportation and having direct contact with others until a differential diagnosis is carried out by a medical professional," she said.

They are also advised to practice good hand hygiene.

The rash associated with monkeypox can be confused with other diseases including secondary syphilis, herpes, chancroid and chicken pox, she explained. 

Less severe strain

Gauci stressed again that monkeypox infection is usually mild and that the strain currently spreading is associated with a less severe strain.

Most of those who are infected recover within weeks, without requiring any treatment. 

However, there may be a heightened risk of complications with newborn babies, young children and people with underlying immune deficiencies, she added.

"Such complications include skin infections, pneumonia, confusion and eye infections which can lead to loss of vision," she said.

To date, there is no vaccine for monkeypox but the one for smallpox (MVA-BN, also known as Imvamun, Imvanex or Jynneos) offers around 85 per cent protection against monkeypox.

Gauci said that people who were vaccinated against smallpox in the past are likely to have some protection against the monkeypox.

The original smallpox vaccines are no longer available to the public, and those under 50 are unlikely to have been vaccinated against it. 

EU eyes smallpox vaccine for monkeypox

On Thursday the European Union's drug watchdog said it is in talks with the maker of a vaccine against deadly smallpox to extend its use to monkeypox.

The European Medicines Agency (EMA) said it was working with the manufacturer of the Imvanex jab "out of precaution" to ensure it had supplies if needed.

"Despite the outbreak being rather unprecedented in Europe, at present this is not a public health emergency," EMA vaccines chief Marco Cavaleri said.

Monkeypox is related to smallpox, which killed millions around the world every year before it was eradicated in 1980, but has far less severe symptoms.

The WHO says more than 550 monkeypox cases have been confirmed in 30 countries outside the West African nations where it is endemic since the start of May.

Imvanex, made by Danish firm Bavarian Nordic, was authorised by the EMA in 2013 for smallpox, but the maker did not apply at the time for its use against monkeypox.

"The EMA emergency task force is in talks with (maker) to prepare for the submission of data that could support an extension of indication" to monkeypox, Cavaleri said.

Animal data showed that Imvanex was "effective" against monkeypox, he added.

The vaccine would most likely be given to close contacts of people infected with monkeypox to prevent its spread.

The EMA hoped the firm could apply "as soon as possible", Cavaleri said, without giving a timeframe.

The watchdog was also ready to discuss how to increase manufacturing capacity, given that smallpox jabs are in short supply due to its eradication more than four decades ago, he said.

The European Commission told AFP last week it was already working on centralising purchases of vaccines and treatments for monkeypox.

The US has said it has around 1,000 doses of Imvanex, where it is known as JYNNEOS and is already authorised for smallpox.