Transplant organization releases guidance on monkeypox
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The American Society of Transplantation has released guidance on preventive measures and treatment of monkeypox for individuals with an organ transplant, along with guidance for accepting donated organs from individuals with the virus.
“This communication is intended to inform the transplant community of the potential risk caused by monkeypox to our transplant patients,” members of the American Society of Transplantation Monkeypox Task Force wrote. “While there have been no published data on monkeypox in transplant recipients, there is an imminent threat to this immunocompromised group of patients, if the ongoing human-to-human spread continues.”
Public health emergency
The task force reported that thousands of cases of monkeypox have been reported in at least 75 countries and territories across the world. On July 21, the WHO declared the monkeypox outbreak as a public health emergency of international concern.
Monkeypox can be transmitted through animal-to-human transmission and can occur from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. “Human-to-human transmission of monkeypox can result from close contact with respiratory droplets and by direct contact with infected body fluids, and skin or mucosal lesions. Since respiratory droplets generally cannot travel more than a few feet, prolonged face-to-face contact is required for transmission.
“Indirect contact with an infected material through fomites, such as clothing, bedding, towels, and contaminated surfaces, has been documented,” the task force wrote. Transmission can also occur through the placenta from mother to fetus or during close contact during and after birth.
Symptoms
Common symptoms include fever, lymphadenopathy and other non-specific symptoms, such as malaise, headache and myalgia, the task force wrote. Most immunocompetent patients with monkeypox will develop mild disease and recover without medical intervention. “Supportive clinical care should be provided to patients to alleviate symptoms, manage complications, and prevent long-term sequelae,” the task force wrote.
Currently, there is no FDA-approved treatment for the monkeypox virus. “A few investigational drugs are available for treatment, under the guidance of public health and infectious disease specialists. Given sparse evidence for treatment efficacy of these investigational drugs, shared decision-making between the patient, primary transplant provider and transplant infectious diseases specialist is recommended,” the task force wrote.
Infected patients should isolate and avoid contact with uninfected household members and should cover all exposed skin lesions.
“The transplant recipient should discuss with their providers if they are eligible for treatment or post-exposure prophylaxis,” the taskforce wrote. “A transplant recipient living with someone with active monkeypox is potentially exposed and may benefit from post-exposure prophylaxis.”
The pre-procurement evaluation of living and deceased donors should include questions to assess the risk of monkeypox exposure or active infection, according to the task force. “The physical examination of living and deceased donors should assess for skin and mucosal lesions, including the anogenital regions, and suspected lesions be tested for monkeypox,” the task force wrote. “Living donors with recent exposure and [who] are asymptomatic should consider deferring organ donation until they are beyond the 21-day incubation period and have remained asymptomatic,” the task force added.
Reference:
- Monkeypox FAQ for transplant community. https://www.myast.org/monkeypox-faqs-transplant-community. Published Aug. 4, 2022. Accessed Sept. 16, 2022.
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