Health
Ministry of Health Provides an Update on Monkeypox
#TurksandCaicos, May 23, 2022 – The Ministry of Health and Human Services has been carefully monitoring reports of monkeypox which have been increasing and are being reported in multiple countries across Europe (Spain, Portugal, Germany, Belgium, France, the Netherlands, Italy and Sweden), the US, Canada and Australia. 12 countries which are not endemic for monkeypox, so far have reported at least 92 confirmed cases with 28 pending investigations. More cases are likely to be reported as surveillance expands.
Although no cases have been reported in the Caribbean, it is important that persons are aware of the situation as it continues to evolve.
Monkeypox is a viral illness and is found in a number of countries in Central and West Africa. The more recent news of spread to countries without known endemic disease is unusual. Cases may occur in persons who have travelled from Nigeria or who have been in contact with persons with the confirmed illness. Cases which have been reported since May 14 2022, have largely had no history of travel.
The UK Health Security Agency (UKHSA) has announced that the total number of monkeypox cases confirmed in England since 6 May is 20. The UKHSA initially identified one case of monkeypox on 7th May 2022 in an individual with a history of recent travel to Nigeria. Subsequently, additional infections have been identified, some of which have been linked and others which have been unrelated. This spread as well as the occurrence of cases in Europe and other countries has suggested the possibility of community spread. Active investigations are ongoing in countries which have identified cases including contact tracing, testing isolation etc. in order to prevent further spread.
The World Health Organization (WHO), held an emergency meeting on Friday 20th May 2022 to discuss the monkeypox outbreak. WHO is working with affected countries in order to expand disease surveillance to find and support people who may be affected, and to provide guidance on how to manage the disease.
It is expected that more cases will be identified through surveillance with the possibility of additional countries being affected.
TCI residents returning from, or going to, countries where cases have been identified, are urged to be aware of the signs of infection and to seek medical help if they think they may be at risk.
How the virus spreads
Monkeypox does not spread easily between people. The virus spreads through close contact with an infected animal (rodents are believed to be the primary animal reservoir for transmission to humans), humans, or materials contaminated with the virus. Human-to-human transmission occurs through large respiratory droplets and by direct contact with body fluids or lesion material. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.
The virus enters the body through broken skin (even if not visible), the respiratory tract, or the mucous membranes (eyes, nose, or mouth).
Person-to-person spread is uncommon, but may occur through:
- contact with clothing or linens (such as bedding or towels) used by an infected person
- direct contact with monkeypox skin lesions or scabs
- coughing or sneezing of an individual with a monkeypox rash
Animal-to-human transmission may occur through a bite or scratch, preparation of wild game (in areas where the virus is present in animals such as Central and West Africa), and direct or indirect contact with body fluids or lesion material.
Individuals, particularly those who are gay, bisexual or MSM, are urged to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a health services if they have concerns.
Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during sex. It can also be passed on through other close contact with a person who has monkeypox or contact with clothing or linens used by a person who has monkeypox.
Symptoms
The incubation period is the duration/time between contact with the infected person and the time that the first symptoms appear. The incubation period for monkeypox is between 5 and 21 days.
Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.
Within 1 to 2 days a rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals.
The rash changes and goes through different stages – it can look like chickenpox or syphilis, before finally forming a scab which later falls off.
The illness tends to be mild and self-limiting within 2-4 weeks, however it can in some cases be severe particularly in persons with weakened immune systems and children. In some cases, affected persons may die.
Treatment
Treatment for monkeypox is mainly supportive. The illness is usually mild and most of those infected will recover within a few weeks without treatment.
There is no specific vaccine for monkeypox, however, vaccines used against smallpox can be used for both pre and post exposure and is up to 85% effective in preventing monkeypox. People vaccinated against smallpox in childhood may experience a milder disease.
Anyone with unusual rashes or lesions on any part of their body, especially their genitalia, is advised to visit their health care provider, particularly anyone who; 1) traveled to countries where monkeypox cases have been reported 2) reports contact with a person who has a similar rash or received a diagnosis of confirmed or suspected monkeypox, or 3) is a man who has had close or intimate in-person contact with other men in the past month.
As the virus does not usually spread easily between people and the risk to the general public is expected to be low, however the public is advised to monitor the situation as it develops and obtain information from credible sources. The MOH should be notified of any suspected cases.
The Ministry of Health will continue to monitor developments and provide updates accordingly.
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Grand Turk, Turks and Caicos Islands – 11th May 2024: On Thursday, 9th May 2024, results of testing for two suspected measles cases were received from the Caribbean Public Health Agency, confirming that both cases were positive for measles. These represent the first cases of measles in the TCI since 1991.
The public health team has been responding since initial reports of the suspected cases, carrying out contact tracing, isolation, public education and outreach in anticipation of yesterday’s results. No additional suspected cases have been identified at this time. All unvaccinated contacts of the confirmed cases have been vaccinated. Additional vaccination efforts will be conducted throughout the TCI. 
The public health team has been receiving technical support from its key stakeholders including the Caribbean Public Health Agency (CARPHA), UK Health Security Agency (UKHSA) and Pan American Health Organisation (PAHO).
Measles is a highly infectious disease caused by a virus that spreads easily between people. Symptoms typically start between 10 and 12 days after catching the infection. The signs and symptoms of measles are:
- A high fever
- Runny or blocked nose
- Cough
- Red, sore, watery eyes
Small greyish-white spots with a bluish-white center inside the mouth, cheek, and throat may appear a few days later. A rash usually appears 2-4 days after the cold-like symptoms start. The rash starts on the face and behind the ears before spreading to the rest of the body.
Measles is spread through close contact with someone with measles. This could be through droplets in the air which are generated by the coughs and sneezes of infected persons or by touching things that someone with measles has coughed or sneezed on.
Measles spreads easily within households and in other places where people mix closely together. Measles is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected. The period when a person is infectious and can spread the virus is within 7 to 10 days of exposure but can be up to 14 days.
Most measles-related deaths are caused by complications associated with the disease and serious complications are more common in children under the age of 5, or adults over the age of 30 and individuals whose immune systems have been weakened. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. Women infected while pregnant are also at risk of severe complications, and the pregnancy may end in miscarriage or preterm delivery. People who recover from measles are immune for the rest of their lives.
Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.
No specific antiviral treatment exists for measles virus.
Severe complications from measles can be avoided through supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.
A number of measles outbreaks have been detected globally and regionally. While the TCI has high vaccination coverage in the measles, mumps and rubella vaccine (MMR) (>95%), unvaccinated persons can still acquire measles through contact with an infectious person. 
Having the MMR vaccine is the best way to prevent measles. The vaccine is safe and effective in providing long term protection against measles, mumps and rubella. Vaccines are offered free of cost to all children at government-operated primary care facilities across the TCI.
The Ministry of Health and Human Services encourages parents to ensure that their children’s vaccines are up to date. If you are unsure if you or your child has had 2 doses of the MMR vaccine, please visit your health care provider. If you have missed a dose, you can still be vaccinated at any age.
The public is being advised to remain vigilant and report any fever with rash or fever followed by rash to their doctor/health care provider as soon as possible.
The Ministry of Health and Human Services is grateful for the support of its stakeholders, including CARPHA, who provided the results of testing in such a prompt manner.
The Ministry of Health and Human Services will continue heightened surveillance for fever and rash and take necessary actions to mitigate against further cases.
For additional information please call 649-338-5469 or visit the Ministry of Health and Human Services Facebook page at https://www.facebook.com/tciministryofhealth/.
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