[Monkeypox Emergency] Second Domestic Patient Breaches Weak Quarantine, Contacts 15 People

Over a 2-Week Incubation Period, 'Overseas Travel History' Not Properly Tracked

[Image source=Yonhap News]

[Asia Economy Reporter Jo In-kyung] The second domestic monkeypox patient was confirmed positive two weeks after entering the country, during which at least 15 community contacts were identified. In particular, there are criticisms that the domestic quarantine system did not function properly as the patient was classified as a suspected case only five days after symptoms appeared.

According to the Central Disease Control Headquarters on the 5th, the second monkeypox patient, Mr. A, entered the country on July 18 after visiting Europe and was classified as a suspected case by the quarantine authorities (Seoul epidemiologists) on August 1 after he voluntarily inquired about health abnormalities at a public health center. Mr. A is currently hospitalized and undergoing treatment, with symptoms reported to be mild.

Mr. A began experiencing symptoms such as fever, headache, and dizziness from August 28, ten days after his entry. On the 30th, he visited a hospital in Seoul due to skin pain, but even there, the possibility of monkeypox infection was not recognized.

The quarantine authorities believe that Mr. A was not detected by the quarantine network for two weeks because the incubation period of monkeypox ranges from as short as 5 days to as long as 21 days, with an average of 6 to 13 days.

At the time of entry, Mr. A was asymptomatic, and when he visited a local clinic, he did not have the typical monkeypox symptoms of skin rash or blisters. The Korea Disease Control and Prevention Agency linked the DUR (Drug Utilization Review) and ITS (International Travel History Information System) in July, and since Mr. A had visited one of the five countries with frequent monkeypox cases (United Kingdom, Spain, Germany, Portugal, France), his travel history was automatically notified to medical staff during hospital visits.

Nevertheless, the clinic did not suspect Mr. A of monkeypox infection. The Disease Control Agency explained that although there was a travel history, the absence of typical monkeypox symptoms such as rash or blisters led to this. At that time, Mr. A did not disclose his travel history to the medical staff, and the medical staff reportedly did not inquire about overseas travel history.

While the possibility that Mr. A was infected domestically cannot be completely ruled out, considering his overseas travel history, it is more likely that he was infected abroad, entered the country, and then developed symptoms after the incubation period.

After investigating contacts during Mr. A’s infectious period, the Disease Control Agency identified two medium-risk contacts who were family or friends and 13 low-risk contacts who met the patient at clinics or pharmacies, based on exposure levels. Medium-risk contacts undergo active monitoring by the public health center for 21 days from the date of contact, with daily checks for suspicious symptoms.

The Disease Control Agency stated, "Medical institutions treating Mr. A wore appropriate protective equipment, and the possibility of direct exposure to bodily fluids, the main transmission route, is low," adding, "Domestic and international monkeypox guidelines report that transmission through everyday community contact is almost nonexistent."

Experts judge that the likelihood of contracting monkeypox through daily life without sexual contact is low. However, since Mr. A was outside the quarantine authorities’ monitoring network for five days after symptom onset, criticism of gaps in the current quarantine system is unavoidable.

Looseness in the monkeypox quarantine network was also raised when the first patient was identified on June 22. The first patient had a mild fever of 37 degrees Celsius, sore throat, weakness, fatigue, and skin lesions upon entry but passed through airport quarantine and only reported to the authorities voluntarily in the airport lobby.

After the first confirmed case, Korean quarantine authorities raised the monkeypox infectious disease crisis level from "interest" to "caution," introduced 504 doses of the treatment drug Tecovirimat in early July, completed vaccination of essential medical personnel, expanded diagnostic testing systems, and strengthened response systems by establishing a 24-hour monkeypox comprehensive situation room and rapid response team.