Health officials issue new guidance to control the community spread of Monkeypox

New guidance to support healthcare professionals to respond to the outbreak of Monkeypox has been agreed by the UK’s four public health agencies – Public Health Wales, UK Health Security Agency, Public Health Scotland, and Public Health Agency Northern Ireland.

The guidance sets out new measures for healthcare professionals and the public for managing the disease and preventing further transmission now that community transmission is occurring here in the UK and elsewhere.

People who have possible, probable or confirmed Monkeypox can now isolate at home, if they remain well enough, whilst following measures advised in the new guidance to reduce further spread while being monitored by local health protection teams.

In addition, UKHSA has purchased over 20,000 doses of a safe smallpox vaccine called Imvanex and this is being offered to identified close contacts of those diagnosed with Monkeypox to reduce the risk of symptomatic infection and severe illness.

The new guidance recommends that:

People with possible, probable or confirmed Monkeypox should avoid contact with other people until all their lesions have healed and the scabs have dried off. The risk of transmission can be reduced by following standard cleaning and disinfection methods and washing their own clothing and bed linen with standard detergents in a washing machine.

Cases should also abstain from sex while symptomatic, including the period of early symptom onset, and while lesions are present. Whilst there is currently no available evidence of Monkeypox in genital excretions, as a precaution, cases are advised to use condoms for 8 weeks after infection and this guidance will be updated as evidence emerges.

If people with possible, probable or confirmed Monkeypox infection need to travel to seek healthcare, they should ensure any lesions are covered by cloth and wear a face covering and avoid public transport where possible.

Contacts of someone with Monkeypox will also be risk assessed and told to isolate for 21 days if necessary.

Where possible, pregnant healthcare workers and severely immunosuppressed individuals (as outlined in the Green Book) should not assess or clinically care for individuals with suspected or confirmed Monkeypox. This guidance will be reassessed as evidence emerges.

The minimum recommended personal protective equipment (PPE) for staff working with confirmed cases includes fit tested FFP3 respirators, aprons, eye protection and gloves. For possible or probable cases minimum recommended PPE for staff includes fluid repellent surgical facemasks (FRSM), gowns, gloves and eye protection.

Within non-domestic residential settings (e.g. adult social care, prisons, homeless shelters, refuges), individuals who are clinically well should be managed in a single room with separate toilet facilities where possible. Close contacts of confirmed cases should be assessed for vaccination.

Vaccine

UKHSA has also updated its guidance on offering the Imvanex vaccine to individuals pre and post exposure to a confirmed Monkeypox case.

The vaccine will be offered pre-exposure to healthcare workers due to care for a patient with confirmed Monkeypox and staff working in sexual health services who have been identified as assessing suspected cases.

Post exposure, the vaccine will continue to be offered to close contacts in the highest exposure categories, ideally within four days of exposure, but it can also be offered to high-risk close contacts, including gay and bisexual men, men who have sex with men, those with immunosuppression, young children and pregnant women, up to 14 days after exposure.

Dr Giri Shankar, Director of Health Protection for Public Health Wales, said: “This guidance provides healthcare staff and people in Wales with the best and most up-to-date knowledge on the management of Monkeypox cases.

“We are reassuring people that Monkeypox does not usually spread easily between people, and the overall risk to the general public is low.

“Anyone with unusual rashes or lesions on any part of their body should contact NHS 111 or call a sexual health service if they have concerns.”

Dr Ruth Milton, Senior Medical Advisor and Monkeypox Strategic Response Director, at UKHSA added: “The highest risk of transmission is through direct contact with someone with monkeypox. The risk to the UK population remains low and anyone with unusual rashes or lesions on any part of their body should immediately contact NHS 111 or their local sexual health service.”