Patient discussions

Advise patients about signs and symptoms of complications that should prompt urgent care (e.g., lesions get worse or increase in quantity, worsening pain, persistent fever, decreased oral intake, visual symptoms, difficult breathing, dizziness, confusion). Also advise patients to monitor for any persistent, new, or changing symptoms, and to seek medical care if this occurs.[14]

Inform patients that once the skin rash has healed they will be fully recovered and no longer infectious, and that they will also have immunity.

Instruct patients who are isolating at home to:[14][254][255]

  • Isolate until:

    • They have not had a high temperature for at least 72 hours

    • They have had no new lesions in the previous 48 hours

    • All lesions have scabbed over

    • They have no lesions in their mouth

    • Any lesions on their face, arms, and hands have scabbed over, all the scabs have fallen off, and a fresh layer of skin has formed underneath (some public health authorities may advise isolation until all scabs on any part of the body have fallen off)

    • Their medical team has advised them to stop self-isolating or they have been cleared by public health officials

  • Remain in their own room when at home, or in a separate well-ventilated area (with separate bathroom facilities) from other family members and pets

    • Do not allow visitors

    • Do not go to work, school, or public areas

    • Limit close contact with other household members (keep at least 1 metre away if contact is necessary)

    • Avoid close or intimate contact with others, including sexual activity (as a precaution, use condoms for 12 weeks after rash has scabbed over and scabs have fallen off)

    • Particularly avoid contact with children, pregnant women, and immunocompromised people

    • Practice hand and respiratory hygiene; alcohol-based hand sanitisers have been found to efficiently inactivate monkeypox virus[256]

    • Avoid use of contact lenses to prevent inadvertent infection of the eye

    • Avoid shaving rash-covered areas of the body to prevent spread of the virus

  • Wear a surgical mask if possible, especially if respiratory symptoms such as sore throat or cough are present, and cover skin lesions to the best extent possible (e.g., long sleeves or pants, gloves) when in close proximity to others or moving outside of the designated area in order to minimise risk of contact with others

    • Wear a face mask (e.g., surgical mask or double-layered face covering) and ensure rash is covered if leaving the house under local public health authority directives (e.g., for essential/emergency purposes such as urgent medical care)

    • Other household members should wear a mask when in close contact with the patient

  • Use designated household items such as clothes, linens, towels, food, eating utensils, plates, and glasses, which should not be shared with other members of the household

    • Wash soiled dishes and eating utensils in a dishwasher or by hand with warm water and detergent

    • Avoid sharing personal items

  • Handle soiled laundry carefully

    • Wash contaminated clothing and linens with regular detergent (or bleach may be used but is not necessary) at 60°C cycles

    • Try to avoid contaminating upholstered furniture and other porous materials that cannot be laundered; use coversheets or blankets over these surfaces and consider steam cleaning

  • Clean and disinfect, particularly frequently touched surfaces, with regular/standard cleaning products

    • Cleaning may be followed by disinfection using 0.1% sodium hypochlorite solution

    • Cleaning surfaces with disinfectant is particularly important in bathrooms that are shared with other household members

  • Wear disposable gloves when directly touching lesions and dispose of after use

    • Dispose of all contaminated waste (e.g., gauzes/dressings, bandages, or other material soaked with lesion fluid or containing scabs) according to instructions from local public health authority

  • Detailed guidance for patients is available:

Pets

  • The risk of a case infecting a pet is considered to be low. There is one case report of possible human-to-dog transmission; however, more evidence is needed.[257][258] Surveillance studies have found no cases in pets in the UK.[259]

  • Advise patients to avoid contact with their pet(s) for 21 days (or until they have recovered). Pets should be cared for by someone else in the same household, if possible. If this is not possible, advise patients to minimise contact with their pet(s) and practise hand hygiene before and after contact, cover any skin rash to the best extent possible, and wear gloves and a mask while providing care.[260]

  • Animal and Plant Health Agency: advice for pet owners isolating because of monkeypox Opens in new window

  • CDC: pets in the home Opens in new window

Travel

  • The World Health Organization (WHO) does not currently recommend any measures that interfere with international traffic for incoming or outgoing travellers.[44] However, the following people should avoid undertaking any travel until they are determined as no longer constituting a public health risk: any person with signs and symptoms compatible with infection; any person who is considered a suspect, probable, or confirmed case by jurisdictional health authorities; and any person who has been identified as a contact of a case.[261]

  • Travel alerts may be published in some countries. Consult your local public health authority for more information.

Blood or tissue donation

  • Although no cases of transfusion-associated transmission have been reported, the presence of viraemia during symptomatic infections creates a theoretical risk to the blood supply. Deferral policies for blood donation may apply in some countries for patients with monkeypox, close contacts of monkeypox cases, or people who have received the smallpox vaccine. Questions to ascertain monkeypox exposure have been added to donor interviews in some countries.[262][263][264] Consult your local public health authority for more information.

  • The WHO recommends that asymptomatic contacts should not donate blood (or cells, tissue, organs, breast milk, or semen) while they are under symptom surveillance.[78]

  • The US Food and Drug Administration (FDA) has stated that existing safeguards for blood safety are likely to identify people who are currently at the greatest risk for monkeypox infection, and does not currently recommend specific screening via questionnaires or laboratory diagnostic tests.[265]

  • The FDA and a European expert panel have warned that clinical use of faecal microbiota transplantation (FMT) has the potential to transmit monkeypox virus, and that additional precautions are required for stool donated on or after 15 March 2022 (e.g., an expanded donor questionnaire, screening donors for the presence of prodromal symptoms and new skin lesions.[266][267]

The following patient resources are available:

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