Monkeypox: secure and detained settings - GOV.UK - ISS-G20 Laboratorium Repository

Monkeypox: background

The symptoms of monkeypox begin 5 to 21 days (average 6 to 16 days) after exposure.

Treatment for monkeypox is mainly supportive. The illness is usually mild and most of those infected will recover within a few weeks without treatment. Further information about the clinical features of monkeypox is available.

See current case definitions for monkeypox.

The virus can spread if there is close contact between people and the risk to the UK population is low. Recent cases are predominantly in gay, bisexual and other men who have sex with men aged 20 to 59 years. These groups are being advised to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a sexual health service if they have concerns.

Identifying cases and contacts

Cases or contacts may be identified at reception into prisons and places of detention (PPDs), following presentation within the PPD setting itself or via contact tracing.

Cases or contacts may be concerned about presenting in the PPD setting due to potential stigma. Staff in PPD settings should be sensitive to the circumstance and be supportive to those concerned.

Reception screening

UK Health and Security Agency (UKHSA) health and justice advice is that new receptions into PPDs should be asked as part of the reception screen:

• whether they have any symptoms of monkeypox (rash, acute illness with fever (>38.5^oC), headaches, myalgia, arthralgia, back pain, lymphadenopathy)

If answering yes to symptoms, establish whether they are likely to be a probable case based on the following criteria.

They:

• have an epidemiological link to a confirmed or probable case of monkeypox in the 21 days before symptom onset
  OR
• reported a travel history to West or Central Africa in the 21 days before symptom onset
  OR
• are a gay, bisexual or other man who has sex with men (GBMSM)

For those who do not currently have symptoms, it is recommended the following information is recorded in case future symptoms develop.

Whether they:

• have any history of travel in the last 21 days (and to where)
• think they may have had close contact* with a confirmed or possible monkeypox case

*definitions of contact

Presentation with symptoms at reception or within the PPD

If a resident presents with symptoms, healthcare staff should wear appropriate personal protective equipment (PPE) and clinically assess the patient according to monkeypox guidance.

Presentation within the PPD setting regarding concerns of close contact with a case

If an individual presents with concerns they have had contact with a monkeypox case then healthcare should undertake an initial risk assessment in regards to potential contact informed by the UKHSA contact classification matrix.

Contact tracing

Contact tracing will be undertaken for suspected and confirmed cases. This should be conducted by the Health Resilience Leads (HRL) in partnership with healthcare, and this information should be provided to the local UKHSA health protection teams (HPTs).

This should include information on contacts within the infectious period (from date of symptom onset as per case definition) and nature of contact as per current contact risk classification– consider household, visitors (to household or households visited), sexual contacts, community settings (including shops and entertainment venues), healthcare exposures, public transport and so on.

Reporting suspected cases and contacts

When cases and contacts are identified, the HPT should be informed and relevant case and contact management guidance followed. Testing is advised for probable cases. Local UKHSA HPTs should be informed of both confirmed and probable cases. HPTs will advise on confirmatory testing for suspected cases.

HPTs are likely to require the following information about cases:

• symptoms, including symptom onset date and symptom progression – ask about systemic influenza-like illness symptoms prior to onset of rash, to determine infectious period and epidemiological analysis
• full travel history for the 21 days prior to onset of symptoms

Management of cases in the PPD setting

Isolation

Probable cases identified should be isolated in single cell accommodation while HPT advice and further clinical assessment is arranged.

Confirmed cases will be isolated for a period of 21 days.

Isolation within the PPD can be used for clinically well ambulatory suspected or confirmed cases for whom it is judged safe and clinically appropriate.

Within non-domestic residential settings (such as adult social care, prisons, homeless shelters, refuges), isolation of individuals who are clinically well should be managed in a single room with separate toilet facilities where possible.

IPC measures for cases

For ambulatory well suspected or confirmed cases with limited lesions, covering lesions and wearing a mask reduces the risk of onwards transmission.

If cases need to be transported to hospital, lesions should be covered and a face covering worn.

Management of contacts

Isolation

See definitions of contacts.

Medium risk contacts (category 2) do not need exclusions or isolation provided they comply with active monitoring, but should be excluded from activities involving close contact with children, severely immunocompromised, or pregnant women. High risk (category 3) contacts should be advised to self-isolate for 21 days. Decisions on contact isolation will be made by the HPT.

Isolation within the PPD may be used for clinically well ambulatory suspected or confirmed cases for whom it is judged safe and clinically appropriate.

Within non-domestic residential settings (such as adult social care, prisons, homeless shelters, refuges), isolation of individuals who are clinically well should be managed in a single room with separate toilet facilities where possible.

IPC measures for cases and contacts

For ambulatory well suspected or confirmed contacts with limited lesions, covering lesions and wearing a mask reduces the risk of onwards transmission.

If cases need to be transported to hospital, lesions should be covered and a face covering worn.

Vaccination

Some contacts may be given vaccination as post exposure prophylaxis; this will be agreed with the HPT. See vaccination guidance.

Vaccination must be accessed at specific regional sites (NHS hospitals). Patients in secure settings must travel to the site to be vaccinated as there is no provision for transporting or delivering vaccine elsewhere to the patient. There are regional leads handling the access pathways for case management and treatment who will need to liaise with health and justice commissioners if vaccination is required. Her Majesty’s Prison and Probation Service (HMPPS) will remain responsible for providing escort staff to accompany the patient to the vaccination site.

General IPC guidance

PPE

For suspected and confirmed clinically well cases managed in residential settings including PPDs, transmission should be based on clinical risk assessment. For possible and probable cases fluid repellent masks should be used, while for confirmed cases requiring ongoing clinical management FFP3 respirators should be used.

HMPPS escort staff should also follow these PPE guidelines, for example if taking a case to hospital or a contact for vaccination at a hospital.

Handwashing

Hand hygiene is important and should be undertaken by the patient before leaving their room. Staff should follow best practice regarding hand hygiene when removing PPE.

Cleaning

It remains important to reduce the risk of fomite transmission. The risk can be substantially reduced by following agreed cleaning methods based on standard cleaning and disinfection, or by washing clothes or domestic equipment with standard detergents and cleaning products.

Increased cleaning is likely to reduce risk and is recommended. Anyone cleaning a contaminated area should wear full PPE.

Waste management

Waste management and decontamination practice should follow best practice and be based on all the available evidence on safe handling of all waste. Waste management in PPD settings should be according to current management of clinical or personal waste in local policies.

Healthcare waste should be disposed of according to the National Infection Prevention Manual.

Contaminated linen

Monkeypox can be spread via contact with clothing or linens (such as bedding or towels) used by an infected person. Any such linen should be bagged (preferably in a water soluble bag) by staff wearing full PPE, and sent to laundry as infected and washed and dried at temperatures above 65^oC. All staff handling laundry should wear full PPE.

Reducing contact with clinically vulnerable people

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

Entire content available on: https://www.gov.uk/guidance/monkeypox-secure-and-detained-settings