Considerations for monkeypox

Progress of the virus

The first case of monkeypox was reported on 7 May 2022 in a patient who had recently travelled to Nigeria (where they are believed to have contracted the virus). On 26 May 2022, the total reported cases of monkeypox in the UK was at 79. Cases have now spread to Wales (one case), Scotland (one case) and England (77 cases). None have yet been reported in Northern Ireland.

Nearly 20 countries which do not normally see monkeypox cases have reported outbreaks of this disease, and there have been more than 130 confirmed or suspected cases across these countries, concentrated in Europe.

Government advice

To assist, the Government has released updated guidance on treating and preventing monkeypox, which can be adapted for the workplace. However, while the guidance refers to “isolation”, it’s important to remember that this does not warrant the same severity or panic as Covid-19 isolation. It may be more helpful to think of the disease in the same way as chickenpox, although the visual symptoms are considerably more unsightly, and it currently seems to affect more adults rather than children.

The main symptoms of monkeypox were identified as: fever, headache, muscle/backache, swollen lymph nodes, chills, exhaustion and a rash of raised spots that later turn into blisters. The illness is usually mild, and the infection normally clears up on its own after between 14 and 21 days.

Those who are a confirmed monkeypox case should follow the advice of medical professionals. It’s likely they will be too poorly to work, so their illness can be treated in line with normal sickness absence rules. Those who have symptoms and suspect they may have the virus should limit their contact with others, ring 111 or contact their local sexual health service as soon as possible for guidance on what actions to take.

In some cases, close contacts of a confirmed case will have to follow public health guidance and isolate for 21 days. This includes those who have had unprotected direct contact or high-risk environmental contact, eg:

• body fluid in contact with eyes, nose or mouth

• penetrating sharps injury from used needle

• contact in room during aerosol-generating procedure without appropriate respiratory PPE

• changing a patient’s bedding without appropriate PPE

• sexual contact

• household contact.

These people are also likely to be offered a vaccine.

Similarly, those who have unprotected exposure to infectious materials, including droplet or airborne potential routes, eg:

• clinical examination of a patient before diagnosis without appropriate PPE

• entering the patient’s room without wearing appropriate PPE and within 1m of the case

• the driver and passengers in a shared car or taxi with the case or sitting next to the case on a plane

• subsequent patients in consulting room after a confirmed case was seen and prior to room cleaning

should be excluded from work for 21 days if work involves contact with immunosuppressed people, pregnant women or children.

Actions for employers

Following so closely from the various lockdowns and restrictions as a result of the Covid-19 pandemic, it is understandable that employees may be particularly concerned about this news. It is important to reassure them that this is a very different matter and one that, crucially, we know much more about. A vaccine is already widely available against this via the smallpox vaccine, which is effective against monkeypox. Transmission is very unlikely unless there is particularly close contact, such as sharing bedding, towels or through bodily fluids.

It is still beneficial to consider whether the employee can temporarily work from home. This allows them to maintain their full, normal salary whilst minimising disruption to business operations. Where this isn’t possible, an employee who is required to stay away from the workplace by the employer will likely be entitled to full pay unless they are unwell. Unlike what we previously saw for Covid-19, it is guidance only and not a legal requirement to stay at home. It is therefore down to the employer’s discretion how they will implement this guidance.

Employers may want the individual to continue working. In these cases, it’s important to take reasonable steps to minimise the spread of the virus. For example, by providing a private workspace, asking the employee to wear a mask and/or gloves, stopping the sharing of (for example) tea towels and hand towels, facilitating regular cleaning and encouraging hand sanitisation.

What happens next

Putting in place the above measures should work to limit the risk of monkeypox becoming an issue within the workplace. As this matter develops, it may be that further guidance is issued by the Government, which should be followed to ensure the safety of the workforce and the wider public.

However, for now there is no need to panic. The information available on this disease all suggests this is not something to be greatly concerned about, but some limited caution and protective measures are wise to implement, where necessary, to reassure and safeguard the workforce.