Volume 26, Number 4—April 2020
Dispatch
Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018
Table
Public Health England risk assessment and public health recommendations for persons potentially exposed to 2 patients with monkeypox, United Kingdom, 2018*
| Risk group | Description | Public health surveillance | Postexposure vaccination with Imvanex | No. persons in risk group† | No. (%) persons in risk group who received postexposure vaccination† |
|---|---|---|---|---|---|
| No risk |
No known contact (direct or indirect) with a symptomatic monkeypox case-patient‡
OR
Laboratory staff handling specimens from a monkeypox case-patient, in a laboratory conforming to UK laboratory standards§ |
None |
Not recommended |
Not applicable |
0 |
| Low |
HCW involved in care of monkeypox case-patient while wearing appropriate PPE (with no known breaches) for all contact episodes
OR
HCW involved in care of monkeypox case-patient while not wearing appropriate PPE for all contact episodes but not within 1 m of case-patient and with no direct contact with body fluids or potentially infectious material
OR
Community contact not within 1 m of case-patient |
Passive¶ |
Not recommended |
158 |
0 |
| Intermediate |
Intact skin-only contact with a symptomatic (with rash) monkeypox case-patient, their body fluids, or potentially infectious material# or contaminated fomite
OR
No direct contact but within 1 m of symptomatic monkeypox case-patient without wearing appropriate PPE (including disposable FFP3 respirator or equivalent) |
Active# |
Vaccination may be considered |
125 |
84 (67) |
| High | Direct exposure of broken skin or mucous membranes to monkeypox symptomatic case-patient, patient’s body fluids, or potentially infectious material** (including clothing or bedding) without wearing appropriate PPE (including disposable FFP3 respiratory or equivalent). Exposure includes inhalation of respiratory droplets or material from scabs from cleaning rooms where a monkeypox case-patient has stayed, mucosal exposure to splashes, penetrating injury from used sharps, device or through contaminated gloves or clothing | Active# | Vaccination recommended | 5 | 5 (100) |
*Imvanex (modified vaccinia Ankara, Bavarian Nordic, http://www.bavarian-nordic.com) was approved by the European Medicines Agency in July 2013 for active immunization against smallpox in adults. Jynneos (modified vaccinia Ankara; Bavarian Nordic) was approved by the US Food and Drug Administration in September 2019 for the prevention of smallpox and monkeypox disease in adults >18 y of age determined to be at high risk for smallpox or monkeypox infection. FFP3, filtering facepiece 3; HCW, healthcare worker; PHE, Public Health England; PPE, personal protective equipment.
†For patients 2 and 3 combined.
‡Case-patients are considered potentially infectious 24 h before the onset of rash.
§See http://www.hse.gov.uk/pubns/books/clinical-laboratories.htm.
¶A person requiring passive surveillance is given information about monkeypox and what to do if illness develops.
#A person requiring active surveillance is given information about monkeypox and instructed to report health status daily to PHE, regardless of symptoms, for 21 d from the date of most recent exposure, and to report any illness immediately. In addition, HCWs with high-risk exposures are to be excluded from work for 21 d after the most recent exposure (note this recommendation was introduced after diagnosis of the third case-patient).
**Potentially infectious biological material consists of skin lesions and detached scabs.
1Current affiliation: London School of Hygiene and Tropical Medicine, London, UK.