For the most up-to-date information on preventing transmission and treating mpox please refer to the WHO or your national public health administration for required clinical advice.

PSI will continue to monitor the situation and provide updates depending on developments. If any unions affiliated to PSI wish to be involved in this monitoring and share information, please contact us at health@world-psi.org. PSI is accredited with the WHO and we are working with the WHO to ensure workers perspectives are included in the response to the mpox health emergency.

Key Links:

• WHO mpox Overview: Monkeypox (who.int)

• Africa CDC mpox information: https://africacdc.org/mpox/

• WHO Clinical management and infection prevention and control guideline: Clinical management of mpox (monkeypox) (who.int)

• Mpox Global strategic preparedness and response plan: https://www.who.int/publications/m/item/mpox-global-strategic-preparedness-and-response-plan  

What is mpox? 

 According to the WHO, mpox is a viral infectious disease caused by the monkeypox virus. The most common symptoms are fever, headache, muscle aches, and a distinctive rash which goes through several stages. The rashes start looking like a pimple, fill with fluid and fall off. Rashes can be itchy and painful. The incubation period of monkeypox is usually 6 to 13 days following exposure but can range from 5 to 21 days. Symptoms last between 2 and 4 weeks.[1] 

How is it transmitted?

Mpox spreads through close and intimate (including sexual) contact with an infected person and occasionally from the environment to people via things that have been used and surfaces that have been touched by a person with mpox, including clothes, towels and bedding.[2] 

Who is at risk? 

According to the WHO, everyone is at risk, but immunocompromised people, such as people living with HIV, people with certain skin conditions, such as eczema, children and pregnant women have an increased risk of severe manifestations and mortality from mpox. 

Which workers are most at risk[3]?

• Health and Care Workers are at risk of exposure through contact with a patient with mpox, contaminated materials, or biological samples. This includes those working at outpatient clinics and residential settings.

• Clinical staff such as physicians, nurses, nursing assistants, emergency, medical technicians, therapists, pharmacists, students, laboratory workers, community health workers, midwives, coroners, etc.

• Laboratory staff including clinical and research scientists and technicians who work with biological samples with the potential to contain mpox virus.

• Support staff who may have contact with contaminated material in patient or service users' rooms when dusting, sweeping, or handling used clothing, bedding, and towels.

• Administrative staff who may be exposed to body fluids during patient intake and other direct contact with a patient with a mpox infection

• Care workers in residential, home care or child or early years where they may encounter service users infected with mpox.

• Local and Regional Government Workers: Workers at risk may come into contact with contaminated materials, such as those involved in cleaning services of public spaces, particularly washroom attendants. There is a possible risk to waste workers, if patients are convalescing at home and there is not adequate waste management of soiled PPE and patients' dressings.

Precautions for preventing transmission

For the most up-to-date information on preventing transmission please refer to the WHO or your national public health administration.

The methods of control for workers against mpox infection should be the same as for other occupational hazards, and should follow the hierarchy of controls:

• Engineering controls - reduce exposure by preventing hazards from coming into contact with workers.

• Administrative controls - information to workers and making adjustments including mpox patient placement and treatment plan

• Personal protective equipment (PPE) - clothing and devices to protect workers including gowns, shoe covers, gloves, eye protection and N95 masks.

The hierarchy of controls is a method of identifying and ranking safeguards to protect workers from hazards. They are arranged from the most to least effective and include elimination, substitution, engineering controls, administrative controls and personal protective equipment. Often, several control methods will be combined to best protect workers.[4]

Vaccinations

The JYNNEOS vaccine is the most recent vaccine approved for mpox prevention in adults[5]. While primarily approved for adults, it's also authorized for emergency use in high-risk children. WHO recommends Pre-exposure prophylaxis (PrEP) for health workers at high risk of exposure, laboratory personnel, clinical laboratory personnel performing diagnostic testing for monkeypox, and outbreak response team members. The vaccine should be given within 4 days of contact with someone who has mpox (or within up to 14 days if there are no symptoms).[6]

What should employers do to protect workers?

Employers must consult workers and their unions on any changes they make that might affect health and safety. They must implement awareness and communication initiatives to raise awareness among staff and involve worker representatives in response coordination at the workplace

“Strengthen the capacity, knowledge, and skills of health and care workers in clinical management and infection prevention and ensure basic water and sanitation services in healthcare facilities, homes, congregate settings, and cross-border transit areas.”[7]

Occupational health and safety protocols should be followed once employers are made aware of a positive case in the workplace, including decontamination protocols and support. Workplaces should be well-ventilated, provide access to relevant personal protective equipment (free of charge), and increase hygiene stations and cleaning of high occupancy areas.

The employer must have a process to identify and protect workers who may be more at risk of contracting or becoming seriously ill from mpox infection, including pregnant staff and those who may be immunocompromised. The employer should undertake risk assessments for those most likely vulnerable to contracting mpox.[8]

Employers must ensure that any period of isolation (as required under the WHO guidance) or time off sick with mpox, is not counted towards employees' formal sickness absence. There should be paid time off for those who need the vaccine.[9]

Employers should ensure that workers with mpox can safely isolate from the time that symptoms start. Where possible and in consultation with unions, employers should offer telework and flexible, sick leave.

Employers must ensure that there are enough staff to ensure service delivery and to prevent remaining staff from burnout and psychosocial stress from short staffing.

What should workers have access to?

All workers have a right to working conditions that do not pose a risk of serious harm. They must receive timely information and training about mpox and methods on how to reduce their risk of exposure. Those in informal employment, temporary work and migrant workers are particularly vulnerable due to their precarious working and living conditions. All workers should be able to report cases of exposure and any other concerns without fear of discrimination. 

Workers who have been exposed to a person with confirmed mpox should undergo a medical evaluation. Workers who have had occupational exposure should undergo active surveillance for symptoms for 21 days post-exposure and should not work with people with increased vulnerability should they be exposed to the virus, such as those who are immunocompromised.[10]

All workers must be able to securely raise concerns and complaints with management if they feel occupational health policies are not followed correctly or if there is a failure to address hazards or risks related to mpox. Workers must be able to exercise their rights under the law without retaliation, including reporting an injury or raising health and safety concerns with their employer or local authority. Workers should not be retaliated against for using their rights to protect themselves, their colleagues or service users from mpox.

Workers' pay must be protected and workers should be given paid time off to recover where staff are required to isolate. If a worker is exposed or infected by mpox they must have access to any relevant workplace compensation schemes.

Unions should encourage the establishment of workplace health and safety committees and elect health and safety representatives to ensure workers are included in the response to mpox.

What should governments do?

Governments globally must address legislation gaps that prevent at-risk workers from accessing paid sick leave to protect essential public service workers and delivery. To ensure health and care service delivery remains unaffected governments must plan for staff absences.

To ensure proper funding for public-led health systems, and emergency response. Governments must provide technical expertise and funding to local and regional authorities in responding to mpox.

Governments should engage in meaningful consultation processes with unions as key stakeholders in the national response to the mpox health emergency.

To secure vaccination for workers and other populations at risk. Vaccines approved for mpox should be global public goods, especially if public funds support vaccine development, such as in the case of the JYNNEOS. Governments must act to have the technology transferred and diversify local, public-led production across Global South countries. We must support multilateral solutions that can secure a fair distribution of vaccines and place them where they are needed.

To draft and disseminate clear and concise information on mpox on transmission prevention, symptoms, management and treatment. To educate health workers on best practices to manage mpox. Governments must ensure all workers at greatest risk receive access to effective PPE.

[1] Monkeypox (who.int), Mpox (Monkeypox) – Africa CDC

[2] How It Spreads | Mpox | Poxvirus | CDC

[3] Monkeypox (Mpox) and Occupational Exposure - PMC (nih.gov)

[4] Managing risk using PPE - Using personal protective equipment (PPE) to control risks at work - HSE

[5] Mpox (Monkeypox) – Africa CDC

[6] Mpox (monkeypox) (who.int)

[7] Mpox Global strategic preparedness and response plan p.3

[8] Monitoring and Risk Assessment for Persons Exposed in the Community | Mpox | Poxvirus | CDC

[9] Mpox (monkeypox) (who.int)

[10] Infection Control: Healthcare Settings | Mpox | Poxvirus | CDC