Monkeypox: What is it and what are the risks?

Monkeypox is a virus which is endemic in Central and West Africa but there have been increasing numbers of cases reported, with potential community infection, in the rest of the world including the UK. There are 2 variants of the virus (1) Central African and (2) West African.

What are the symptoms?

The usual incubation period of Monkeypox is 6 to 13 days but can range from 5 to 21 days and symptoms include: 

Monkeypox is self-limiting and symptoms will resolve within 2 to 4 weeks.

How is Monkeypox transmitted?

The primary route of infection where the virus is endemic is animal to human following contact with infected animals.

Where the virus is not endemic human-to-human infection can occur as a result of

• Large respiratory droplets requiring prolonged face to face contact with an infected person  Direct contact with bodily fluids or lesions
• Indirect contact with lesion material i.e. via contaminated clothing or linens

Who is most at risk?

Most adults who are infected suffer relatively mild symptoms. However more severe disease can be found in young children or those with suppressed immune systems.

Diagnosis

The swelling of the lymph nodes is a distinctive feature of Monkeypox when compared to other rash illnesses such as chickenpox, measles or scabies and will form part of the clinical diagnosis of the virus. PCR tests are available to confirm the infection.

What are the risks?

The number of cases reported in the UK and indeed globally remain low but the evidence of community infection in non-endemic areas are a concern. Given the routes of transmission those likely to be at risk of infection are

• Healthcare workers whilst providing close personal care or when handling clothes and linens contaminated with lesion material from an infected person
• Care w workers whilst providing close personal care or when handling clothes and linens contaminated with lesion material from an infected person
• Laundry workers whilst handling linens contaminated with lesion material from an infected person
• Leisure industry workers e.g. in gyms, saunas or hotels whilst handling linens contaminated with lesion material from an infected person

Management of the risk

As stated above the number of infections is low at present and the risk is relatively small. However, employers and service provides should ensure that the infection control policies are reviewed and updated to consider the potential risk of Monkeypox. Control measures may include:

• Isolation of any employee/service user reporting symptoms compatible with Monkeypox  Provision of respiratory protective equipment (RPE)
• Provision of personal protective equipment (PPE) such as gloves for handling potentially contaminated linens
• Refresher training on the need to wash hands regularly with soap and water

Many of the control measures which may have been considered for reducing the risk of COVID- 19 infections may be appropriate to mitigate the risks of Monkeypox although no analogy is drawn between the 2 conditions save for that.

The UK Government has provided guidance in relation to environmental cleaning and contamination and primary patient care. 

The UK Health Security Agency (UKHSA) are to advise those who have been diagnosed or those who have had direct contact with an infected person to self-isolate for 21 days and provide their details for contact tracing.

Breach of Duty

The usual suite of EL Regulations would apply:

• The Control of Substances Hazardous to Health Regulations 2002 (“COSHH”)
• Personal Protective Equipment Regulations 1992 (“PPE”)
• The Management of Health and Safety at Work Regulations 1999 (“MHSW”)
• The Workplace (Health, Safety and Welfare)Regulations 1992 (“WHSW”)
• The Provision and Use of Work Equipment Regulations 1998 (“PUWER”)

COSHH may apply on the basis that Monkeypox is a “substance hazardous to health” being a “biological agent” i.e. a “micro-organism…which may cause infection, allergy, toxicity or otherwise create a hazard to human health” (Reg. 2(1))

Reg. 6 prohibits work which may expose employees to a substance hazardous to health unless control measures are in place. There is an argument that the “work” referred to in COSHH should be confined to the definition of a task or operation or whether it could be interpreted as the wider definition of any task completed by the employee during the course of his/her employment i.e. the work must involve known and direct contact with the virus.

Causation

Subject to the availability of PCR testing diagnosis is likely to be made on a clinical basis. Given the low incidence levels of the virus causation is not likely to be an significant issue. However, consideration will be required as to alternative sources of exposure. The usual ‘but for’ test would apply.

Summary

Overall the risks of claims, EL or PL, are low but employers and service providers in at risk industries ought to ensure that their risk assessments and infection control policies have been reviewed (not necessarily updated) to ensure that the potential risk is being managed effectively. As with all emerging risks the risk assessments and policies should be regularly updated if and when new evidence emerges.

For more information or advice, please contact one of our experts in our Disease Team.