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Public health advice for prisons and other prescribed places of detention.

There has been a recent increase in cases of monkeypox in the UK as well as other parts of the world where it has not been seen before.

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 (GBMSM) 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.

The Health Protection (Notification) Regulations 2010 have been amended to include monkeypox as a notifiable disease in Schedule 1 and monkeypox virus as a notifiable causative agent in Schedule 2.

The National Health Service (Charges to Overseas Visitors) Regulations 2015 have been amended to include monkeypox in Schedule 1.

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 of those concerned.

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:

If they answer yes to any of these symptoms, establish whether they are a probable case.

A probable case is someone with an unexplained rash on any part of their body plus one or more of the other symptoms above, and either:

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

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

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 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.

When cases and contacts are identified, the HPT should be informed and relevant case and contact management guidance followed.

Testing is advised for possible and probable cases. Local UKHSA HPTs should be informed of confirmed, possible and probable cases as soon as possible. Testing to be confirmed in line with locally agreed pathways.

HPTs are likely to require the following information about cases:

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

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

Arrangements for individual patients should be considered on a case-by-case basis. Confirmed cases are able to end isolation once the de-isolation criteria are met.

Isolation within the PPD can be used for clinically well ambulatory suspected or confirmed cases for whom it is judged safe and clinically appropriate. They should be managed in a single room with separate toilet facilities where possible. If this cannot be arranged, this must be discussed with the HPT.

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

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

Infection prevention and control (IPC) requirements for escort staff are detailed in the general IPC guidance section.

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

When managing contacts, staff should follow general IPC guidance as outlined below.

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).

Residents in secure settings must travel to the site to be vaccinated as there is no provision for transporting or delivering vaccine elsewhere to the resident.

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 resident to the vaccination site.

Staff should receive appropriate training and be competent in the required PPE donning and doffing procedures and hand hygiene. Staff should know their local procedures for reporting any PPE breach or other risk contact with a confirmed case so that they can be assessed for follow-up and possible restrictions.

For suspected and confirmed clinically well cases managed in residential settings including PPDs, transmission risks should be based on a clinical risk assessment. For possible and probable cases, the minimum PPE is:

HMPPS escort staff should also follow these PPE guidelines.

In the event of a hospitalised patient requiring ongoing contact escort, enhanced PPE may be required for the attending staff and should be risk assessed with support from the HPT and trust IPC team.

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. Alcohol-based hand sanitiser can be used as an alternative to soap and water for visibly clean, dry hands.

It remains important to reduce the risk of transmission on surfaces. The risk can be substantially reduced by following agreed cleaning methods based on standard cleaning and disinfection using chlorine based products.

If using reusable crockery and cutlery, use full PPE (FRSM, non-sterile disposable gloves, and a disposable apron) to collect crockery and cutlery, place in a plastic bag for transfer to a dishwasher, and then wash hands thoroughly after removing and disposing of the collection bag and PPE.

Increased cleaning is likely to reduce risk and is recommended. Anyone cleaning a contaminated area should wear full PPE, consisting of FRSM, non-sterile disposable gloves, and a disposable apron. Any used cloths and mop heads must be disposed of and should be put into waste bags.

Once the person is recovered (or left the cell/room) then a final clean should be undertaken while wearing full PPE (FRSM, non-sterile disposable gloves, and a disposable plastic apron). Using the standard cleaning detergent and disinfection products:

All waste produced by the case in isolation (whilst infectious) should be bagged in the cell or room. This bag should be placed into another waste bag outside the room for transport to the appropriate waste collection bin for usual domestic waste management in accordance with local policy.

Usual protective equipment should be worn by people handling waste and hands washed on disposal of PPE.

Waste generated by healthcare should be disposed of as healthcare waste according to the National Infection Prevention Manual.

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) in cell or room, ideally by the infected person. This bag should be placed into a plastic bag outside the cell or room and transported to laundry.

Where possible, wash laundry items separate from the rest of the residential accommodation’s laundry using the normal detergent, following manufacturer’s instructions.

Where a residence has off site laundry facilities, each premise should discuss the requirements for safe pre-laundering storage, transfer and processing of contaminated laundry.

Ideally laundry should be washed at temperatures above 65°C and dried. Usual protective equipment should be worn by people handling used laundry and hands washed after disposing of PPE.

If staff handle contaminated laundry, they should wear full PPE – specifically FRSM, non-sterile disposable gloves, and a disposable apron.

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

Updated guidance and added information on notification of confirmed cases.

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