Monkeypox: What employers need to know 

On July 23 the Director-General of the World Health Organization (WHO) declared monkeypox a Public Health Emergency of International Concern. In the past week, New York, California, and Illinois followed suit with similar declarations. The United States declared monkeypox a public health emergency on August 4 - allowing the government to free up additional funding and resources to fight the virus. 

There have been more than 26,000 confirmed cases around the globe. The United States is currently reporting the highest number of cases for any given country, although the European region of WHO, where cases are rising the fastest, is the only region that WHO considers high risk at this time. Elsewhere, including in the US, WHO considers monkeypox to be a moderate risk.

The CDC has issued a level 2 alert encouraging enhanced precautions for individuals traveling outside of the US. The Biden administration released a fact sheet acknowledging the outbreak and outlining plans to broaden access to vaccines and treatment, and the President has named Robert Fenton, a veteran emergency response official, as the White House Coordinator for monkeypox.

Background

The first monkeypox case recorded in humans was in 1970 in the Democratic Republic of the Congo. Historically, outbreaks have occurred almost exclusively in 11 African countries.

Current evidence suggests that there are several ways that humans can contract monkeypox. The first is through close, personal contact with an infected person. Often that will be skin-to-skin contact, but transmission can also occur indirectly, such as through linens or other items used by an infected person that have material from rash or lesions. The virus can also spread through large respiratory droplets transferred from any symptomatic individual within 6 feet, through prolonged face-to-face exposure. A pregnant person can spread the virus to their fetus through the placenta. It is also possible to contract monkeypox via contact with infected animals; however, person-to-person contact is the primary mode of transmission.

The majority of diagnosed cases of monkeypox in the US have been found among men reporting sexual intimacy with other men, but anyone can catch the virus through close contact with an infected person. Five cases of monkeypox among children have been identified in the United States.

Signs and symptoms

• Symptoms can include fever, headaches, muscle aches, swollen lymph nodes, fatigue, and a blistery, extremely painful rash that goes through several stages before healing.
• The typical illness lasts between 2 and 4 weeks, and the rash is often the onset symptom.
• The incubation period between contact and initial symptoms is typically 6-13 days but can range from 5-21 days.
• The period of infectiousness is from symptom onset (including the period before the rash appears) until lesions scab and fall off completely.
• Fatality rates associated with monkeypox are reported to be (between 3-6%) by WHO, though slightly higher among young children, especially in medically underserved regions of the world.

Prevention and treatment

Monkeypox is genetically similar to smallpox, so treatments and vaccines used for smallpox can be used to prevent spread and treat conditions.

• Prevent: Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox and isolate contaminated items like bedding, clothes and towels until they have been laundered. Frequent handwashing with soap and water or use of an alcohol-based hand sanitizer is recommended. The CDC recommends limiting the number of anonymous sexual partners, avoiding kissing and keeping clothes on during intimacy to minimize skin-to-skin contact.
• Vaccinate: Vaccinations are recommended for anyone who hasn’t had a smallpox vaccine in the last 3 years, which will be most adults (other than researchers or military personnel). Individuals who have been exposed to monkeypox are urged to get vaccinated as a post-exposure prophylaxis within 4 days and no later than 14 days.
• Treat: Antivirals such as tecovirimat may be recommended for severely ill or immune-compromised people diagnosed with the virus.

Employer Implications

So far, neither the CDC nor any state or local government have issued a set of guidelines for employers. In the meantime, here are some suggestions for what employers can do to be prepared:

Continue to monitor the outbreak, and if needed, educate. If your organization formed a COVID response team during the pandemic, it may be time to call a meeting to discuss monkeypox. Otherwise, designate an individual within your organization to stay on top of updates related to the virus. This will help ensure that your team is prepared with a uniform response in case questions do arise.

Follow federal and state guidance. Social distancing guidance that we saw at the peak of the coronavirus pandemic are not currently recommended to protect against monkeypox. However, be prepared to act quickly to comply with any updated guidance to ensure employee safety.

Be flexible. Offering time off or the flexibility to work from home when not feeling well or after potential exposure can help prevent outbreaks within the workforce. Based on current CDC guidance, close contacts of confirmed cases should be monitored for monkeypox symptoms for up to 21 days from the date of last exposure.

Make sure employees feel supported. Consider providing a hotline and/or a contact tracing service. Because the virus currently is of special concern for gay and bisexual men, protecting and supporting your LGBTQ+ population should be a priority. Reach out to your EAP to discuss their readiness to address heightened anxiety and other employee concerns, and be prepared to deal decisively with any discriminatory behavior in the workplace. Importantly, employee education should stress the critical fact that anyone can get monkeypox. It’s important not to focus on cases among gay and bisexual men, which could lead to stigmatization and create a false sense of safety in the rest of your population.