Mpox

This advice guide will be updated regularly as new information is available.

Here are some frequently asked questions about the ongoing global outbreak of Mpox. You can also read the RCN’s position statement. 

Mpox, previously called Monkeypox, is a zoonotic viral illness caused by the monkeypox virus (MPXV), a member of the smallpox family. There are two distinct clades (subgroups) of the virus: clade I (with subclades Ia and Ib) and clade II (with subclades IIa and IIb) (WHO 2024)    

In 2022 a global outbreak of Clade IIb occurred associated with sexual contact, particularly men who have sex with men. Infections caused by Clade II continue to occur globally, and within all countries of the UK with most cases supported through sexual health clinics. Latest data on Clade IIb UK infections can be found on Gov.uk. Clade IIb infections are no longer classified as a High Consequence Infectious Disease (HCID) however healthcare workers must continue to be vigilant and use personal protective equipment in line with local policies and risk assessment.

Clade I Mpox can cause severe infection and is classified as a HCID. It has historically been associated with a small numbers of countries in central Africa, however as a result of an unprecedented outbreak cases are now being identified outside of central African countries with recent cases imported to Sweden, UK and Thailand. The World Health Organization (WHO) has declared mpox a Public Health Emergency of Continental Security and a Public Health Emergency of International Concern.

Spread through close contact in households and sexual contact can occur. Health care workers are at risk of infection and vigilance is required if patients present with suspected infection. The UKHSA has provided information on clinical assessment and an operational mpox HCID case definition.

The UKHSA advises ‘relevant clinical services – including primary care, urgent care, sexual health services, paediatrics, obstetrics and emergency departments – are aware of the information in this public health message and that a differential diagnosis of Clade I mpox virus (MPXV) infection is considered in any patient who meets the operational case definition below and that adequate stocks of appropriate personal protective equipment (PPE) and relevant staff are trained in its use for the assessment and treatment of patients presenting with suspected Clade I MPXV infection’.

The UKHSA has published guidance Principles for control of clade II mpox in the UK: 4 nations consensus statement. This is supported by Wales, Northern Ireland, Scotland and England.  

Mpox is classified as a group 3 biological hazard, therefore your employer has a legal duty to carry out a suitable and sufficient risk assessment in accordance with the Control of Substances Hazardous to Health (COSHH) Regulations.  

Adequate control measures should be implemented by your employer, so far as is reasonably practicable, in order to prevent exposure.  

The minimum recommendation by the UK Health Security Agency (UKHSA) on personal protective equipment for staff working with confirmed or highly probable Mpox cases includes, fit tested FFP3 respirators, long sleeved fluid repellent gown, eye protection and gloves.  

For possible cases the UKHSA states the minimum recommended PPE for staff should include fluid repellent surgical facemasks (FRSM), gowns, gloves and eye protection. However, an FRSM should be replaced with an FFP3 respirator and eye protection if the case presents with a lower respiratory tract infection with a cough and/or changes on their chest x-ray indicating lower respiratory tract infection (UKHSA 2024).  Refer to your local policies for more information.  

For further advice and guidance about carrying out a COSHH risk assessment, please follow the advice in our COVID-19 respiratory risk assessment toolkit. 

If you have any concerns, please contact us for advice.

The vaccine strategy for monkeypox is available from Mpox (monkeypox) guidance (UK Health Security Agency).
 
There is no specific vaccine for Mpox but the Smallpox Modified Vaccinia Ankara – Bavarian Nordic (MVA-BN) vaccine is recommended and approved for Mpox. 

As with most vaccines, it should ideally be given to help prevent infection pre-exposure. The vaccine can give a rapid immune response and therefore may also be indicated post exposure.  

The vaccine is recommended for high-risk individuals only and staff involved in caring for people infected. Please see Mpox (monkeypox) vaccination recommendations on the government website for detailed information and dose requirements, and Smallpox and Monkeypox: the green book, chapter 29.

It is important the risk of exposure to Mpox is considered as part of your individual pregnancy risk assessment. See the risk assessment section of our Having a family toolkit for more information. 

There is limited information on Mpox in pregnancy, however the World Health Organisation (WHO) states that Mpox during pregnancy may lead to complications, congenital Mpox or stillbirth. 

If you are pregnant and at risk of exposure to Mpox, control measures may include redeployment or alternative ways of working. Speak to your manager about your concerns and if they are not resolved, contact the RCN for advice and support. 

If you contract Mpox after caring for (or having been in close contact with) a patient who has Mpox, your employer should notify the Health and Safety Executive or the Health and Safety Executive (Northern Ireland) by completing a RIDDOR report (Reporting of Injuries, Diseases, Dangerous Occurrences Regulations). Your employer should also capture this information on their internal incident reporting system, for example DATIX.  

Contacts of someone with Mpox should be risk-assessed and advised to isolate for 21 days if necessary. 
 
In addition to the UKHSA top level principles, we are currently awaiting government guidance on the approach health care employers should take with regard to self-isolation. Nevertheless, the RCN expects its members not to be placed at detriment when complying with relevant safety measures.  

Where an employer requires a member of staff who is clinically well enough to work to stay away from their workplace, the expectation is that staff should receive the pay they would receive if they were at work. This arrangement should be treated as authorised absence, not sickness absence.  

Where possible, employing organisations should facilitate staff members to work from home and it may be appropriate for employers to consider reallocating duties to facilitate home working.  

In circumstances where staff are not well enough to work or home-working is not possible, staff should still receive the pay they would receive if they were at work and any absence be treated as an authorised absence.  

Speak to your manager about any concerns you may have and if they are not resolved, contact the RCN for advice and support. 

Any period of isolation or time off sick with Mpox (as required under the UKHSA guidance) should not be counted towards formal sickness absence triggers.  
 
Any absence should be treated as an authorised absence by the employer. 

It is not appropriate for employers to apply sickness absence triggers or absence management procedures to any absence related to Mpox, particularly if acquired through work related activities.  

Speak to your manager about any concerns you may have and if they are not resolved, contact the RCN for advice and support. 

There may be circumstances where staff are redeployed away from their normal role in order to mitigate risks from the Mpox outbreak. Any redeployment in relation to Mpox should be short term and temporary. Employing organisations could also require working from home as appropriate.  

The RCN’s expectation is that such arrangements are discussed and agreed with the post holder prior to implementation.  

See our redeployment guide for more, including: 

• a redeployment checklist 
• advice around competency, and 
• advice around occupational health issues. 

Under equalities legislation, it is unlawful for employers to treat staff less favourably on grounds of protected characteristics. For further information see our advice guide on discrimination.   

If you believe you are being discriminated against, please contact the RCN for advice and support. 

The RCN’s expectation is that all employers will follow the UKSHA guidance, including carrying out a suitable and sufficient organisational risk assessment in accordance with the COSHH Regulations and ensuring adequate control measures are in place. 

If you are concerned about your employer’s approach to managing absence related to Mpox you should contact the RCN immediately. You can also refer to the RCN risk assessment toolkit and ask to see your employer’s risk assessment. 
  
The RCN is monitoring the evolving situation closely and highlighting relevant advice to members as it emerges.