Monkeypox: secureprisons and detainedplaces settingsof detention

Monkeypox: background

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.

Notification of confirmed cases of monkeypox

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.

Identifying cases and contacts

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 toof those concerned.

Reception screening

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:

• screen whether they have any symptoms of monkeypox (rash, acute illness with :
  • rash
  • fever (>38.5^oC),(>38°C)
  • headache
  • muscle headaches,aches myalgia,(myalgia)
  • joint arthralgia,pain back(arthralgia)
  • backache
  • swollen pain,lymph lymphadenopathy)nodes (lymphadenopathy)

  If answeringthey answer yes to any of these symptoms, establish whether they are likelya toprobable becase.

  A a probable case basedis someone with an unexplained rash on any part of their body plus one or more of the followingother criteria.symptoms above, and either:

  They:

  • havehas an epidemiological link to a confirmed or probable case of monkeypox in the 21 days before symptom onset
    OR

  or

  • reported a travel history to West or Central Africa in the 21 days before symptom onset
    OR

  or

  • areis a gay,gay or bisexual man, or othera man who has sex with menother (GBMSM)men

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

  Whether they:

  • do they have any history of travel in the last 21 days (and to where)
  • do they think they may have had close contact*contact with a confirmed or possible monkeypox case

  *definitions of contact

  Presentation with symptoms at reception or within the PPD

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

  Presentation within the PPD setting regardingabout concerns of close contact with a case

  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

  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–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.

  Reporting suspected cases and contacts

  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.cases. Local UKHSA HPTs should be informed of bothconfirmed, confirmedpossible and probable cases.cases HPTsas willsoon adviseas onpossible. confirmatoryTesting testingto forbe suspectedconfirmed cases.in line with locally agreed pathways.

  HPTs are likely to require the following information about cases:

  • symptoms, including symptom onset date and symptom progression – ask about systemic influenza-like illness symptoms prior to onset of rash, to determine infectious period and epidemiological analysis
  • full travel history for the 21 days prior to onset of symptoms

  Management of cases in the PPD setting

  Isolation of cases

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

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

  ConfirmedArrangements casesfor willindividual patients should be isolatedconsidered foron a periodcase-by-case ofbasis. 21Confirmed days.cases are able to end isolation once the de-isolation criteria are met.

  Isolation within the the PPD can can be used for clinically well ambulatory suspected or confirmed cases for whom it is judged safe and clinically appropriate.

  Within non-domesticThey residentialshould settingsbe (suchmanaged asin adulta socialsingle care,room prisons,with homelessseparate shelters,toilet refuges),facilities isolationwhere ofpossible. individualsIf whothis arecannot clinically well should be managedarranged, inthis amust singlebe roomdiscussed with separatethe toilet facilities where possible.HPT.

  Infection prevention and control (IPC) measures for cases

  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 coveringmask worn.

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

  Management of contacts

  Isolation of contacts

  See definitions of contacts.

  Medium risk contacts (category 2) do not need exclusionsexclusion or isolation provided they comply with active monitoring, but should be excluded from activities involving close contact with children, severelypregnant immunocompromised,women, or pregnantthose women.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.

  Isolation within the PPD may be used for clinically well ambulatory suspected or confirmed cases for whom it is judged safe and clinically appropriate.

  Within non-domestic residential settings (such as adult social care, prisons, homeless shelters, refuges), isolation of individuals who are clinically well should be managed in a single room with separate toilet facilities where possible.

  IPC measures for cases and contacts

  ForWhen ambulatorymanaging wellcontacts, suspectedstaff or confirmed contacts with limited lesions, covering lesions and wearing a mask reduces the risk of onwards transmission.

  If cases need to be transported to hospital, lesions should befollow coveredgeneral andIPC aguidance faceas coveringoutlined worn.below.

  Vaccination

  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 Patients in secure settings must travel to the site to be vaccinated as there is no provision for transporting or delivering vaccine elsewhere to the patient. 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 patientresident to the vaccination site.

  General IPC guidance

  PPE

  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 casescases, the minimum PPE is:

  • gloves
  • fluid repellent maskssurgical shouldfacemask (FRSM) (an FRSM should be used,replaced whilewith foran confirmedFFP3 casesrespirator requiringand ongoingeye clinicalprotection managementif FFP3the respiratorscase shouldpresents bewith used.
    a lower respiratory tract infection with a cough and/or changes on their chest x-ray indicating lower respiratory tract infection)
  • apron
  • eye protection is required if there is a risk of splash to the face and eyes (for example when taking diagnostic tests)

  HMPPS escort escort staff should also follow thesethese PPE guidelines.

  In the event of a hospitalised patient requiring ongoing contact escort, enhanced PPE guidelines,may be required for examplethe ifattending takingstaff aand caseshould tobe hospitalrisk orassessed awith contactsupport forfrom vaccinationthe atHPT aand hospital.trust IPC team.

  HandwashingHand hygiene

  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.

  Cleaning

  It remains important to reduce the risk of fomitetransmission transmission.on surfaces. The risk can be substantially reduced by following agreed cleaning methods based on standard cleaning and disinfection,disinfection orusing bychlorine washingbased clothesproducts.

  If orusing domesticreusable equipmentcrockery withand standardcutlery, detergentsuse full PPE (FRSM, non-sterile disposable gloves, and cleaninga products.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.

  Waste management

  WasteOnce managementthe andperson decontaminationis practicerecovered (or left the cell/room) then a final clean should followbe bestundertaken practicewhile wearing full PPE (FRSM, non-sterile disposable gloves, and bea baseddisposable onplastic allapron). Using the availablestandard evidencecleaning ondetergent safeand handlingdisinfection products:

  • remove all disposable items and dispose of into waste bags
  • bag laundry packs and remove as described for contaminated laundry
  • clean all waste.hard surfaces and touch points including walls, floors, chairs, bed frame, mattress and ensuite facilities adhering to local policy of process including colour coding of mops and cloths
  • any soft furnishings should be steam cleaned or vacuumed. If using a vacuum, use only a machine with HEPA filtration. Full PPE to be worn when emptying vacuum into waste bag

  Waste management

  All waste produced by the case in PPDisolation settings(whilst infectious) should be accordingbagged in the cell or room. This bag should be placed into another waste bag outside the room for transport to currentthe managementappropriate ofwaste clinicalcollection orbin personalfor usual domestic waste management in accordance with local policies.policy.

  HealthcareUsual 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.

  Contaminated linen

  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 staffthe wearinginfected fullperson. PPE,This bag should be placed into a plastic bag outside the cell or room and senttransported to laundry.

  Where possible, wash laundry asitems infectedseparate andfrom washedthe 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 driedprocessing of contaminated laundry.

  Ideally laundry should be washed at temperatures above 65^oC.65°C Alland staffdried. Usual protective equipment should be worn by people handling used laundry shouldand wearhands fullwashed after disposing of PPE.

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

  Reducing contact with clinically vulnerable people

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