Mpox: prisons and places of detention

Who this guidance is for

This guidance is for staff in prisons and places of detention (PPDs) to use where healthcare staff suspect or it is confirmed that a prisoner has mpox. The guidance is also to be used for individuals who have had contact with a case of mpox. There is separate information available on the case definitions of mpox.

Mpox: background

Mpox is a viral zoonotic disease that is caused by the MPXV virus. There are 2 distinct clades of MPXV, clade I and clade II. Mpox was previously classified as a high consequence infectious disease (HCID). In January 2023, the Advisory Committee on Dangerous Pathogens (ACDP) advised that clade II mpox no longer met the criteria for an HCID. In February 2025, the ACDP recommended that clade I mpox should no longer be classified as an HCID. This guidance therefore covers all cases of mpox, irrespective of clade, and replaces the clade-specific guidance previously published. 

How mpox spreads

Mpox does not spread easily between people unless there is close contact.

Spread between people may occur through:

• direct contact with rash, skin lesions (spots, blisters or ulcers) or scabs, including during sexual contact, kissing, cuddling or other skin-to-skin contact
• contact with bodily fluids such as saliva, snot, mucus, semen or vaginal fluids
• contact with clothing or linen (such as bedding or towels) or other objects and surfaces used by someone with mpox

It is possible that mpox may spread between people through close and prolonged face-to-face contact such as talking, breathing, coughing or sneezing close to one another. However, there is currently limited evidence so this will be updated as new information becomes available.

Symptoms of mpox usually appear 5 to 21 days after contact with someone with mpox. Mpox infection usually resolves without treatment, although severe illness can occur. The illness may begin with fever and the symptoms listed on Mpox: background information.

Clinicians may refer to UKHSA guidance for examples of mpox lesions to aid detection of suspected cases.

Cases of clade II mpox in the 2022 outbreak were predominantly in gay, bisexual and other men who have sex with men (GBMSM) aged 20 to 59 years. There have been fewer cases of clade I mpox detected in the UK.

Identifying cases and contacts

Cases or contacts may be identified at reception into PPDs, following presentation within the PPD setting itself or through 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 circumstances and be supportive of those concerned.

Reception screening

UK Health Security Agency (UKHSA) Health and Justice advice is that new receptions into PPDs should be risk assessed for rashes as part of the reception screen. Guidance on when to suspect a case of mpox is available. This includes information on when infection specialists should be contacted about the suspected case.

If mpox is considered, it is recommended that the following information is recorded:

• do they have any history of travel in the last 21 days (and to where)
• do they think they may have had close contact with a confirmed or suspected mpox case
• have they had a recent new sexual partner
• do they have a link to an infected animal or meat

Presentation with symptoms at reception or within the PPD

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

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

If an individual presents with concerns that they have had contact with an mpox case, the following information should be obtained:

• name of mpox case (if known)
• date of contact with this case
• nature of contact as per the contact classification matrix and where it occurred including location or foreign travel

Once this information is collected, contact your local health protection team (HPT) to discuss if any public health actions are required. The individual should remain vigilant for any symptoms that occur up to 21 days from last contact.

Management of cases in the PPD setting

Testing of suspected cases

Testing is advised for all suspected cases, and should be carried out in line with locally agreed pathways. Clinicians treating patients with suspected mpox should discuss the case with local infection specialists. Further information is available in the guidance on when to suspect a case of mpox.

Notification of confirmed cases of mpox 

The local HPT should be informed of suspected or confirmed cases as soon as possible.

HPTs are likely to require the following information about cases:

• symptoms (including symptom onset date and symptom progression)
• potential routes of exposure, including a full travel history, sexual history or any known contact with a suspected or confirmed case, in the 21 days prior to symptom onset
• settings the case has visited or attended during the infectious period, including community or healthcare settings
• contacts of the case within the PPD setting and any community settings, such as household or other close contacts – contacts in the community will be managed by the HPT

If the index case is a resident, the management of the case and contacts in the PPD setting is likely to be supported by an incident management team (IMT). The chair of the IMT will be agreed between His Majesty’s Prison and Probation Service (HMPPS) and the HPT.

The Health Protection (Notification) Regulations 2010 include mpox as a notifiable disease in Schedule 1 and mpox virus as a notifiable causative agent in Schedule 2.

The National Health Service (Charges to Overseas Visitors) Regulations 2015 include mpox in Schedule 1.

Isolation of cases

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

Arrangements for individual patients should be considered on a case-by-case basis.

Suspected cases should be isolated in single cell accommodation while further clinical assessment is arranged. 

Confirmed cases should isolate in a single cell and 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.

Additional environmental cleaning, including of the case’s clothing and linen, should minimise the risk of possible transmission via surfaces.

Infection prevention and control (IPC) measures for cases

For ambulatory well suspected or confirmed cases with few lesions, covering lesions reduces the risk of onwards transmission. Suspected or confirmed cases with respiratory symptoms or oropharyngeal lesions should wear a fluid resistant surgical mask (FRSM), if possible, to reduce the risk of onwards transmission.

If a case needs to be transported to hospital, they should have their lesions covered and wear an FRSM. If a case has extensive lesions that cannot be readily covered, then ambulance transport will be required. The receiving hospital and ambulance service should be made aware of the suspicion of mpox to ensure appropriate IPC measures are taken.

IPC requirements for prison staff including those undertaking escort duties are detailed in the general IPC guidance section.

Vehicles other than ambulances should be cleaned and decontaminated in line with the guidance for environmental cleaning and decontamination in non-healthcare settings.

Management of contacts

Contact tracing 

Contact tracing should be undertaken for all confirmed mpox cases and any suspected cases, as advised by the HPT or IMT. This should be conducted by healthcare in partnership with HMPPS, and this information should be provided to the local HPT.

Information gathered should include:

• information on contacts within the infectious period (from when their symptoms start, until their lesions have scabbed over, all the scabs have fallen off and a fresh layer of skin has formed underneath)
• the nature of contact as per the contact tracing matrix
• contacts within (including both staff and prisoners) and outside of the PPD setting

Public health measures for contacts

See definitions of contacts.

High risk (category 3) contacts do not routinely need exclusion or isolation, but should comply with passive monitoring. They should be allocated a single cell where possible to avoid close contact with other people. This should last for 21 days after their last exposure to the case. They can leave the cell to carry out their normal activities but should be advised to avoid close contact with other people, and avoid all contact with:

• immunosuppressed people
• pregnant women
• children under the age of 5

This should last for 21 days from their last exposure. They should be given advice to avoid sexual or intimate contact and other activities involving skin-to-skin contact with other people for the same time period.

Medium risk (category 2) contacts of mpox cases do not routinely require exclusion or isolation, but should comply with passive monitoring. They should be given advice to avoid sexual or intimate or other contact, and other activities involving skin-to-skin contact with other people, for 21 days from their last exposure to the case. During this time period and where possible, they should avoid contact with:

• immunosuppressed people
• pregnant women
• children aged under 5 years

Isolation of close contacts of a resident case within a PPD setting may be advised to help control spread. This will be advised by the IMT.

Staff members who are contacts should be advised about the public health actions that they should undertake within their own households according to the category of contact that they are. Occupational Health or the employer should carry out a risk assessment to consider the implications for the contact’s work, which may include redeployment or exclusion. High risk contacts (category 3 contacts) will require redeployment or exclusion if their work involves direct contact with individuals who are immunosuppressed, pregnant or aged under 5 years.

Category 1 contacts do not require any public health actions. As with all contacts, they should be advised to monitor themselves for symptoms of mpox for 21 days after their last exposure.

IPC measures for contacts

For category 3 contacts, cell cleaning may be undertaken by the prisoner using general purpose detergent.

Laundry should be double bagged with an inner soluble alginate bag placed carefully into a polythene bag or impermeable sack before removal from the room. Remove the soluble alginate bag directly into a standard washing machine. Wash the items with detergent at the highest temperature possible for the material, and set to the longest wash cycle available. Avoid overloading the machine, use plenty of water, and avoid economy cycles.

There are no additional requirements for the handling of waste. Staff are not required to wear PPE, however, hand hygiene should be undertaken after contact with the resident as per standard precautions.

There are no additional IPC requirements for category 2 or category 1 contacts.

Vaccination

Vaccination may be recommended for some contacts as post-exposure prophylaxis; this will be agreed with the HPT. Wider vaccination may be considered in certain circumstances. Information about mpox vaccination is available in the Green Book chapter 29.

If the HPT or IMT advises that mpox vaccination is required, then this should be delivered to residents of PPD settings via an agreed in-reach model.

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 advised accordingly.

For suspected and confirmed clinically well cases managed in PPDs, transmission risks should be based on a clinical risk assessment.

For suspected cases, the minimum PPE for non-healthcare prison staff required to have contact with the case is:

• gloves
• FRSM (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 or changes on their chest x-ray indicating lower respiratory tract infection)
• apron (the use of long-sleeved single-use disposable gowns should be considered where extensive manual handling or unavoidable skin-to-skin contact is anticipated)
• eye protection is required if there is a risk of splash or droplet exposure of the face and eyes (for example when taking diagnostic samples such as throat swabs)

HMPPS escort staff should also follow these PPE guidelines.

For confirmed cases, or those requiring ongoing clinical management (for example inpatient care or repeated assessment of an individual who is clinically unwell or deteriorating), the minimum recommended PPE is:

• fit-tested FFP3 respirator
• eye protection
• long-sleeved, fluid-repellent, disposable gown
• gloves

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

When classifying contacts the use of the above PPE will be considered.

Hand hygiene

Hand hygiene is important and should be undertaken by both the case and any contacts before leaving their room. Staff should follow best practice regarding hand hygiene when removing PPE. Alcohol-based hand sanitiser, if available, can be used as an alternative to liquid soap and water for visibly clean, dry hands.

Cleaning and decontamination

Increased cleaning is likely to reduce risk and is recommended. Poxviruses such as MPXV can survive in the environment and on different types of surfaces for up to 56 days depending on the environmental conditions. Evidence on the survival of MPXV itself is limited, but viable MPXV has been detected on household surfaces at least 15 days after contamination of the surface.

While there is limited data on transmission of poxviruses from contaminated objects or materials other than linens such as clothing or bedding, there remains a risk that mpox can be transmitted via this route. Appropriate cleaning and disinfection can help reduce this risk.

All staff who are cleaning and decontaminating in PPD settings should be trained in donning and doffing of PPE, safe disposal of PPE, and in the use of disinfectants as required by control of substances hazardous to health (COSHH) regulations.

Cleaning and decontamination at the end of the isolation period

Once the case is recovered (or has left the cell or room) then a final clean should be undertaken while wearing full PPE as outlined below. Cleaning should be carried out in the following order:

1. Clean your hands

2. Apply PPE

3. Collect and dispose of general waste items in the room, including objects such as bandages, paper towels, food packaging, and other common waste items

4. Remove contaminated clothing and linen from the environment

5. Clean and disinfect hard surfaces, for example counters, toilets, walls

6. Steam clean soft surfaces, for example cushions, cushioned chairs

7. Steam clean carpet and wash hard flooring

8. Remove PPE

9. Collect waste generated from cleaning (for example, sponges and mops) into impermeable bags, tie securely and dispose of into usual waste stream

10. Wash your hands

Dispose of all objects and waste from cells or shared areas in the general waste stream. Objects and waste from healthcare areas should be disposed of in the category B waste stream.

PPE for cleaning and decontamination

Individuals cleaning where a confirmed case has spent significant time should wear the PPE listed below to avoid direct contact with contaminated material during the process:

• single pair of disposable gloves
• disposable plastic apron (if available, the health care provider should assist with risk assessing whether there is a need to use a disposable fluid resistant long-sleeved gown)
• FRSM

While wearing PPE, keep your hands away from your face and the PPE you are wearing. Change your gloves if they become torn or heavily contaminated.

When taking off (doffing) PPE:

• PPE should be removed in an area where clean equipment cannot inadvertently be contaminated while you are taking it off
• remove your PPE carefully to prevent contaminating yourself – for example, do not touch the outside of your gown, and only touch the ties of your face mask when removing it
• wash your hands with soap and water for at least 20 seconds after cleaning, and make sure to do so immediately after removing gloves

Dispose of all PPE and disposable materials used for cleaning cells and shared areas in the general waste stream. PPE and disposable materials used in healthcare settings should be disposed of in the Category B waste stream.

Management of contaminated clothing and linen

Collect contaminated clothing, removable soft furnishings, and linens such as bedding and towels first before the room is cleaned. Do not shake, sort or handle these items in a manner that may disperse infectious particles.

Items that have been in direct contact with the skin of someone with mpox and which are not easily washable in a washing machine, for example duvets, pillows, or blankets, may need to be disposed of. Obtain permission from the owner if these are personal or individuals’ items. Contaminated items from cells and communal areas that cannot be washed should be disposed of via the usual waste stream. Contaminated items from healthcare settings should be disposed of in the Category B waste stream.

All other clothing and linen items should be double bagged with an inner soluble alginate bag placed carefully into a polythene bag or impermeable sack before removal from the room. Remove the soluble alginate bag directly into a standard washing machine while wearing PPE. Wash the items with detergent at the highest temperature possible for the material, and set to the longest wash cycle available. Avoid overloading the machine, use plenty of water, and avoid economy cycles.

After all contaminated clothing and linens have been removed, the rooms can be cleaned and disinfected using disposable equipment (for example mops with disposable heads, disposable cleaning wipes).

Cleaning hard surfaces 

It is important to prevent the spread of dust particles that may contain MPXV. To minimise this risk, avoid dry dusting or sweeping, as these actions can release dust into the air. Instead, use wet cleaning methods, such as using disinfectant wipes, sprays, or mopping, which are more effective at containing dust. It is recommended that you do not use vacuum cleaners, as this may disperse dust particles around the environment.

Clean hard surfaces by using detergent, followed by disinfection with either:

• a solution of freshly prepared bleach or sodium hypochlorite diluted to no lower than 1,000 ppm (0.1%) available chlorine
• a commercial alcohol spray, containing 70% ethanol or isopropanol

When using bleach:

• take care to prepare the correct concentration (at least 1,000 ppm or 0.1% available chlorine)
• it is recommended that the bleach has one minute contact time with the surface being disinfected
• follow the manufacturer’s instructions and do not mix cleaning products
• be aware that bleach may trigger asthma in poorly ventilated spaces
• make sure you comply with the safety data sheets and COSHH regulations
• be aware that bleach may damage some surfaces

Make sure you thoroughly clean frequently touched surfaces like tables, door handles, toilet flush handles and taps.

Cleaning soft surfaces

Soft furnishings, such as carpets, sofas, curtains, mattresses, and vehicle interiors can be cleaned with commercial alcohol sprays (70% ethanol or isopropanol) while wearing full PPE as above. Alternatively, these surfaces can be steam cleaned by individuals wearing full PPE as described above; this may need to be carried out professionally. Steam cleaners then need to be disinfected after use following the manufacturer’s instructions.

If an item has been heavily contaminated with body fluids, it may need to be disposed of and replaced. The need for this should be discussed with the owner, and permission obtained prior to disposal.

Waste disposal 

Cleaning equipment and non-reusable equipment in the rooms used by a confirmed mpox case that cannot be cleaned may need to be disposed into the normal waste stream. Equipment used in healthcare areas should be disposed of in the category B waste stream. This also applies to any other waste generated that has not been previously mentioned. Advice can be sought from the local waste contractor, a Dangerous Goods Safety Adviser, or in Health Technical Memorandum 07:01 ‘Safe Management of Healthcare Waste’.

Hand hygiene

Staff undertaking cleaning should wash their hands with soap and water for at least 20 seconds after cleaning, and make sure to do so immediately after removing gloves. Alcohol-based hand sanitiser containing at least 60% alcohol can be used to clean hands that are visibly clean. If hands are visibly dirty, they should be washed with soap and water before using hand sanitiser.

More information on hand hygiene can be found on the NHS How to wash your hands page. 

Cleaning communal areas 

If the case spent any time in communal areas such as wing landings, gyms or visiting areas these may need to be cleaned. The decision on which communal areas require cleaning should be informed by the IMT, considering factors such as the clinical condition of the case (for example, nature of the case’s lesions), patient timelines including when they first felt unwell or when a rash developed, type of exposure, and other relevant factors.

For areas where the case has spent limited time, appropriate PPE for cleaning includes a FRSM, eye protection, disposable gloves and a disposable plastic apron (if available, the health care provider should assist with risk assessing whether there is a need to use a disposable fluid resistant long-sleeved gown). Pay particular attention to frequently touched surfaces such as tables, door handles, toilet flush handles and taps.

Reducing contact with clinically vulnerable people

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 mpox.