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Monkeypox: What to Know and How to Mitigate your Community’s Risk

Over the past few weeks, the monkeypox virus has been spreading quickly, prompting a recent wave of public health emergency declarations at the local, national and global level. As the back-to-school season ramps up, schools are wondering how to protect their community and minimize the spread on campuses. This blog post answers common questions from schools about monkeypox and offers some guidance on best practices for mitigation and response. 

What is monkeypox?

Monkeypox is a virus similar to the smallpox virus. It has less severe symptoms and is typically characterized by a rash that can look like pimples or blisters that appear on the face, inside the mouth, and on other parts of the body. It can also cause other flu-like symptoms including fever, body aches, headaches, and exhaustion.

How does monkeypox spread? 

Current data indicates that monkeypox is transmitted from person to person through close skin-to-skin contact, coughing and sneezing, or by touching or sharing infected items like clothing and bedding.

How quickly is monkeypox spreading? 

As of this week, there are estimated to be nearly 9,000 cases in the US, and 30,000 cases worldwide, with the vast majority of cases occurring in countries that have not historically reported monkeypox. Last week, the Biden Administration declared a national health emergency over the growing spread of monkeypox in the US, and several states have recently declared a state of emergency as case counts rise. The World Health Organization has also declared the spread of monkeypox to be a global health emergency.

Are children at high risk? 

According to the American Academy of Pediatrics, the risk of children getting infected with the monkeypox virus is low. As of August 3rd, two pediatric cases had been confirmed in the United States, which equates to less than 0.1% of all cases. Children and adolescents are more likely to be exposed to monkeypox if they live in or have recently traveled to a community with higher rates of infection. Infants, young children (under 8 years of age), children with eczema and other skin conditions, and children with immunocompromising conditions may be at increased risk of severe disease when they contract monkeypox.

Why is monkeypox considered less of a public health threat than Covid-19? 

There are a few reasons for this:

Monkeypox is not a new virus. Monkeypox (a virus similar to the smallpox virus, but with less severe symptoms) has been circulating in humans for decades. The first human case of monkeypox was detected in 1970. Since then, monkeypox has become endemic in Africa and has periodically caused small outbreaks throughout the continent.

Vaccines already exist for monkeypox. A vaccine called Jynneos was approved in 2019 to protect against smallpox and monkeypox, and is currently available for people 18 and older. This past June, federal health officials made the national stockpile of the vaccine available to states, which can now offer it to anyone exposed to the virus. The vaccine can work both before and after exposure to monkeypox. 

Monkeypox is less transmissible. Current data indicates that monkeypox does not spread through aerosol particles as Covid does, but spreads from close skin-to-skin contact, through coughing and sneezing, or by touching or sharing infected items like clothing and bedding. This makes Covid-level rates of community spread unlikely.

Monkeypox has very low fatality rates. Monkeypox produces a variety of symptoms that range from uncomfortable to excruciatingly painful, but it is rarely fatal. Out of 25,000 cases, six deaths have been reported in places where the virus was not known to exist previously. The risk of death is higher for young children and people who are immunocompromised or pregnant, though these populations have not seen high infection rates thus far.

Should staff and students get vaccinated against monkeypox?

While there is a vaccine available for monkeypox, CDC recommends vaccination for people who have been exposed to monkeypox and people who may be more likely to get monkeypox. This includes people who have been identified by public health officials as a contact of someone with monkeypox. Individuals should contact their healthcare provider or local health department to determine their eligibility for vaccination. They will help determine if an individual should get vaccinated.

As schools come back this fall, are we likely to see high transmission rates on campus?

Experts believe monkeypox is more likely to spread at home than at school, but school-based transmission is certainly possible. Taking mitigation measures will be important to ensure in-school transmission rates stay low.

For a detailed Q&A about monkeypox, visit the CDC’s monkeypox FAQ page.

GUIDANCE MITIGATING AND MANAGING MONKEYPOX AT SCHOOL

With smart prevention policies, strong response protocols, and clear communication, monkeypox can be mitigated so our students and community can continue to be a safe space for learning. As a reminder, below are some steps you can take to protect your campus community:

Prevention and Mitigation Measures:

Communicate with staff, students, and parents

Provide clear information about monkeypox prevention, including the potential for transmission through close physical contact. Encourage anyone exhibiting symptoms, or anyone living with someone diagnosed with monkeypox to stay home. (See template communication to staff and families here.)

Promote hand washing

Continue your Covid handwashing protocols to prevent transmission.  Make soap and water or hand sanitizer with at least 60% alcohol available to all staff and students at all times.

If a suspected exposure occurs:

  • Isolate the symptomatic individual - Those suspected to have monkeypox should be sent home as quickly after detection of symptoms as possible. 
  • Recommend medical care and testing - The person exhibiting symptoms should be medically evaluated by their healthcare provider and tested (if warranted by the healthcare provider) for monkeypox. The healthcare provider will help determine vaccine eligibility. 
  • Identify close contacts - This includes anyone who may have had skin-to-skin contact with the infected person. In some instances, close contacts may include an entire class if multiple items were shared when symptoms appeared. 
  • Notify close contacts - Notify all close contacts of the exposure and encourage any individuals exhibiting symptoms to stay home. (See template notification letter here). Work with local public health officials or their healthcare providers to determine whether close contacts who are not exhibiting symptoms can be given the option to continue attending school in person as long as they do not develop symptoms. They should be monitored for 21 days after exposure and sent home immediately if symptoms arise. 
  • Clean and disinfect key areas - Identify the areas where the individual with monkeypox spent time and disinfect it as quickly as possible. Avoid activities that could spread dried material from lesions (e.g., use of fans, dry dusting, sweeping, or vacuuming) in these areas. Provide appropriate personal protective equipment (PPE) when deemed necessary, and ensure anyone who has touched lesions or clothing, linens, or surfaces that may have had contact with lesions washes their hands immediately.
  • Discontinue isolation - Those with monkeypox should isolate themselves away from others until the rash is healed, all scabs separate and a fresh layer of healthy skin has formed underneath. Decisions about the discontinuation of isolation should be made in consultation with the local or state health department and their healthcare provider.

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