06/21/2022: Lab Advisory: Interagency Partners Update Planning Guidance for Disposal and Shipment of Material Suspected to Contain Mpox Virus

CDC's Laboratory Outreach Communication System (LOCS)

Audience: Clinical Laboratory Professionals

Level: Laboratory Advisory

Interagency partners at the U.S. Transportation, Labor, and Defense departments, the U.S. Environmental Protection Agency, CDC, and the Assistant Secretary for Preparedness and Response have updated the planning guidance for handling category A solid waste, which addresses the transportation and disposal of material suspected to contain mpox virus.

Previous studies have defined two distinct mpox clades, West African and Congo Basin, with unique disease manifestations (i.e., how disease presents in people, the severity of its effects, and how readily it spreads). Human disease associated with West African clade mpox virus infection is less severe and associated with less human-to-human transmission compared to infections with Congo Basin clade mpox virus. Therefore, recommendations for packing, shipping, inactivation methods, and managing waste contaminated with mpox virus differ based on the clade of the virus.

All currently known mpox cases in the United States are of the West African clade. As long as clinical teams can reasonably determine that it holds true for the specific patient they are caring for (i.e., because of disease presentation, epidemiologic linkage to a case known to have West African clade mpox, no travel history to a country where Congo Basin clade mpox virus is known to circulate), then materials known or suspected to contain only West African clade mpox virus can be classified at lower levels (i.e., below Category A) under the Hazardous Materials Regulations (HMR).

Waste can be packed, transported, treated/inactivated, and disposed of as United Nations (UN) 3291, Regulated Medical Waste (RMW) under the HMR and any applicable state, tribal, local, or territorial regulations—the same way other waste from healthcare facilities is routinely managed.

Laboratory specimens can be packed and shipped as Category B infectious substances (UN 3373, Biological Substance, Category B). Specimens suspected to contain only West African clade mpox virus do not require a DOT Special Permit.

Note: Public health laboratories have capacity for the current testing demand. Laboratories with specimens that are suspected to contain mpox virus should contact their state or territorial public health department (contact list) as soon as possible.

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