Monitoring Persons Exposed

Person feeling ill.

Contacts of animals or humans that have been confirmed to have monkeypox should be monitored for symptoms.

Monitoring Contacts with No Symptoms

Asymptomatic contacts of animals or humans confirmed to have monkeypox should be placed under symptom surveillance for 21 days after their last exposure.

Symptoms* of concern include:

  • Fever ≥100.4°F (38°C)
  • Chills
  • New lymphadenopathy (periauricular, axillary, cervical, or inguinal)
  • New skin rash

Contacts should monitor their temperature twice daily. If symptoms develop, contacts should immediately self-isolate and contact the health department for further guidance.

Asymptomatic contacts should not donate blood, cells, tissue or organs while they are under symptom surveillance.

Asymptomatic contacts can continue routine daily activities (e.g., go to work, school). Those who are in the intermediate or high-risk exposure category should remain close to home for the duration of surveillance. However, it may be prudent to exclude pre-school children from daycare or other group settings.

*Fever and rash occur in nearly all persons infected with monkeypox virus.

Monitoring Contacts with Symptoms

  • If fever or rash develop, contacts should self-isolate and contact their local or state health department.
  • If only chills or lymphadenopathy develop, the contact should remain at their residence and self-isolate for 24-hours.
    • During this time, the individual should monitor their temperature for fever; if a fever or rash develop, the health department should be contacted immediately.
  • If fever or rash do not develop and chills or lymphadenopathy persist, the contact should be evaluated by a clinician for potential cause. Clinicians can consult with their state health departments if monkeypox is suspected.

Affected individuals should not donate blood, cells, tissue, organs, breast milk or semen while ill or are under symptom surveillance.

Monitoring Exposed Healthcare Professionals

Healthcare workers who have unprotected exposures (i.e., not wearing PPE) to patients with monkeypox need not be excluded from duty, but should undergo active surveillance for symptoms, including measurement of temperature at least twice daily for 21 days following the exposure. Prior to reporting for duty each day, the healthcare worker should be interviewed regarding evidence of fever or rash. Healthcare workers who have cared for or otherwise been in contact with exposed monkeypox patients while adhering to recommended infection control precautions may undergo self-monitoring or active monitoring as determined by the health department. Any healthcare worker who has cared for a monkeypox patient should be alert to the development of symptoms that could suggest monkeypox infection, especially within the 21 day period after the last date of care, and should notify infection control, occupational health, and the health department to be guided about a medical evaluation.

Exposure risk assessment and public health recommendations for individuals exposed to a monkeypox (MPX) case-patient during the period of interest, July 2021

Definitions:

  • Period of interest—5 days prior to rash onset and including the entire period when the MPX case-patient has a rash (lesions)
  • Direct contact—contact with the MPX case-patient, case-patient materials (e.g., linens, clothing, healthcare equipment), crusts, or bodily fluids of the case-patient (including soiled surfaces)
  • Indirect contact—presence within 6 feet of a MPX case-patient in the absence of a N95 or filtering respirator for ≥3 hours

Persons with no risk

  • Definition of exposure during period of interest
    • No known contact (direct or indirect) with a MPX case-patient
  • Surveillance
    • Surveillance for 21 days after last exposure is not needed
  • Smallpox vaccination
    • Post-exposure smallpox vaccination is not recommended

Persons with uncertain or low risk

  • Definition of exposure during period of interest
    • Healthcare provider involved in care of MPX case-patient while wearing at least gown, gloves, eye protection, and medical facemask or respirator (with no known breaches) for all direct and indirect contact episodes, OR
    • Passengers sitting adjacent (one seat in all directions) to case-patient on the domestic flighta, OR
    • Use of a mid-cabin bathroom on the international flighta, OR
    • Airplane bathroom cleaning staff for the international flighta, OR
    • Special circumstances identified by public health officials
  • Surveillance
    • Active monitoringb,c,e for 21 days after last exposure is recommended
  • Smallpox vaccination
    • Post-exposure smallpox vaccination is not recommended

Persons with intermediate risk

  • Definition of exposure during period of interest
    • Direct contact via intact skin with a MPX case-patient, case-patient materials, crusts, or bodily fluids, OR
    • Indirect contact with a MPX case-patient (including passengers seated in a 6-foot radius to the case-patient on the international flighta), OR
    • Flight crewa who provided service to the MPX case-patient, OR
    • Healthcare provider not wearing at least gown, gloves, eye protection or medical facemask for all direct and indirect contact episodes
  • Surveillance
    • Active monitoringc,e for 21 days after last exposure is recommended
  • Smallpox vaccination
    • Post-exposure smallpox vaccination may be considered in consultation with public health authorities

Persons with high risk

  • Definition of exposure during period of interest
    • Direct contact via broken skin or mucous membranes with a MPX case-patient, case-patient materials, crusts, or bodily fluids. (Exposure includes inhalation of respiratory droplets or material from scabs from cleaning rooms where a monkeypox case-patient has stayed, mucosal exposure to splashes, penetrating injury from used sharps/devices, or any penetrating injury through contaminated gloves or clothing)
  • Surveillance
    • Direct active monitoringd,e for 21 days after last exposure is recommended
  • Smallpox vaccination
    • Post-exposure smallpox vaccination is recommended

a Identified as flights for which the case-patient was a passenger.

b Self-monitoring may be considered for healthcare providers. Self-monitoring is when the person being monitored is responsible for taking their temperature twice a day and watch for signs/symptoms. The individual should immediately report to public health officials if they have signs/symptoms. After the 21-day monitoring period is completed, the public health officials shall contact the person under self-monitoring to verify that they are asymptomatic.

c Active monitoring is when public health officials are responsible for checking at least once a day to see if a person under monitoring has signs/symptoms. The individual under monitoring must take their temperature twice daily, watch for signs/symptoms, and immediately report to public health officials if they have a signs/symptoms. This monitoring involves establishing regular communication (e.g., phone call or another system) between public health representatives the individual under monitoring. The schedule and timing of regular communication will be determined by the health department.

d Direct active monitoring is when public health officials directly observe the person being monitored. It involves establishing direct observation through in-person meeting or video meeting between representatives of the health department (HD) and potentially exposed individuals at least once a day to review signs/symptoms and check temperature. A second follow-up per day can be done by telephone or video as permitted by Health Department. The person under monitoring should immediately report to public health officials if they have a signs/symptoms.

e The following signs/symptoms should be monitored for individuals exposed to Monkeypox virus: fever (≥100.4°F), chills, new lymphadenopathy (periauricular, axillary, cervical, inguinal), and new skin rash [Fever and rash occurred in nearly all of persons with the West African and Congo Basin clades of Monkeypox virus from published studies].