Monitoring People Who Have Been Exposed

Person feeling ill.

Contacts of animals or people confirmed to have monkeypox should be monitored for symptoms 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

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

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

  • If fever or rash develop, contacts should self-isolate and contact their local or state health department immediately.
  • 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.

Contacts who remain asymptomatic can be permitted to continue routine daily activities (e.g., go to work, school). Contacts should not donate blood, cells, tissue, breast milk, semen, or organs while they are under symptom surveillance.

Monitoring Exposed Healthcare Professionals

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.

Healthcare workers who have unprotected exposures (i.e., not wearing PPE) to patients with monkeypox do not need to be excluded from work duty, but should undergo active surveillance for symptoms, which includes measurement of temperature at least twice daily for 21 days following the exposure. Prior to reporting for work each day, the healthcare worker should be interviewed regarding evidence of fever or rash.

Healthcare workers who have cared for or otherwise been in direct or indirect contact with monkeypox patients while adhering to recommended infection control precautions may undergo self-monitoring or active monitoring as determined by the health department.

Exposure risk assessment and public health recommendations for people who may have been exposed to travel-associated monkeypox case, November 2021

Definitions:

  • Period of interest—5 days prior to rash onset and including the entire period when the monkeypox (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

Risk group

Definition of exposure during the period of interest

Surveillance for 21 days after the last exposure

Post-exposure vaccination for prevention of orthopoxvirus infection

Risk group

No risk

Definition of exposure during the period of interest

No known contact (direct or indirect) with a MPX case-patient

Surveillance for 21 days after the last exposure

None

Post-exposure vaccination for prevention of orthopoxvirus infection

None

Risk group

Uncertain / Low

Definition of exposure during the period of interest

  1. Healthcare worker 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
  2. Special circumstances identified by public health officials

Surveillance for 21 days after the last exposure

Active monitoringb, c, e

Post-exposure vaccination for prevention of orthopoxvirus infection

None

Risk group

Intermediate

Definition of exposure during the period of interest

  1. Direct contact via intact skin with a MPX case-patient, case-patient materials, crusts, or bodily fluids, OR
  2. Indirect contact with a MPX case-patient (including passengers seated in a 6-foot radius to the case-patient on a flighta), OR
  3. Flight crewa who provided service to the MPX case-patient, OR
  4. Healthcare worker not wearing at least gown, gloves, eye protection or medical facemask for all direct and indirect contact episodes
  5. Laboratory staff within six feet of an analytic instrument (not contained within a BSC and/or not wearing appropriate personal protective equipment to prevent aerosol or another direct exposure) while specimens from a confirmed MPX case-patient were loaded, run, and/or unloaded, or one hour after unloading the specimens.

Surveillance for 21 days after the last exposure

Active monitoringc, e

Post-exposure vaccination for prevention of orthopoxvirus infection

Vaccination may be considered in consultation with public health authorities

Risk group

High

Definition of exposure during the 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 if scab material present while cleaning rooms where a monkeypox case-patient stayed, mucosal exposure to splashes, penetrating injury from used sharps/devices, or any penetrating injury through contaminated gloves or clothing)

Surveillance for 21 days after the last exposure

Direct active monitoringd, e

Post-exposure vaccination for prevention of orthopoxvirus infection

Vaccination is recommended

 Identified as flights on which the patient was a passenger during the period of interest.

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, public health officials should contact the person under self-monitoring to verify that they remained asymptomatic.

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., at least daily phone call or another system) between public health representatives and the individual under monitoring. The schedule and timing of regular communication will be determined by the health department.

Direct active monitoring is when public health officials directly observe the person being monitored. It involves establishing direct observation through in-person or video meeting between representatives of the health department 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 the health department. The person under monitoring should immediately report to public health officials if they have any signs/symptoms.

e The following signs/symptoms should be monitored for individuals exposed to Monkeypox virus: fever (≥100.4°F), chills, new swollen lymph nodes (periauricular, axillary, cervical, or inguinal lymphadenopathy), and/or new skin rash. Fever and rash have occurred in nearly all published reports of people infected with Monkeypox virus.