What Healthcare Workers Need to Know to Be Protected from Monkeypox At Work

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What Is Monkeypox?

Human monkeypox is a viral disease caused by the monkeypox virus, which belongs to the same family of viruses as smallpox. Monkeypox symptoms are less severe than smallpox (eradicated in 1980), less contagious, and rarely fatal. Monkeypox is not related to chickenpox. Since May 2022, Monkeypox has started to spread globally, including in the United States.

Public health efforts are aimed at keeping the disease from becoming endemic[1] in the U.S. and worldwide.  The new rapid spread may indicate that the virus has mutated to become more contagious.

The current outbreak in the United States is associated with the virus’s less virulent West African “clade” (genetic group).  It is rarely fatal but painful and can cause permanent scarring.  People with weakened immune systems, the elderly, children under age 8, people with a history of eczema, and people who are pregnant or breastfeeding are at higher risk for severe outcomes.

Healthcare workers are at a potentially higher risk of exposure to the monkeypox virus if infected patients are present at their facility.  While monkeypox is much less infectious than COVID-19 and does not spread through brief encounters infection control protocols should be implemented by employers to identify cases, protect workers, and reduce transmission.

According to the Centers for Disease Control and Prevention (CDC), “Transmission in healthcare settings has been rarely described.” The CDC has developed the guidance document ‘Infection Prevention and Control of Monkeypox in Healthcare Settings’[2] which provides guidance on the following topics:


Monkeypox can spread to anyone through close, personal, often skin-to-skin contact, including:

According to the CDC, you may be at an increased risk of contracting monkeypox if you were exposed to an infected person who was coughing while not wearing a mask or respirator, or if you were not previously vaccinated against smallpox or monkeypox.[3]

Researchers do not yet know if monkeypox can be transmitted through semen, vaginal fluids, urine, or feces.  Monkeypox is not considered a sexually transmitted disease (STD) at this time. Anyone can be infected through close personal contact. It is critical that our efforts do not stigmatize

monkeypox, which may result in people failing to seek medical care, an increase infection spread, and stalled contact tracing. 

Incubation and Infectious Period


Most people infected with monkeypox get a rash that develops into pustules on or near the genitals (penis, testicles, labia, and vagina) or anus and could be on other areas like the hands, feet, chest, face, or mouth.  Many people also experience fever, chills, sore throat, headache, muscle aches, and swollen lymph nodes.  The swollen lymph nodes can help to diagnose monkeypox because measles and chickenpox do not include that symptom.  Some people may experience severe pain; others will have fewer symptoms.  Complications can include pneumonia, encephalitis, and eye infections.

The CDC urges healthcare providers to be on the lookout for rash illnesses consistent with monkeypox[4].


Many infected people can isolate themselves at home with advice from their healthcare provider about over-the-counter topical agents, antihistamines, and pain medication.  Some patients will need to be hospitalized and treated with antiviral drugs developed for smallpox or with Vaccinia Immune Globulin Intravenous (VIGIV) therapy.  Tecovirimat (TPOXX), a new investigational drug, is available from the Strategic National Stockpile.


Two vaccines – JYNNEOS or ACAM2000 – may be used to prevent monkeypox disease as a pre-exposure prophylaxis and can also be used for treatment as post-exposure prophylaxis.  

The “CDC is not currently encouraging pre-exposure vaccination for most U.S. healthcare workers.”[5]  According to its’ ‘Clinician FAQs: Questions and Answers about Monkeypox for Healthcare Professionals:’ The ‘CDC Monkeypox and Smallpox Vaccine Guidance,” issued on June 2, 2022, for healthcare professionals, may change, however, based on vaccine supply and the outbreak evolution.

“The risk of monkeypox for most front-line healthcare workers is currently low.  Monkeypox virus primarily spreads through close contact and does not spread as easily as respiratory viruses (e.g., influenza and SARS-CoV-2 viruses).  Proper use of personal protective equipment and infection control practices are likely to be effective at reducing the risk of transmission of the monkeypox virus when examining a patient or handling contaminated materials.  However, healthcare workers who have been exposed to monkeypox may benefit from post-exposure prophylaxis with the JYNNEOS vaccine, ideally within four days.”

Pre-Exposure Prophylaxis to Prevent Monkeypox[6]

The CDC’s Advisory Committee on Immunization Practices (ACIP) recommend that people whose jobs may expose them to orthopoxviruses, such as monkeypox, get vaccinated with either ACAM2000 or JYNNEOS to protect them if they are exposed to an orthopoxvirus.  This is known as pre-exposure prophylaxis (PrEP).

People who should get PrEP include:

Health and Safety Protections for Healthcare Workers

The following PPE should be worn by healthcare staff when handling patients with suspected or confirmed monkeypox—this includes direct care staff and staff who handle soiled clothing, linen, used dishes, trash, and waste:

Employer Responsibilities

Employers should implement protocols to safely care for potentially infected patients and patients with confirmed infections of the monkeypox virus. The CDC has provided recommendations for infection control in healthcare settings[7] which includes training for direct care staff and environmental services staff. Employers should also offer paid leave to employees infected with the monkeypox virus.

Transportation of contaminated medical wastes should be performed in accordance with the U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR; 49 CFR parts 171-180.)

Required waste management practices and waste classification currently differ depending on the monkeypox virus clade (strain).  The DOT indicates that waste contaminated with the West African clade[8] of monkeypox virus should be managed as UN3291 Regulated Medical Waste (RMW) in the same manner as other potentially infectious medical waste (e.g., soiled dressings, contaminated sharps).  Facilities should also comply with state and local regulations[9] for handling, storage, treatment, and disposal of waste, including RMW.

Laboratory workers should consult with laboratory biosafety officers and supervisors to identify risks and precautions, depending on the type of work they are doing.  Regardless of whether a PrEP vaccine is received, clinicians and laboratorians should use recommended infection control practices; these are important to prevent any infection. 

Notification and Contact Tracing Recommendations

The information presented in this section would be implemented at the discretion of the medical facility or as required by local public health authorities.  Notification policies could be a subject of impact bargaining.


Centers for Disease Control and Prevention (CDC)

Environmental Protection Agency (EPA)

For more information, contact the IBT Safety and Health Department at (202) 624-6960 and visit https://teamstersafety.org.

[1]Endemic refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area. www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html

[2] Infection Control: Healthcare Settings | Monkeypox | Poxvirus | CDC https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html

[3] Infection Control: Healthcare Settings | Monkeypox | Poxvirus | CDC  www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html

[4] What Healthcare Professionals Should Know | Monkeypox | Poxvirus | CDC www.cdc.gov/poxvirus/monkeypox/clinicians/what-hcps-should-know.html

[5] Clinician FAQs | Monkeypox | Poxvirus | CDC www.cdc.gov/poxvirus/monkeypox/clinicians/faq.html

[6] Monkeypox and Smallpox Vaccine Guidance | Monkeypox | Poxvirus | CDC https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html

[7] Infection Control: Healthcare Settings | Monkeypox | Poxvirus | CDC  www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html

[8] Managing Solid Waste Contaminated with a Category A Infectious Substance (dot.gov)


[9] Healthcare Environmental Resource Center (HERC) (hercenter.org) www.hercenter.org/rmw/rmwlocator.php 

[10] Infection Control: Healthcare Settings | Monkeypox | Poxvirus | CDC www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html#anchor_1660143677200