(modified from Guidelines issued by the Centers for Diseases Control and Prevention, Atlanta, USA)

Human monkeypox is a rare infection that was first reported in humans in 1970 in individuals living in remote rural villages in the African Rain Forest. Studies have identified the source of infection as an orthopoxvirus, with the natural host being African rodents. In June 2003, monkeypox was reported in prairie dogs and in humans in the United States. Variola, vaccina and cowpox are also orthopoxviruses. Studies of human monkeypox infections in rural and west Africa, where people live in remote areas and are medically undeserved, have reported case fatality rates as high as 10%.

Persons seeking medical care with fever or rash should be asked about possible exposure to small rodents, especially pet a Gambian giant rats and potentially infected prairie dogs (gophers). If an outpatient or inpatient is suspected of having monkeypox virus , infection control personnel should be notified immediately. Routine practices in combination with additional contact and additional contact and airborne precautions should be implemented immediately. These will include :

• Thorough hand hygiene after all contact with an infected patient and/or the environment of care. (alcohol-based hand solutions are appropriate).
• Use of gown and gloves for ALL contact with the patient and/or the environment. Handle all patient care equipment in a manner that prevents contamination of hands, uniforms and other clothing.
• Airborne respiratory protection when entering the room where an infected patient is housed. Specifically this will include :
  1. N95 mask of equivalent for all entry into the room.
  2. Private isolation room that has negative air pressure relative to the surrounding areas.
  3. Anteroom if possible.
• Eye protection at ALL times to prevent droplet contamination to the eyes.
• All waste for the patient's room or care area must be considered infectious waste, and disposed of accordingly. Special attention must be paid to bandages or other materials in contact with developing lesions.
• Soiled laundry must be considered infectious and must be handled with utmost caution to avoid contact with lesion exudates.
• Clean the environment with a hospital grade disinfectant (detergent based products are not adequate) following manufacturers directions for concentration, contact time and care in handling.

• Segregate the patient from others in the reception area as soon as possible, preferably in a negative pressure private room.
• Place a surgical mask over the patient's nose and mouth.
• Cover exposed lesions to prevent health care worker contact with infectious exudate.

Health care workers with unprotected exposures to patients with monkeypox virus need not be excluded from duty, but should undergo active surveillance for symptoms, including measurement of body temperature twice daily (BID) for 21 days following exposure. Employer should actively monitor the health care workers by inquiring about fever and other symptoms prior to each work period. Health-care workers who have cared for infected patients, while using appropriate precautions should be vigilant for signs for 21 days post exposure. Monitoring of temperature should be done at least once a day. Employers should actively contact the health care workers inquiring about fever and other symptoms.

Isolation precautions should be continued until all lesions are crusted.

www.cdc.gov/ncidod/monkeypox/infectioncontrol.htm, "Interim Infection Control and Exposure management Guidance in the Health-Care and Community Settings for Patients with Possible Monkeypox Virus Infection".

Weber DJ and Rutela WA. Risks and Prevention of Nossoccomial Transmission of Rate Zoonotic Diseases. CID 2001, 446-456.