On July 23, 2022, the World Health Organization (WHO) declared the monkeypox outbreak a Public Health Emergency of International Concern (PHEIC). As of August 5, over 28,000 cases have been identified globally, spanning 88 countries and territories. In the U.S., according to the Centers for Disease Control and Prevention (CDC), 7,510 cases have been identified to date. As reported by Politico, the Biden Administration declared monkeypox a public health emergency on August 4. In a statement released by The White House, President Biden announced the team to lead the monkeypox response, which will include “equitably increasing the availability of tests, vaccinations and treatments.” As reported by The New York Times, in an effort to mobilize resources and secure federal assistance, affected states and localities are also taking action.
Monkeypox transmission is currently occurring predominately through encounters among gay men, bisexual men and other men who have sex with men. While the mortality and population-wide health risk remains relatively low for the majority of people, swift action is needed to prevent a larger outbreak. Anyone can contract the virus through direct contact, regardless of sexual orientation. Employers are well-positioned to educate all employees on the harms of stigmatization of the virus.
As with COVID-19, employers can play an important role in helping public officials worldwide prevent further spread of the virus and challenging misinformation. Keeping employees up to date with accurate, culturally competent guidance from reputable sources about the impact of the virus, the way it transmits, its symptoms, vaccine availability and other prevention efforts are actions that employers can take to manage employees’ fear and uncertainty about the spread of monkeypox. As more reports about monkeypox are publicized, employers will need as much information as possible on how to respond to employee concerns.
At-risk Populations and Transmission
Currently, the populations most at risk for monkeypox exposure are gay men, bisexual men and other men who have sex with men. During the HIV/AIDS epidemic in the 1980s and early 1990s, these communities faced stigma and discrimination. The hope is to avoid marginalization of the LGBTQ+ community this time around, as well as misinformation that may impact prevention efforts to stop the spread of monkeypox. On the international front, there may be a geographical stigma associated with the disease, as it is typically endemic in certain West and Central African nations.
Monkeypox is transmitted via direct or indirect contact with the infectious monkeypox rash or body fluids. This includes close, skin-to-skin contact, contact with respiratory secretions or intimate contact with someone who is infected after symptom onset, or through contact with items or fabrics that have touched the infectious rash or body fluids.
The CDC recommends that people who believe they have been exposed to the virus consult with a health care provider about receiving a monkeypox test. Isolation is recommended for those who have monkeypox, but the CDC recognizes that this may not be realistically possible in all situations due to the potential 4-week duration of the illness.
Considering the methods of transmission, employees who could be at-risk include:
- Those who touch skin directly, such as health care workers and massage therapists;
- Workers who handle soiled linens, such as hotel staff and airline staff;
- Workers who handle surfaces or items that may have saliva or body fluids, including restaurant staff, sanitation staff for fitness centers and transportation, and those handling samples in biomedical facilities.
In addition, others who may be at higher risk of severe illness from monkeypox include, but are not limited to, people who have a weakened immune system, those with a history of eczema, individuals who are pregnant or breastfeeding and children under the age of 8.
The CDC released considerations for monkeypox vaccinations that detail two different vaccine options for eligible people: JYNNEOS and ACAM2000 (originally developed for smallpox). While more studies are needed to fully assess the effectiveness of these vaccines against the current monkeypox outbreak, they are playing a significant role in preventing the disease even after exposure, if received early enough. The time for maximum development of the immune response differs between the two vaccine options, with JYNNEOS taking 14 days and ACAM2000 taking 4 weeks. Therefore, the CDC recommends coupling vaccination with other prevention efforts to impede the spread of the virus most effectively.
Actions Employers Can Take to Support Public Health Efforts
In many workplaces, protocols preventing the spread of COVID-19 may still be in place. Reevaluating previous guidance and leveraging adopted health, safety and workplace cleaning protocols can also help prevent the spread of monkeypox.
In addition to general measures to prevent the spread of viruses learned from the COVID-19 response, employers can consider the following strategies:
- Stay up to date on monkeypox developments by using information from reputable sources, such as CDC, WHO, the Department of Health and Human Services (HHS) and state public health departments, to keep workplace health and safety guidelines current.
- Follow local, state and country guidelines for actionable steps to prevent the spread of monkeypox. If needed, concentrate communications and increase prevention efforts in geographic areas of greatest risk.
- California Department of Public Health: Monkeypox Communications Toolkit
- New York State Department of Health: Monkeypox
- CDC: Reducing Stigma in Monkeypox Communication and Community Engagement
- WHO: Monkeypox Outbreak 2022
- Pan American Health Organization: Public Health Advice on Monkeypox
- Use targeted, culturally sensitive communications to educate employees, especially those who are at risk, about transmission and symptoms of monkeypox. Ensure that virtual care providers and navigator teams establish proper communications strategies or designate resources to handle member questions. Remind employees of anti-discrimination and anti-harassment policies and advise all employees to avoid making assumptions about those who are infected.
- Inform employees about how to avoid infection and prevent the spread of monkeypox. Precautions are similar to those adapted to prevent COVID-19 spread, such as washing hands, using alcohol-based hand sanitizer, routinely cleaning all frequently touched surfaces in the workplace, avoiding skin-to-skin contact with people who have a rash, avoiding contact with people who are sick, and staying home when sick.
- Adjust sick leave policies to allow for appropriate precautions related to exposure to and diagnosis of monkeypox. Educate members on how to recognize symptoms and establish confidential channels for communicating the need to take leave related to exposure. Consider offering paid time off or work-from-home options for people experiencing symptoms or feeling sick.
- The CDC recommends vaccination for people who have been exposed to monkeypox and people who may be more likely to get monkeypox. Communicate vaccine eligibility criteria to all employees and encourage vaccination. Include information on locations where vaccines are available and insurance coverage information for employees concerned about payment for the vaccine. Consider deploying on-site clinic resources in vaccination efforts.