Mpox Information

Since May 2022 numerous countries have reported cases of monkeypox, including areas where the disease is not typically present. In late July, the World Health Organization declared an international public health emergency over a global outbreak of monkeypox. Although this disease is still considered rare, the Centers for Disease Control and Prevention (CDC) and the New York State Department of Health (NYSDOH) continue to monitor this situation as it unfolds here in the United States. This webpage is based upon the most current guidance provided by the CDC and NYSDOH and will likely change as the global monkeypox outbreak continues to evolve.

The NYSDOH has asked all medical providers within the state to maintain a high index of suspicion for monkeypox infections. It is common for affected individuals to experience a flu-like prodrome followed by a rash; however, this is not a required symptom. A clinical course of the infection typically lasts 2-4 weeks. Lesions commonly progress through various stages until they ultimately heal. Co-infections with sexually transmitted illness and skin infections may be present. Infected individuals may experience a significant amount of pain throughout the course of their illness.

Anyone can get monkeypox regardless of gender identity, birth sex, sexual orientation, or sex partner(s). This guidance serves to support all individuals on campus. We should work hard to share fact-based information and to avoid marginalizing groups that may be at increased risk for monkeypox during this current outbreak. Additionally, some groups may be at increased risk for severe outcomes if they contract monkeypox, including individuals with weakened immune systems, older adults, children under eight years of age, and who are pregnant.

Signs and Symptoms

• Rashes, bumps, or blisters on or around the genitals or in other areas like hands, feet, chest, mouth, or face.
• Flu-like symptoms, such as fever, headache, muscle aches, chills, and fatigue; these symptoms may occur before or after a rash appears, or not at all (prodromal phase).
• Significant pain may be associated with symptoms and can interfere with basic functions like eating, urination, and defecation.

Transmission

• Direct contact with monkeypox rash, scabs, and/or body fluids from a person with monkeypox.
• Contact with respiratory secretions during prolonged face-to-face contact or during intimate physical contact.
• Touching objects, fabrics (i.e., clothing, bedding, towels), or surfaces that have been used by someone with monkeypox.

Monkeypox can spread from the time symptoms start until all symptoms have resolved. A typical course lasts 2-4 weeks.

Protection

• Ask your sexual partner(s) whether they have a rash or other signs or symptoms consistent with monkeypox.
• Avoid skin-to-skin contact with someone who has a rash or other monkeypox signs and symptoms.
• If exposed or experiencing symptoms, contact a healthcare provider.
• Rely on reputable sources of health information, including NYSDOH, CDC, ACHA, and OCHD.

Medical Evaluation

• Anyone who is suspected to have monkeypox should be medically evaluated and tested for monkeypox in collaboration with the Oneida County Health Department (OCHD). Students should contact the Health Center for testing. Employees should reach out to their primary care physician.
• After hours or weekends, students with a known monkeypox exposure who are concerned about being infected should reach out to Campus Safety, 315-859-4141. Officers will connect students with a medical provider from the Health Center and, if needed, authorize students to move into isolation at the Bristol Center until a follow up evaluation and testing can be completed at the Health Center in collaboration with OCHD.
• Per NYSDOH, any suspect case must be reported immediately to Oneida County Health Department (OCHD), 315-793-6284 during regular business hours. Hamilton’s first point of contact there for a suspected case of monkeypox is Melissa Lemieux.
• If unable to reach OCHD, please contact the NYSDOH Bureau of Communicable Disease Control, 518-473-4439 during business hours, or 866-881-2809 evenings, weekends, and holidays.

Testing

Specimen collection and submission must be coordinated with OCHD and/or NYSDOH.

Specimens collected and transported in viral transport media (VTM) can be tested for varicella zoster virus, and herpes simplex viruses I and II, in addition to orthopoxvirus (monkeypox).

The student health center is able to test students for monkeypox here on-campus, if they are eligible for testing, and in collaboration with the OCHD. Eligibility will be determined by medical providers following their direct conversation with individuals. Possible reasons for testing could include meeting the case definition for monkeypox coupled with risk factors like:

• Multiple sexual partners in a 2 week period
• Anonymous sex using social media sites
• Intimate contact with a known exposed person
• Intimate contact in verified high risk areas

Specimen collection for health center personnel

• Make sure that you are wearing appropriate personal protective equipment (gown, gloves, N95 respirator, and face shield).
• Sanitize the patient’s skin with an alcohol wipe and allow the skin to air dry (do not “wave” the site to facilitate drying).
• Identify two lesions per patient to sample, preferably from different locations on the body and/or with different appearances.
• Collect cells from the lesion base by:
  • Vigorously swabbing or brushing lesion with two separate sterile synthetic swabs (Dacron, nylon, polyester, or Rayon)
  • Place each swab in a separate sterile tube containing VTM.
  • Secure each tube with parafilm
• Report the process on different lesions.
• A total of four samples should be prepared for transport to the designated lab for processing.
• After specimen collection is completed, all PPE worn by the specimen collector and all waste generated during the collection process should be discarded as regulated medical waste (red bag).
• Hand hygiene should be performed before and immediately after specimen collection and following removal of PPE. Alcohol based hand sanitizers are preferred unless hands are visibly soiled, in which case soap and water should be used.
• Additional specimen samples, such as bloodwork, may also be requested in collaboration with OCHD and/or NYSDOH.
• Make sure that appropriate lab requests are completed and accompany all samples.
• Specimens should be stored and shipped refrigerated or frozen.

Isolation for Suspect and/or Confirmed Cases

In collaboration with OCHD and/or NYSDOH, students with suspected or confirmed monkeypox will be moved to an isolation housing space if they are unable to travel home by personal vehicle to isolate there instead. Per the direction of OCHD personnel, any suspect case needs to be moved into isolation housing until they are confirmed to have monkeypox by laboratory testing and have completed their prodrome phase, if present.

• The isolation space should have a door that can be closed and a dedicated bathroom that is not shared with others.
• Transport and movement outside of the isolation room should be limited to medically essential purposes, solitary walks on campus (need to avoid close contact with other students), and to pick up Grab-N-Go meals. Individuals should make sure that all lesions are covered as well as be wearing a well-fitting face covering, like a surgical mask, when they travel outside of their isolation room.
• If we have multiple students that are confirmed positive for monkeypox, they may share isolation housing.
• It is recommended that positive individuals avoid close or physical contact with animals in addition to other people. This may impact students with emotional support animals (ESAs). They may need to utilize their back up caregiver indicated on paperwork shared with the assistant dean of accessibility services on campus.
• At time of this writing, we recommend use of the rooms in the Bristol Center for isolation housing in such circumstances unless other options become available.
• Students need to notify their professors that they are not able to attend class in person. Students should contact the Dean of Students Office if they experience pushback from their professors while in isolation.
• Before leaving isolation and returning to their dorm room, the individual should have a medical evaluation in order to review their current symptoms and the recommended treatment plan. This provides an opportunity for the medical provider to discuss the emotional toll which the illness has had on the individual. This will also allow the provider to make sure that all outstanding concerns have been addressed directly before the individual returns to campus life. It may also result in the individual remaining in isolation for an additional period of time.

Key Isolation Reminders

• Only leave your room for medically essential purposes, solitary walks on campus (avoid close contact with other students), and to pick up Grab-N-Go meals.
• You should not have in person visitors while in isolation
• Avoid close contact with others
• Avoid close contact with pets
• Abstain from all sexual activity
• Do not share items that could be contaminated by the lesions (like bed linens, clothing, towels, clothing). Do not share drinking glasses or eating utensils.
• Routinely clean and disinfect commonly touched surfaces and items (Facilities Management will leave necessary cleaning supplies at the isolation room for use by individual during their time staying there)
• Wear a well-fitting mask at all times when leaving your isolation room
• Avoid use of contact lenses to prevent inadvertent infection of the eye
• Avoid shaving areas of the body with lesions as this may spread the virus
• Use a separate bathroom while in isolation. When released from isolation but still contagious, make sure to clean and disinfect surfaces in the bathroom after using it in a shared space. If lesions are present on your hands, wear disposable gloves when present in shared spaces

Per updated guidance on 8/26/22 from NYSDOH, isolation will continue until a confirmatory test for monkeypox has been received and the individual has completed the prodrome phase if present. The rash is typically the last issue to resolve, often lasting 2-4 weeks, until a fresh layer of skin has formed and all scabs have fallen off. Students should remain in contact with health center staff if they have questions or need to discuss their changing medical needs.

To be clear, while a rash persists, but in the absence of fever and/or respiratory symptoms:

• Cover all parts of the rash with clothing, gloves, and/or bandages
• Wear a well-fitting face covering, like a surgical mask, to prevent spreading oral and respiratory secretions when interacting with others until the rash and all other symptoms have resolved
• Masks should fit closely on the face without any gaps along the edges or around the nose and be comfortable when worn properly over the nose and mouth
• Limit activity to essential activities like attending class, dining, laundry. Defer participation in sports, social outings, work, etc. until all lesions have scabbed over and new skin covers them which typically takes 2-4 weeks.

Treatment

Supportive care is the mainstay of therapy. This includes fluids, wound hygiene/care, pain management, and treatment of any secondary infections. Skin lesions should be kept clean and dry. Analgesics, like acetaminophen and ibuprofen, should be taken as needed for pain. Oral antihistamines and topical agents such as calamine lotion, over the counter hydrocortisone, and petroleum jelly can help alleviate itching. Individuals should be aware of sun exposure to avoid discoloring exposed lesions (they should not be outside without keeping their lesions covered). Over the counter stools softeners, like docusate sodium, or laxatives, like Miralax, may be helpful in reducing peri-anal discomfort, especially in constipated individuals. Prescription medicated mouthwash may provide pain relief to mouth lesions until they fully heal. More severe infections are managed in collaboration with local health departments and may involve trials of medications held in reserve by the CDC.

Contact Tracing

Individuals with suspect or confirmed monkeypox will have limited contact tracing completed on campus by health center personnel. Broader tracing efforts will be completed by OCHD and/or NYSDOH.

Exposed individuals do not need to be moved into quarantine or isolation housing as long as they remain asymptomatic. They will be asked to monitor for symptoms for 21 days following exposure. They should remain in regular communication with health center personnel during this time frame. Travel during this time is discouraged. They should avoid any form of sexual contact. They should also avoid contact with immunocompromised people, children, and/or pregnant women. Their case should also be reviewed with OCHD and/or NYSDOH personnel at that time to determine if they are eligible for post-exposure vaccine prophylaxis.

Vaccinations

Currently there are two licensed vaccines in the United States to prevent smallpox which are being used against monkeypox, although they are not readily available to the general public.

Due to the limited vaccine supplies, the following are eligible for vaccination:

• An exposed contact of a confirmed monkeypox case
• Individuals that may be at higher risk for developing monkeypox that are living in areas with identified cases but without a known exposure

Eligibility would be confirmed in collaboration with OCHD and/or NYSDOH. At time of writing, the closest vaccination points of distribution are located in the cities of Rochester and Albany.

Environmental Infection Control

Poxviruses have been shown to survive on both non-porous and porous surfaces for at least 15 days after exposure. Porous surfaces may harbor infectious viruses longer than non-porous surfaces, especially in dark, cool environments and in low humidity conditions. As a result, it is recommended that positive individuals limit direct contact with porous surfaces that cannot be laundered. The use of cover sheets, waterproof mattress covers, blankets, and disposable mattress liners are some methods used to protect porous surfaces when an individual is infectious. Once the infection is resolved, they should be discarded, or removed and laundered by the individual. Individuals should routinely wipe down surfaces in real time in order to limit viral exposure within the room.

All waste should be collected in a designated and lined trash can where they are isolated. All waste should be mixed, no separate recycling containers. Upon disposal, the bag should be sealed and disposed of as regular waste.

The individual should launder their own personal clothing, towels, bedding, etc. Laundry should not be shaken or handled in a way that may disperse infectious material. Items should not be mixed with laundry from other individuals. Bedding and linens can be folded inward when collecting them. Gather all items into a plastic garbage bag or a mesh bag before cleaning and disinfecting the isolation room. All materials should be washed and dried using the highest temperature settings recommended. Discard all plastic bags used to transport the soiled laundry or launder the mesh bag with the items being cleaned. Washing items with laundry detergent at the highest allowable temperature is enough to kill the virus. No additional measures are necessary for soiled laundry. Bleach is not necessary to remove infectious particles. Hand hygiene should be performed after handling soiled laundry.

Standard cleaning and disinfection procedures should be performed using hospital-grade disinfectants with an emerging viral pathogen claim. Avoid dry dusting, and sweeping. Vacuuming is only acceptable when it contains a high-efficiency air filter. Wet cleaning methods are preferred. Fans should not be used to facilitate quicker drying as they will only serve to spread viral particles within the room. Objects should be allowed to air dry. All non-porous surfaces and objects should be cleaned, not limited to but including tables, countertops, door handles, toilet flush handles, faucets, light switches, cell phones, laptops, remote controls, sex toys. This also includes interior surfaces of refrigerator, freezer, and microwave oven, other appliances, interior cabinets, and drawers they have accessed. A dishwasher with detergent and run on the hot water cycle is the preferred method for cleaning soiled dishes and eating utensils. However, hand washing with hot water and dish soap is an acceptable alternative method. Steam cleaning may be considered for porous surfaces if excessive contamination has occurred.

The CDC recommends that individuals isolating alone should regularly clean and disinfect the spaces they occupy throughout the course of their isolation. It is very important that a thorough job be done when disinfecting a space. If unsure about the amount of contact, always err on the side of caution and disinfect the object/space. We recommend that rooms utilized for isolation in the Bristol Center are set up with furniture that is not porous and can easily be cleaned. We also recommend that the room be closed to everyone for at least 24 hours after an individual is released from isolation and before more thorough cleaning is completed by personnel from FM or an outside agency.

Per the CDC, a household/isolation space should be cleaned and disinfected in the following order:

1. General waste containment
   1. Collect and contain any soiled waste and general trash in a sealed bag. Use of a trash bin with a bag liner is recommended. Individuals should keep the trash bin closed when not actively depositing trash.
2. Laundry
   1. Gather contaminated clothing and linens before anything else in the room is cleaned. Do not shake linens as this could spread infectious particles.
3. Hard surfaces and household items
4. Upholstered furniture and other soft furnishing
5. Carpet and flooring
6. Waste disposal

Disposable gloves should be worn during the cleaning and disinfecting process. Hand hygiene should be performed after completion.

If cleaning and disinfection is done by someone other than the person with monkeypox, that person should wear the appropriate PPE. Hamilton employees are required to wear a yellow poly-coated Tyvek suit to protect their clothing, booties to protect their footwear, 2 pairs of gloves, and an N-95 respirator. At the time of this writing there are 6 custodians plus 4 supervisors/foremen that are respirator qualified to do this work. It is the recommendation of Brian Hansen, Director of Environmental Protection Safety and Sustainability, that all employees be trained on this policy, including a hands-on class for proper donning/doffing techniques for PPE, before they are asked to perform such cleaning duties.

Revised 9/14/22; 9/6/22; 8/8/22 BFluty

Sources:

• https://apps.health.ny.gov/pub/ctrldocs/alrtview/postings/CDC_HAN_with_Cover_MPox_Final_17June_1655497561508_0.pdf
• https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html
• https://www.cdc.gov/poxvirus/mpox/clinicians/
• https://www.cdc.gov/poxvirus/monkeypox/clinicians/faq.html
• https://www.cdc.gov/poxvirus/mpox/
• https://www.health.ny.gov/diseases/communicable/zoonoses/monkeypox/docs/2022-07-08_han.pdf
• https://health.ny.gov/diseases/communicable/zoonoses/monkeypox/docs/cleaning_and_disinfection_guidance.pdf
• https://www.cdc.gov/poxvirus/monkeypox/specific-settings/home-disinfection.html
• https://health.ny.gov/diseases/communicable/zoonoses/monkeypox/docs/mpv_college_q_and_a.pdf