The closest contacts of monkeypox cases should isolate for three weeks, the UK Health Security Agency (UKHSA) has said.

UKHSA guidance published on Friday (20 May) said that those at the highest risk of having caught monkeypox should be subject to ‘self-isolation for 21 days, including exclusion from work’ and no travel.

They should be actively monitored with daily communication for 21 days after their last exposure and should ‘avoid contact’ with the immunosuppressed, pregnant women and children aged under 12 where possible, it added.

The guidance defined those at highest risk as those who have had ‘direct exposure of broken skin or mucous membranes to monkeypox case (once symptomatic), their body fluids or potentially infectious material (including on clothing or bedding) without wearing appropriate PPE’.

They should be offered smallpox vaccine MVA-BN ‘ideally within four days’ and up to a maximum 14 days from exposure, it added.

The guidance said that the vaccine should also be offered to those at medium risk – including those who clinically examine patients without PPE, those who come within one metre of a case without PPE and ‘subsequent patients in [the] consulting room after a confirmed case was seen and prior to room cleaning’.

They should avoid contact with the immunosuppressed, pregnant women and under-12s and be excluded from work for 21 days if their work involves contact with these groups, it said.

Those who come into contact with a confirmed monkeypox case or an environment contaminated with monkeypox while wearing appropriate PPE should also be offered the smallpox vaccine, according to the guidance.

Separate UKHSA guidance on vaccination against monkeypox, also published on Friday, said: ‘As monkeypox is related to the virus causing smallpox, vaccines designed for smallpox will likely provide a degree of cross-protection.

‘Previous data from Africa suggests that previous vaccines against smallpox may be up to 85% effective in preventing monkeypox infection.’

The guidance recommended that healthcare staff ‘due to care for a patient with confirmed monkeypox’ should have a ‘pre-exposure vaccination’.

It said that for ‘individuals at risk of exposure on the basis of an occupational health assessment, pre-exposure vaccination with two doses of MVA-BN with a minimum interval of 28 days is recommended.’

However, it added that ‘the priority is to ensure appropriate PPE is worn’.

The vaccine should also be used as soon as possible and ‘ideally within four days’ after an identified exposure, the guidance said.

But it added: ‘As the vaccine might only attenuate rather than prevent disease in some cases, contacts who have been vaccinated require equivalent follow up to those contacts who remain unvaccinated.’

The BBC has reported that the UK has procured further doses of smallpox vaccines.

UKHSA announced on Monday that it has identified 36 additional cases of monkeypox in England, bringing the total number of monkeypox cases confirmed since 7 May up to 56

Dr Susan Hopkins, UKHSA chief medical adviser, said: ‘We anticipated that further cases would be detected through our active case finding with NHS services and heightened vigilance among healthcare professionals.

‘We expect this increase to continue in the coming days and for more cases to be identified in the wider community. Alongside this, we are receiving reports of further cases being identified in other countries globally.’

UKHSA is investigating the source of the recent spread of monkeypox infections in England, which have especially affected men who have sex with men (MSM).

This article was originally published by The Pharmacist's sister publication Pulse.