Risk stratification and management after an exposure to mpox (monkeypox)

Exposure category	Community	Health care setting	Management^*
High	Any sexual or intimate contact involving mucous membranes (eg, kissing, oral-genital, oral-anal, vaginal, or anal sex [insertive or receptive]) with an individual who has mpox or Contact between an exposed individual's broken skin or mucous membranes with either: The skin lesions or bodily fluids from an individual with mpox Materials (eg, linens, clothing, objects, sex toys) that have contacted the skin lesions or bodily fluids of an individual with mpox (eg, sharing food, handling or sharing of linens used by a person with mpox without having been disinfected or laundered)^¶Δ	Unprotected contact between an exposed HCP's broken skin or mucous membranes and either: The skin lesions or bodily fluids from a patient with mpox (eg, inadvertent splashes of patient saliva to the eyes or mouth of HCP, needlesticks) or Soiled materials (eg, linens, clothing) visibly contaminated with body fluids, dried lesion exudate, or crusts	Post-exposure vaccination recommended^◊ Monitor for 21 days
Intermediate	Being within 6 feet of a person with mpox who has laryngeal disease, cough, respiratory symptoms, or oral lesions for an extended period or Contact between an exposed individual's intact skin with either: The skin lesions or bodily fluids from a source patient with mpox Materials (eg, linens, clothing, objects, sex toys) that are visibly contaminated with body fluids or lesions, exudates, or crusts from a person with mpox without having been disinfected or laundered^Δ	Unprotected contact between an exposed individual's intact skin or clothing and either: The skin lesions or bodily fluids from an individual with mpox Soiled materials (eg, linens, clothing) visibly contaminated with body fluids, dried lesion exudate, or crusts^§ or Being inside the room of an individual with mpox without wearing all recommended PPE during either: Medical procedures that may create aerosols from oral secretions (eg, cardiopulmonary resuscitation, tracheal intubation) or Activities that may resuspend dried exudates (eg, shaking of soiled linens) or Examining the oral cavity of a person with mpox with oral or laryngeal lesions while not wearing all recommended PPE	Post-exposure vaccination determined on a case-by-case basis^◊¥ Monitor for 21 days
Uncertain to minimal	Entry into the living space of a person with mpox (regardless of whether the person with mpox is present) and in the absence of any exposures above or Contact between an exposed individual's intact skin or clothing and the intact skin or clothing of a person with mpox who has completely covered lesions (eg, bandaged, covered with clothing)	Unprotected contact with a person with mpox who has completely covered lesions (eg, bandaged, covered with clothing) if there is no contact with their skin lesions, bodily fluids, or any materials (eg, linens or clothing) visibly contaminated with body fluids, dried lesion exudate, or crusts	Post-exposure vaccination not indicated Monitoring at discretion of public health authorities or health care facility, as appropriate^‡
No identifiable risk	No direct contact with the person with mpox, their potentially infectious contaminated materials, and only transient time spent within 6 feet of the person with mpox	No direct contact with the patient with mpox or their contaminated materials or surfaces, and at most only transient time spent around the person with mpox^†	Post-exposure vaccination and monitoring not indicated

This table is to be used in conjunction with UpToDate content on mpox, orthopoxvirus vaccines, and infection prevention. It provides a framework for determining risk after an exposure; however, institutional policies may vary.

In November 2022, the World Health Organization changed the name of the disease referred to as "monkeypox" to "mpox." The virus that causes mpox continues to be referred to as monkeypox virus.

HCP: health care personnel; PPE: personal protective equipment.

* Post-exposure vaccination is not indicated for those who received pre-exposure prophylaxis and those who developed mpox during the outbreak that started in 2022. In addition, if mpox develops after the first vaccine dose, the second dose should be deferred.

¶ This includes activities such as sharing food or handling or sharing of linens used by a person with mpox.

Δ For appropriate disinfection, individuals should use a disinfectant registered with the US Environmental Protection Agency (EPA) with an emerging viral pathogens claim.

◊ Post-exposure prophylaxis generally refers to vaccination with the modified Ankara vaccina (MVA) vaccine (sold as JYNNEOS in the United States), which requires two doses 28 days apart. A replication-competent vaccine (ACAM2000) can also be considered for post-exposure prophylaxis in select patients but can be associated with severe adverse reactions.

§ This type of contact may occur during turning, bathing, or assisting with transfer.

¥ The decision to vaccinate depends on the specific details of the exposure as well as the exposed individual's risk of developing severe disease.

‡ The United States Centers for Disease Control and Prevention (CDC) suggests that monitoring in this group should be based on guidance of institution and/or public health officials.

† The authors consider HCP who use appropriate PPE and follow recommended infection control precautions to have no recognized exposure, and for this population we do not recommend monitoring. Appropriate PPE includes use of a gown, gloves, eye protection (goggles or face shield), and a National Institute for Occupational Safety and Health (NIOSH)-approved N95 filtering facepiece or equivalent or higher-level respirator. While there is no epidemiologic evidence to date that monkeypox virus is spread by the airborne route, at this time the CDC recommends respiratory protection be used.

Adapted from:

Mpox monitoring and risk assessment for persons exposed in the community. Centers for Disease Control and Prevention. https://www.cdc.gov/mpox/php/monitoring/ (Accessed on January 6, 2025).
Mpox infection prevention and control in healthcare settings. Centers for Disease Control and Prevention. https://www.cdc.gov/mpox/hcp/infection-control/healthcare-settings.html (Accessed on January 6, 2025).
Interim clinical considerations for use of vaccine for mpox prevention in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/mpox/hcp/vaccine-considerations/vaccination-overview.html (Accessed on January 6, 2025).

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Risk stratification and management after an exposure to mpox (monkeypox)