While uncertainties about monkeypox and how to contain it abound, employers can take steps now to keep their workforces safe and protect the communities in which they operate. Six considerations will help them craft policies.

Already weary from the Covid-19 pandemic, governments and businesses are now facing a new public health challenge. Monkeypox is spreading rapidly in the United States and globally. Although this infectious disease presents significantly less risk than Covid-19, employers should be prepared to address potential infections in their workforces and communities.

The monkeypox virus is a relative of smallpox and causes systemic symptoms, including fever, swollen lymph nodes, muscle aches, and a characteristic rash that progresses from blisters to pustules. The Jynneos vaccine, initially designed to protect against smallpox, can lower risk of infections and decrease symptoms if given within two weeks of exposure. It has been in short supply in the United States, but supplies are expected to increase in the coming months. Monkeypox testing is now available through health departments and public labs.

Here are some key considerations for employers:

Monkeypox is primarily transmitted from direct skin-to-skin contact with individuals who have skin sores. Currently, the vast majority of reported cases are in men who have sex with men, but non-sexual skin contact or exposure to coughing or sneezing from someone with a monkeypox rash can also spread the disease. Transmission can also occur through exposure to clothing or linen that has been in contact with skin lesions, and the virus can be transmitted to an unborn child during pregnancy. Monkeypox virus can be found on the surfaces of objects, but this does not appear to be a significant cause of transmission. People with monkeypox are contagious from when they first have symptoms until their last lesions have crusted over, which takes approximately two to four weeks

Employers can take concrete steps to lower the risk of workplace monkeypox transmission. They can promote contact-free greetings and continue to encourage hand-washing and provide hand sanitizer. Individuals whose work requires them to touch skin or material that was in contact with skin, such as dirty towels or bedsheets, should consider wearing gloves routinely. This includes health care personnel, hotel staff, hair stylists, nail technicians, and daycare workers. High-quality, well-fitting masks can provide protection against the low risk of respiratory transmission.

Pregnant and immunocompromised individuals are at higher risk for transmission and severe illness, so any protocols that are developed should address how best to protect high-risk individuals.

Managers should have access to protocols to keep employees safe with minimal disruption to the workplace. A monkeypox-response policy can help address employee safety, as well as business continuity and privacy needs.

Those who are exposed to monkeypox can come to work safely, but should monitor themselves 21 days post-exposure for symptoms, including a fever of more than 100.4 degrees Fahrenheit, chills, swollen lymph nodes, muscle aches, and skin lesions. If they develop any of these symptoms, they should seek medical evaluation prior to returning to the workplace.

People diagnosed with monkeypox should seek medical care and must isolate at home until cleared by public health authorities. They can work remotely if their work does not require their physical presence at the worksite, but some patients will have severe pain or other symptoms that will make them unable to work during isolation.

Employers will need to disinfect spaces that were recently occupied by an employee with monkeypox and should pay special attention to door handles, toilet flush handles and seats, faucets, light switches, and floors. Companies should use EPA-approved cleaners. Porous surfaces may require steam cleaning, and those performing such cleaning should wear protective clothing, including masks, and follow state regulations for the disposal of hazardous waste.

Monkeypox cases must be reported to state public health departments by treating providers and laboratories. Public health authorities will attempt to identify and notify individuals who have been exposed so that they may be vaccinated, monitored for symptoms, and, if necessary, seek treatment. Employers are not required to report cases, but local and state public health departments can be a resource if there is a workplace exposure.

The federal government is working with state health departments to disseminate the Jynneos vaccine, which is currently only available for individuals who have been exposed to monkeypox or are at very high risk of infection — largely those with recent exposure and laboratory workers. Mandating employee vaccination is not practical or possible at this time. This vaccination, and antiviral medications such as tecovirimat (also known as TPOXX), is being provided without cost by the federal government, although employer-sponsored health insurance plans may pay administration fees.

Paid time off, including sick leave, encourages those with illness to stay home when they could be contagious, but weeks of isolation for monkeypox will exceed paid time off for many employees. Employees may be eligible to take an unpaid, job-protected leave under the Family and Medical Leave Act. Some employees with monkeypox may be eligible for income replacement from short-term disability insurance or state disability programs after a waiting period.

Employers can help by offering supplemental sick leave to those who are isolating, although this requires employees to report their diagnoses, which poses privacy challenges. So do programs that allow employees to transfer paid time off to colleagues who have an extended illness. In addition, employers may want to consider how employees can safely isolate for up to four weeks if they are diagnosed while traveling for work.

Adult caregivers of children may also be impacted. There are a handful of cases of toddlers in the United States with monkeypox, and if this spreads in daycare settings, more caregivers could miss work due to childcare needs. Remote and flexible work options can help address such issues.

Employers are a trusted source of health information and can demonstrate their concern for employee well-being by delivering accurate communication about monkeypox. Employers should communicate promptly if there is a workplace exposure, while maintaining full confidentiality of any employee who is infected. Employees should address individual medical questions to their physicians or a virtual care clinician.

Fact-based, nonjudgmental communication that is inclusive and doesn’t stigmatize will help make people feel comfortable reporting monkeypox and will avoid creating a sense of false security among those who are not gay or bisexual men. Recommendations should be concise and practical.

Human-to-human transmission of monkeypox has occurred outside of endemic areas for just a few months, and there is much we do not know. Our understanding of transmission and the best measures to curtail spread and treat disease is likely to change in the coming months. Vaccine access will improve, and more antiviral agents will become available. The virus could also develop mutations that alter its severity or transmissibility.

Consequently, employers should expect changing recommendations and guidance as more robust data becomes available. They should monitor virus updates from reputable sources such as the Centers for Disease Control and Prevention and the World Health Organization.

Given that monkeypox is less contagious and less deadly than Covid-19, it will not cause the level of economic dislocation seen in the Covid-19 pandemic. Nevertheless, it has the potential to disrupt workplaces, and employers should be prepared to take actions to reduce its spread and ease the concerns of employees who are diagnosed or exposed. Employers can demonstrate their concern for employee well-being by encouraging safe practices, communicating clearly, and providing sick leave for those in isolation. By taking these and other actions, employers can minimize health risks and protect their workers and business from yet another infectious disease.