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Cal/OSHA just posted guidance on monkeypox (MPX) to ensure workers in California are protected from the aerosol transmissible disease. This guidance applies to workplaces covered by the Aerosol Transmissible Diseases (ATD) standard, including health care facilities, medical transport, police, public health services and more.

This guidance provides a brief overview of some, but not all, of the requirements of Title 8 CCR section 5199 as it applies to protection of workers from MPX. Employers not covered by section 5199 are not discussed in this guidance but must protect their employees under the Injury and Illness Prevention Program (section 3203), sanitation requirements (section 3362), and other laws and regulations.

Monkeypox (MPX) spreads primarily by close or direct contact, but can also become airborne. Thus, MPX is an aerosol transmissible disease covered by Cal/OSHA’s Aerosol Transmissible Diseases (ATD) Standard which contains mandatory requirements that certain employers must follow to protect their employees.

For example, regulations require employers to:

– – Implement a written program to prevent or reduce the transmission of aerosol transmissible diseases specific to the workplace and operations.
– – Provide and ensure the use of respiratory protection.
– – Ensure that personal protective equipment (PPE) is provided and used by employees exposed to persons with or suspected to have MPX, or to linens or surfaces that may contain the virus.
– – Implement written procedures for exposure incidents.
– – Report the exposure to the local health officer.

Cal/OSHA’s Aerosol Transmissible Diseases (ATD) Standard has differing requirements for three different types of employers – (1) referring employers, (2) laboratories, and (3) all other employers. Details about the requirements for each of these categories start on page 3 of the Cal/OSHA MPX Guidance.

MPX spreads primarily by close or direct contact with infectious rashes, lesions, scabs, or body fluids. It can also spread through touching materials used by a person with MPX that haven’t been cleaned, such as clothing, towels, and bedding. The virus can become airborne during changing or handling of contaminated linen. In addition to lesions on the skin, lesions may be located in the mouth or throat, and research is underway to further understand the role of respiratory fluids, droplets, and particles in the transmission of MPX.

Infection with MPX may start with symptoms similar to the flu, including fever, low energy, swollen lymph nodes, and general body aches, although some patients do not have these symptoms. After the fever starts, the person can develop a rash or lesions. The lesions will develop through several stages, including scabs, before healing. They can look like pimples or blisters and may be painful and itchy. The illness typically lasts 2-4 weeks.

During the current outbreak, skin lesions have presented most commonly in the anogenital area, followed by trunk and limbs, face, and palms or soles. Lesions may also occur in the mouth and throat.

Since May 2022, there has been a rapid rise in cases of MPX in many regions, including California. The disease is typically self-limited (resolves on its own without treatment) but may be severe in young children or immunocompromised individuals, such as those infected with HIV.

On August 1, 2022, Governor Newsom issued a statewide proclamation of emergency due to MPX. On August 4, 2022, the U.S. Department of Health and Human Services declared the U.S. MPX outbreak to be a public health emergency.