World Health Organization · 1st edition, October 2024 · 60 pages
Operational guidance for safe home-based care and isolation of mild, uncomplicated mpox cases in resource-limited settings for health workers, responders and caregivers.
- Issuer
- World Health Organization
- Edition
- 1st edition, October 2024
- Audience
- Emergency responders, IPC and WASH focal points, health and care workers including community health workers, social workers, national and local public health authorities, humanitarian organizations
- Evidence
- Expert consensus, adapted from existing WHO IPC guidance and WASH standards (Sphere, WHO drinking-water quality guidelines)
- Reviewed
- 23 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO/UNICEF interim operational guide provides detailed infection prevention and control (IPC) and water, sanitation and hygiene (WASH) measures for managing persons with mild, uncomplicated mpox at home in resource-limited settings. It is designed for exceptional circumstances where implementation of standard WHO rapid response guidance cannot be applied. The document emphasises that children under 5 years of age should be cared for in health facilities as they are at higher risk for complications.
The guidance outlines clinical evaluation criteria, IPC measures for health and care workers, caregivers and persons with mpox, linen management, environmental cleaning, waste disposal and WASH requirements. Key principles include assessing suitability for home care, maintaining isolation in a separate room or designated area, frequent hand hygiene, covering lesions, daily cleaning and disinfection with 0.05% (500 ppm) sodium hypochlorite solution and ensuring access to basic WASH services (minimum 60 litres/person/day for persons with mpox, 20 litres/person/day for other household members).
The document provides alternative options when resources are limited, such as using fabric masks instead of medical masks, reusable gloves instead of disposable, and alternative cleaning methods. It emphasises avoiding recommendations that could exacerbate existing infrastructure issues, such as promoting disposable PPE without ensuring safe waste disposal. Isolation should be discontinued only when all lesions have crusted, scabs have fallen off and a new layer of skin has formed.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Children under 5 years of age with mpox should be cared for in a health facility due to higher risk of complications; not suitable for home care
- Persons with mpox require minimum 60 litres of water per person per day; other household members require 20 litres per person per day
- Environmental surfaces must be cleaned with soapy water first, then disinfected by wiping with cloth soaked in 0.05% (500 ppm) sodium hypochlorite solution with 1 minute contact time; prepare solution daily
- Linen and laundry should be washed separately in hot water with detergent for at least 20 minutes, or in warm water with 0.05% (500 ppm) sodium hypochlorite solution for at least 20 minutes
- Health and care workers entering homes must wear gown, gloves, filtering face piece respirator (N95 or FFP2) and eye protection; if PPE unavailable, maintain at least 1 metre distance and do not enter the home
- Caregivers must wear medical mask and disposable gloves when within 1 metre of person with mpox; perform hand hygiene before and after contact
- Household members should monitor for symptoms daily for 21 days from the last contact with person with mpox; monitor temperature twice daily
- Isolation continues until all lesions have crusted over, scabs have fallen off and a fresh layer of skin has formed underneath
IPC measures for person with mpox during home care
Table extracted from the guideline
| WHO statement | Alternative options for implementation if resources are limited |
|---|---|
| Separate, well-ventilated area away from other household members, pets and shared areas | If separate room not available, identify and clearly mark a dedicated space using screens, curtains or tape. If person must leave isolation area, cover lesions with sterile dressing or clean clothing, wash hands, physically distance at least 1 metre and wear well-fitting medical or fabric mask |
| Person with mpox should manage self-care | If person requires assistance, designate one person in household to care for them. Preferably someone in good health, not pregnant, no underlying chronic conditions, with previous smallpox/mpox vaccination or MPXV infection |
| Frequent hand hygiene with soap and water when hands visibly dirty or alcohol-based handrub when clean | Work with implementing partners to provide IPC supplies for home care and isolation. Person with mpox should have their own soap not shared with other household members |
| Should not share bed or sleeping area with other people or animals | Use separate mattress or identify separate sleeping area for person with mpox only |
| Avoid direct contact with soft household furnishings | Cover soft furnishings with sheets, blankets or waterproof mattress protectors before use. Launder coverings after use |
| People outside immediate household should refrain from visiting during isolation | Facilitate communication remotely via phones or protective screens |
Source: World Health Organization, Infection prevention and control and water, sanitation and hygiene measures for home care and isolation for mpox in resource-limited settings: interim operational guide. Reproduced in summary form.
From the guideline
Verbatim
“Persons with mpox who are cared for at home should remain in isolation and refrain from close contact with others until their skin lesions have crusted; the scabs have fallen off; and a fresh layer of skin has formed underneath.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia and WHO consultant on health and migration, I recognise this guidance addresses a critical gap for the South Caucasus region where health facility capacity for isolation may be quickly overwhelmed during outbreaks. The recommendation I would most strongly emphasise to Georgian clinicians is the absolute contraindication for home care of children under 5 years of age—these children must be referred to health facilities given their high risk of complications. One realistic implementation challenge for Georgia will be ensuring consistent access to safe water in rural areas where intermittent supply is common; national programmes should work with water authorities and WASH partners to prioritise affected households for water delivery or storage capacity before recommending home isolation. The guidance's pragmatic approach to adapting IPC measures when resources are limited (such as using reusable PPE with proper decontamination rather than disposables when waste services are inadequate) aligns well with Georgia's resourceful primary health care system.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026
Applicability
Georgia and the South Caucasus
This guidance has direct relevance for Georgia and the South Caucasus region, where rural and remote areas may have limited health facility capacity during mpox outbreaks and where home-based care may be necessary. National programmes would need to assess existing community health worker networks, WASH infrastructure availability in target communities (particularly access to safe water in rural areas where piped supply may be intermittent) and municipal waste collection services. Georgia’s primary health care system, strengthened under the UHC programme since 2013, could serve as a platform for training community health workers and distributing essential IPC supplies. Particular attention should be paid to adapting recommendations for households using communal toilets/latrines (common in older Soviet-era housing) and ensuring culturally appropriate messaging in Georgian, Armenian, Azerbaijani and minority languages. The guidance’s emphasis on avoiding PPE-heavy strategies where waste disposal infrastructure is inadequate is particularly relevant for resource-constrained settings in the region.
Questions this guideline answers
Quick answers
Which persons with mpox can safely be cared for at home?
Persons with mild, uncomplicated mpox may be isolated at home if they can manage self-care (or have a designated caregiver), have no risk factors for severe disease, the household can maintain necessary precautions and has access to sufficient safe water and supplies. Children under 5 years of age, pregnant persons, immunosuppressed persons (particularly those with HIV and CD4 counts ≤200) and those with chronic co-morbidities are not suitable for home care and should be referred to health facilities.
What concentration of bleach solution is needed for cleaning and disinfection?
Surfaces should be cleaned first with soapy water, then disinfected by wiping with a cloth soaked in 0.05% (500 ppm) sodium hypochlorite solution (household bleach) with 1 minute contact time. To prepare from 3.5% liquid bleach, pour 285 ml into a 20 L bucket and fill to the 20 L mark (or 1 part bleach to 69 parts water). The solution should be prepared daily in a well-ventilated area and not used more than 24 hours after preparation as it becomes ineffective.
How much water does a household with an mpox case need?
The person with mpox (including caregiver) requires 60 litres per person per day for drinking, cooking, personal hygiene, cleaning, disinfection and laundry. Other household members require 20 litres per person per day (basic water service). If 60 L/person/day cannot be provided, a minimum of 15 litres per person per day (SPHERE standard) may be considered for all family members including the person with mpox, though this is less than optimal.
When can a person with mpox discontinue isolation?
Persons with mpox should remain in isolation until all lesions have crusted over, the scabs have fallen off and a fresh layer of skin has formed underneath. During the 21-day monitoring period after isolation ends, household contacts should monitor or self-monitor daily for onset of symptoms (headache, fever, chills, sore throat, myalgia, malaise, fatigue, rash, lymphadenopathy) and temperature twice daily. Quarantine or exclusion from work is not necessary during contact monitoring as long as no symptoms develop.
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- Issuer
- World Health Organization
- Type
- Publication
- Edition
- 1st edition, October 2024
- Status
- Current
- Published
- 2024-10-18
- Languages
- English, French
- Scope
- Home care and isolation of mild, uncomplicated mpox cases in resource-limited settings
- Audience
- Emergency responders, IPC and WASH focal points, health and care workers including community health workers, social workers, national and local public health authorities, humanitarian organizations
- Pages
- 60
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-010165-4
- Evidence
- Expert consensus, adapted from existing WHO IPC guidance and WASH standards (Sphere, WHO drinking-water quality guidelines)
- Record history
- Created 23 Oct 2026 · updated 23 Oct 2026 · next check Apr 2027
World Health Organization, United Nations Children's Fund (UNICEF). Infection prevention and control and water, sanitation and hygiene measures for home care and isolation for mpox in resource-limited settings: interim operational guide. Geneva: World Health Organization; 2024. 60 p. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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