Pan American Health Organization · Interim guidance, 1 December 2022
Interim guidance on IPC measures, case management, isolation, and contact-tracing for mpox in prisons and detention facilities.
- Issuer
- Pan American Health Organization
- Edition
- Interim guidance, 1 December 2022
- Audience
- National health authorities, prison healthcare workers, prison staff, prison administration
- Evidence
- Expert consensus based on WHO IPC principles and mpox transmission evidence
- Reviewed
- 18 Oct 2026 · GMJ
What this guideline says
GMJ summary
This interim guidance provides comprehensive infection prevention and control (IPC) recommendations for managing mpox in prisons and custodial facilities, settings where overcrowding and close contact increase transmission risk. The document addresses healthcare workers, prison staff, and the management of incarcerated individuals with suspected, probable, or confirmed mpox.
The guidance emphasizes standard and transmission-based precautions (contact and droplet), use of appropriate PPE (gloves, gown, respirator or surgical mask, eye protection), and isolation in single-cell accommodation with dedicated toilet facilities until all lesions have crusted, scabs have fallen off, and a fresh layer of skin has formed. Contact-tracing should be initiated within 24 hours of case identification, with contacts monitored for 21 days from last exposure.
The document stresses human rights principles throughout, requiring informed consent, confidentiality, protection from stigmatization, and no punitive measures for those identified with mpox. Access to testing and treatment should be equivalent to community standards, with seamless linkage to health facilities upon release.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Healthcare workers caring for mpox cases must use PPE: nonsterile gloves, gown, respirator or surgical mask (if respirators unavailable), and eye protection if risk of splashing
- Isolate suspected/probable cases in single-cell accommodation with dedicated toilet facilities; confirmed cases may be cohorted with ≥1 m separation if single cells unavailable
- Maintain isolation until all lesions have crusted, scabs have fallen off, and a fresh layer of skin has formed underneath
- Monitor contacts daily for 21 days from last exposure for fever, headache, rash, or lymphadenopathy; asymptomatic contacts can continue routine activities without quarantine
- Perform hand hygiene with soap and water for 40–60 seconds or alcohol-based rub (≥60% alcohol) for 20–30 seconds at WHO's 5 Moments
- Launder contaminated linens separately at temperatures >60 °C or >65 °C, or soak in chlorine if hot water unavailable
- Health workers with unprotected exposure should monitor for symptoms twice daily for 21 days; no work restriction if asymptomatic, but avoid vulnerable persons
- Use condoms consistently during sexual activity for 12 weeks after recovery as a precautionary measure
Case definitions for mpox surveillance
Table extracted from the guideline
| Classification | Criteria |
|---|---|
| Suspected case | Contact of probable/confirmed case in 21 days before onset with acute fever >38.5°C, headache, myalgia, back pain, and profound weakness OR unexplained acute rash, mucosal lesions, or lymphadenopathy since 1 Jan 2022 that cannot be explained by common causes |
| Probable case | Unexplained acute rash, mucosal lesions, or lymphadenopathy PLUS one of: epidemiological link to case in 21 days; gay/bisexual/MSM with multiple/casual partners in 21 days; detectable anti-OPXV IgM antibody; or positive OPXV test without MPXV-specific confirmation |
| Confirmed case | Laboratory confirmed mpox virus infection by detection of unique viral DNA sequences by real-time PCR and/or sequencing |
Source: Pan American Health Organization, Infection Prevention and Control for the Management of Mpox in People in Situations of Vulnerability such as Prisons and Other Custodial Facilities. Reproduced in summary form.
From the guideline
Verbatim
“Precautions should remain in place until lesions have crusted, 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 someone who has worked extensively on health systems in vulnerable populations, I recognize that this PAHO guidance addresses a critical gap in Georgia's preparedness for emerging infectious diseases in custodial settings. Our prison healthcare infrastructure, while improved since the 2012 reforms, still faces challenges with overcrowding and resource allocation that make the recommended single-cell isolation with dedicated toilet facilities difficult to implement in many facilities. The emphasis on human rights—particularly the prohibition of punitive measures and requirement for informed consent during medical examinations—is essential given the historical vulnerabilities of incarcerated populations in our region. The most practical recommendation for Georgian prison healthcare staff is the 21-day contact monitoring protocol that does not require quarantine of asymptomatic contacts, which is operationally feasible even in resource-limited settings. However, implementation will require urgent investment in PPE stockpiles, particularly respirators and eye protection, training of both healthcare and custodial staff on IPC procedures, and establishment of formal linkages between prison health services and regional public health centres for seamless contact-tracing and post-release care continuity.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 18 Oct 2026
Applicability
Georgia and the South Caucasus
This guidance is highly relevant for Georgia and the South Caucasus given the region’s prison systems, where overcrowding and resource constraints are documented challenges. National programmes would need to ensure that prison healthcare facilities have adequate supplies of PPE (respirators, gowns, gloves, eye protection), access to single-cell isolation with dedicated toilets, and capacity for laundry disinfection at temperatures >60–65 °C. Georgia’s public health surveillance infrastructure would need to integrate prison-based mpox reporting and contact-tracing within the 24-hour notification standard, with clear protocols for seamless transfer to community health facilities upon release. The human rights framework emphasized in this guidance aligns with Georgia’s obligations under international treaties and would require training of both healthcare and custodial staff on confidentiality, informed consent, and non-punitive approaches to case identification.
Questions this guideline answers
Quick answers
What PPE is required for healthcare workers caring for mpox patients in prisons?
Healthcare workers must wear nonsterile gloves, gown, respirator or surgical mask (if respirators not available), and eye protection (goggles) if there is risk of splashing to face and eyes. Hand hygiene with soap and water (40–60 seconds) or alcohol-based rub (≥60% alcohol, 20–30 seconds) is required before donning and after removing PPE.
How long should a person with mpox be isolated in a prison setting?
Isolation should continue until all lesions have crusted, scabs have fallen off, and a fresh layer of skin has formed underneath. During isolation, the person should be in single-cell accommodation with a dedicated toilet if possible, or cohorted with other confirmed cases maintaining at least 1 m separation.
Do contacts of mpox cases in prisons need to be quarantined?
No, asymptomatic contacts who adequately and regularly monitor their status can continue routine daily activities without quarantine. However, they must monitor for symptoms (including temperature twice daily) for 21 days from last contact with the case, practice hand hygiene and respiratory etiquette, and avoid physical contact with children, pregnant women, immunocompromised individuals, and animals.
How should contaminated laundry from mpox patients be handled?
Linens should be carefully lifted and rolled (not shaken) to prevent dispersion of infectious particles, bagged in the room, and laundered separately from other prison laundry. Wash at temperatures above 60–65 °C with normal detergent, or soak in chlorine if hot water is unavailable. Staff handling contaminated laundry must wear PPE (gown, heavy duty gloves, respirator, eye protection) and perform hand hygiene after removing PPE.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
Quality & accreditation
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Medical Transport — Standard 5 — Infection Prevention & Control
- ASF Laboratory — Standard 7 — Examination: Process & Safety
- ASF Hospital — Standard 9 — Refugee & Migrant Health
- ASF Laboratory — Standard 9 — Refugee & Migrant Health
- ASF Medical Transport — Standard 8 — Refugee & Migrant Health
- ASF Hospital — Standard 11 — Critical Care
- ASF Medical Transport — Standard 6 — Emergency Response During Transport
Other guidelines on this topic
- Manual for Surveillance of Events Supposedly Attributable to Vaccination or Immunization in the Region of the Americas
- Silence can be damaging: How to talk about monkeypox without doing harm
- Guidance on Clinical Suspicion and Differential Diagnosis of Monkeypox
- Recommendations for Adapting Emergency Medical Teams (EMTs) at Temporary COVID-19 Vaccination Sites
- Infection Prevention and Control Pre-Service Education and Training Curriculum: Foundational Learning for All Health and Care Workers
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- Interim guidance, 1 December 2022
- Status
- Current
- Published
- 2022-01-01
- Languages
- English
- Scope
- Infection prevention and control for mpox in prisons and custodial facilities
- Audience
- National health authorities, prison healthcare workers, prison staff, prison administration
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus based on WHO IPC principles and mpox transmission evidence
- Record history
- Created 18 Oct 2026 · updated 18 Oct 2026 · next check Apr 2027
Pan American Health Organization. Interim Guidance: Infection Prevention and Control for the Management of Mpox in People in Situations of Vulnerability such as Prisons and Other Custodial Facilities. 1 December 2022. Washington, D.C.: PAHO; 2022. (PAHO/PHE/IMS/mpox/22-0021).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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