MPOX: Self-Isolation Guidance

1. Phase One: Self-Isolation

• Immediately self-isolate from the day your symptoms start. This means stay home, do not attend work, school or public areas.
• If you live with other people, isolate in your own room, avoid common areas with other people, eat in your own room/area and use a separate bathroom if possible. Avoid contact with other people, especially those who are immunocompromised, pregnant or children 12 years of age or younger.
• Cover lesions with bandages and dressings or long sleeves or pants.
• If you need to be around others, a surgical mask should be worn in addition to covering lesions. Wear gloves if lesions are on the hands.
• Wash hands often with soap and water, especially after changing bandages and dressings.
• Surfaces/objects in common spaces should be cleaned and disinfected after use.
• Avoid sharing household items including dishes, drinking glasses, cups, eating utensils, towels, and bedding.
• If possible, have your own separate items for use.
• Items that are shared should be washed with soap or detergent in warm water after use. No special soap is needed.
• Dishwashers and washing machines can be used.
• Cover upholstered furniture (e.g. couches, chairs, mattresses) with a sheet, waterproof mattress cover, blanket that can be washed (see safe washing of laundry for additional information).
• Avoid contact with household pets if possible, as well as contact with wild animals (see safe handling of pets for additional information).
• Avoid contact with those at higher risk of severe MPOX illness including people who have an underlying illness, weakened immune system, pregnant women, and children 12 years of age or younger.
• Avoid sexual contact.
• As much as possible, have necessities delivered to your home (e.g. medication, groceries). Items should be left outside and picked up after the delivery person has left.
• Stay home unless you are seeking essential emergency medical care. Tell your healthcare provider of your MPOX status before your appointment. When leaving ensure to cover all lesions, wear a medical mask and gloves if lesions are on hands. Avoid public transportation. If travelling in a shared vehicle keep windows open.
• If you develop a fever, respiratory symptoms and/or skin lesions that cannot be covered, re-enter Phase One and self-isolate.

2. Safe Disposal of Contaminated Materials

Be careful when handling waste. Disposal of contaminated materials including bandages and dressings, as well as tissues or other items that came in to contact with droplets from nose or mouth of a MPOX positive or person under investigation should be disposed of as follows:

• Dispose contaminated materials directly into dedicated waste container and do not touch the outside of the container.
• Food waste, tissues, bandages and gauze must be double-bagged using strong bags, securely tied before disposing.
  • Multi-residential (e.g. condo, apartment buildings):
    • Food waste and tissues should be disposed of in the Green Bin (if applicable), or garbage without organics/green bin collection.
  • Single dwelling (e.g. house):
    • Bandages and gauze should be disposed of in the garbage. Store waste in secure bin before municipal pick up.
    • Food waste and tissues should be disposed of in the Green Bin. Ensure the Green Bin is set out for collection in the locked position.
  • Animal waste such as straw, feces, left over food, should be handled in the same way as human waste as per above.
  • Wear gloves if handling bags and wash hands after removing gloves.
  • Keep waste away from animals/rodents.

3. Safe Washing of Laundry

• Avoid direct contact when handling contaminated laundry/linens (i.e., wear disposable gloves).
• Do not shake soiled laundry in a way that could spread virus particles.
• You can wash laundry in a standard washing machine with warm water and detergent.
• Hand launder at home.
• Have someone help with the laundry. The person doing your laundry should take precautions and wear gloves and immediately wash their hands with soap and water after removing their gloves.
• If you are washing laundry in a shared laundry room:
  • Wear a medical mask
  • Cover all lesions
  • Go at off peak hours
  • Maintain 2 metres distance form others at all times
  • Perform hand-hygiene
  • Use a household disinfectant to wipe shared objects e.g. laundry machine
  • Avoid sitting on shared chairs/benches

4. Check for Symptoms

• While self-isolating, check for symptoms every day.
• If symptoms get worse, call your family physician or Health Connect Ontario at 811.
• If symptoms are severe such as difficulty breathing or chest pain, call 911.
• Before getting in-person medical care, tell the provider that you have tested positive for MPOX, are under investigation for MPOX or have symptoms of MPOX.

5. Inform Close Contacts

• Tell people you live with (household members) or any close contacts, including sexual contacts that they need to self-monitor for symptoms for 21 days from last contact.
• Inform your close contacts they should avoid sexual contact with others during their 21-day monitoring period.
• Inform your contact that if they develop symptoms, they must self-isolate immediately and contact their health care provider.
• Inform your close contacts that public health can assess their eligibility of a preventative vaccine (i.e. post-exposure prophylaxis).

Who are close contacts?

• People living in the same household.
• People having direct physical contact, including sexual contact.
• People having direct contact with skin lesions and/or bodily fluids without personal protective equipment.
• People having direct contact with surfaces or objects contaminated by skin lesion(s) and/or bodily fluids.

6. Safe Handling of Pets

The risk of a pet getting MPOX is unclear. Avoid contact with household pets if possible, as well as contact with wild animals. If you have pet(s) at home, take these extra precautions:

• Pets must be kept in the home until 21 days (3 weeks) from the last exposure to you while you were infectious (in Phase One and/or Two).
• If possible, get someone else to take care of your pet until you are out of isolation. This can also be someone in your home who is not sick or has not been exposed to MPOX.
• For dogs that need to go outside periodically, keep them on a leash and avoid contact with other people and animals.
• If the animal was exposed to a MPOX positive individual, the person caring for the exposed animal should not be anyone immunocompromised, and/or pregnant or a child 12 years of age or younger.
• If possible, keep pets in your home and physically distanced from others. The virus can be carried on an animal’s fur or feathers.
• Avoid close or prolonged contact with pets, including touching, snuggling, and kissing. It is important to prevent direct contact to pets with any unhealed skin lesions.
• If you are caring for your pet, wear a mask if you are in the same room, cover your sores as much as possible (use bandages, wear a long sleeve shirt and long pants and gloves), and wash your hands before and after touching your pet, their food, or other pet supplies.
• If your pet gets sick (e.g. fever, depression, not eating, respiratory signs, diarrhea, oral ulcers, skin lesions), contact your vet.
• Dispose of animal waste (see safe disposal of contaminated materials for additional information).

7. Phase Two: Ending self-isolation with risk mitigation measures

• You can enter Phase Two when you have had:
  • No fever for at least 24 hours; AND
  • No respiratory signs and symptoms; AND
  • Skin lesions have started to heal and can be easily covered by clothing, bandages, medical mask, and/or gloves.
• You may leave self-isolation and engage in daily living activities with the following risk mitigation measures:
  • Wear a medical mask.
  • Cover lesions (this may include wearing long sleeves/pants, bandages, gloves).
  • Avoiding crowds and congregate settings e.g. visiting long-term care home, shelter.
  • Avoiding public settings during peak times.
  • Avoiding close, direct skin-to-skin contact with others (e.g. sexual contact, crowded concert, contact sports such as wresting).
  • Do not go for personal services such as haircuts, manicures, pedicures, tattooing and piercings.
  • Do not use shared recreational water facilities (e.g., pool, hot tub).
  • Avoid sharing items and having items laundered by someone else (e.g. towels at gym).
• Avoid close or direct interactions, especially with those who are immunocompromised, pregnant or children 12 years of age or younger.

8. Phase Two: Return to Work and Activities

• If you work with a population at higher risk of severe MPOX illness or a setting with an increased risk of transmission you need to contact your Toronto Public Health (TPH) Communicable Disease Investigator (CDI) who can help determine how and when it is safe for you to return to work.

• You may be able to return to work and other essential activities such as school if you are able to:

• • Follow Phase Two risk mitigation measures.
  • You are not interacting with those at higher risk of severe MPOX illness (e.g. immunocompromised, elderly, children 12 years of age or younger).
  • The setting is not high risk (e.g. a long term care home, hospital, day care)

If you meet the criteria above, re-testing (e.g. clearance testing) or getting a doctor’s note is not required to return to work/activity.

• Consult your occupational health and safety department if applicable.
• Medical and dental visits should be avoided. If you think you need to attend, first notify your healthcare provider or dentist of your current MPOX diagnosis so that they can determine if the visit is essential or should be rescheduled.
• Post-pone all non-essential (elective) medical and dental appointments/procedures (e.g. cleanings) until Phase Three: Recovered.
• If you develop a fever, respiratory symptoms and/or skin lesions that cannot be covered , you re-enter Phase One and must  self-isolate again.

9. Phase Three: Recovered

• You can enter Phase Three (recovered) when you have no symptoms and all lesions have scabbed over and fallen off with a fresh layer of skin formed underneath.
• You should be cautious and counselled on using barrier methods (i.e. condoms, dental dams) for sexual activities after recovery.  A barrier method may decrease the risk of exposure to MPOX in the genital excretions for sexual partner(s) of the recovered case.
• There is little evidence to support a length of time that a recovered individual should utilize barrier methods during sexual activity. Some countries are recommending a minimum of 8 weeks.
• There is currently no available evidence that an individual who recovered from a MPOX infection can transmit the virus via genital excretions (i.e.seminal or vaginal fluids). Guidance will be updated as additional evidence becomes available
• It is recommended to consult your health care provider prior to donating bodily fluids (e.g. blood, semen, breast milk), human cells, or tissues.

10. Vaccine Eligibility for Recovered Cases (Phase Three)

At this time, based on provincial guidance, those who have had a MPOX infection are not eligible to receive the Imvamune vaccine as they are considered immune for about one year.

11. Social Support

• If you encounter challenges with self-isolation reach out to family or friends to help you with essentials e.g. grocery delivery, picking up medications.
• If you have limited or no supports contact your Toronto Public Health Communicable Disease Investigator (CDI).

Call 416-338-7600 if you do not recall your CDIs telephone number and let the operator know the CDIs name. A message will be taken and a member of the team will call you back.