Mpox Production Guidelines

Last Updated July 27, 2022
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I. Mpox Information

Mpox is caused by infection with the mpox virus. While it is not solely a sexually transmitted disease, it can be transmitted by sexual activity. If you develop a rash or become sick, do not continue to work and visit your medical provider immediately. 

 What is mpox?

  • The mpox virus is a member of the family Poxviridae, which is related to the virus that causes smallpox and the cowpox virus. While similar, it is much less dangerous than smallpox.

  • Mpox is a zoonotic virus - originating from animals, specifically rodents. 

  • Mpox has been around since 1958, with minimal outbreaks across central and west Africa, Europe, the United States and Canada.

What are the symptoms of Mpox?

  • It is possible to experience a rash or sores on the body (often on the hands or feet, or in the oral, anal, genital areas) before other symptoms may present themselves.

  • It is common to experience flu-like symptoms such as fever, aches, fatigue, and swollen lymph nodes. 

  • A blistering rash (appearing as bumps, or lesions) develops with varied severity. The appearance can be varied, and might be mistaken for genital warts or herpes if located in the genital region.

  • The incubation period of Mpox (the time between infection and the appearance of symptoms) is generally 7-14 days.

How is mpox transmitted?

  • Transmission of mpox usually requires a high dose of the virus, which is why it is typically spread through animal bites. However, recent cases have shown that it can also be spread through prolonged close contact between humans, like sex.

  • Sores and lesions from the virus carry and transmit the infection through skin-to-skin contact, including sex. 

  • Touching items that have had contact with the virus, such as bedding or clothing, can transmit the virus.

  • Respiratory droplets are also capable of transmitting the virus, although you would need much greater exposure for transmission than for something like the flu or COVID-19.

  • Mpox can be passed to a fetus through the placenta in pregnant individuals. 

How is mpox treated?

  • As smallpox and mpox are related, well-researched treatments for smallpox are capable of being used to treat Mpox. 

  • There are two vaccines: JYNNEOS and ACAM2000, used to treat and prevent mpox. If there is a known exposure of mpox, vaccination during the incubation period can prevent the development of symptoms and be used as antiretroviral (ART) therapy.

  • Antivirals such as cidofovir and brincidofovir can also be used as treatment.

  • If a vaccine is administered within 4 days of exposure, as post-exposure prophylaxis (PEP), it may prevent you from contracting the infection or lessen the severity if an infection does occur. 

  • If you have a known exposure to mpox, contact your medical provider immediately.

Mpox Vaccines

  • Two vaccines have been FDA approved for mpox: JYNNEOS and ACAM2000.

  • Currently, only JYNNEOS vaccines are being distributed in the United States. The JYNNEOS vaccine is two doses, each dose four weeks apart.

  • ACAM2000 is the smallpox vaccine, and is not recommended for immunocompromised individuals.

  • Vaccines are currently being distributed by referral only, but qualifications are changing by the day.

II. Health Monitoring

Health Screening

The purpose of the health screening is to identify anyone with symptoms of illness and

prevent them from working on-set in order to reduce the chance of exposing others to infection.

It is not intended to diagnose any illness and anyone who presents with symptoms

should be referred to a medical professional for further evaluation and treatment advice.

Every person who works on-set or visits the set should be screened every day.

The health screening consists of two parts:

  1. Questionnaire regarding symptoms of illness

  2. Temperature check

Part 1 - Health Questionnaire

Please ask the following questions of ALL PEOPLE -not just talent- entering the set.

  1. Is there currently any new or unexplained rash, bump, or lesions anywhere on your body?

  2. Have you experienced any of the following symptoms in the last week?

    • Fever

    • Chills

    • Muscle pain (not related to exercise or exertion)

    • Unusual or unexplained headache, coupled with feeling sick

    • Swollen Lymph Nodes

    • General malaise; feeling sick, tired, or weak

If a person answers YES to ANY of the questions, DO NOT allow that person to enter the set.

If a person answers NO to ALL of the questions, proceed to PART 2.

Part 2 - Temperature Check

Check each person’s temperature with a contact-free thermometer.

If the person’s temperature is 100.4° F or higher, DO NOT allow that person to enter the set. Advise the person to seek further medical advice before returning.

If the person’s temperature is lower than 100.4° F, that person is cleared to enter the set.

Any person who has symptoms when they arrive on site, or becomes sick during the day,

should immediately be separated from others and sent home.

Testing

As of right now, there is no test available that screens for mpox unless a rash or lesions are present, and thus we cannot use testing as a way to prevent transmission on set. Confirmatory testing is available for folks with suspected mpox and who have developed lesions, through their health provider.  

Managing Exposure and Illness

People with mpox should isolate at home until any rash has fully resolved, the scabs have fallen off, and a fresh layer of skin has fully formed. 

You can read the CDC’s guidance on isolation and infection control here.

Contact Tracing

If you know of a confirmed case of someone with mpox who has recently been on an adult film shoot, please contact PASS as soon as possible and we will assist with contact tracing. 


People who have been knowingly exposed to a confirmed case of mpox are likely eligible for vaccination, which can be used as a Post-exposure Prophylaxis (PEP) to prevent mpox infection after exposure to the virus. 

III. Personal Protective Measures

Personal Hygiene

  • Avoid touching your eyes, nose, and mouth with unwashed hands or while wearing gloves.

  • Cover your coughs and sneezes.

  • Cover your mouth and nose with a tissue when you cough or sneeze.

  • Throw away used tissues in a lined trash can.

  • Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.

    • Wash your hands often with soap and water for at least 20 seconds, every hour if possible.

    • Soap and water are the best option, especially if hands are visibly dirty.

    • Use hand sanitizer if soap and water are not available.

    • Use an alcohol-based hand sanitizer with at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry.

    • Sanitizers can quickly reduce the number of germs on hands in many situations. However, sanitizers do not get rid of all types of germs. When hands are very dirty, oily or greasy, hand sanitizers may not work well.

Key Times to Wash Your Hands

  • Before, during, and after preparing food

  • Before eating food

  • Before and after wearing a cloth face mask

  • After using the toilet

  • After removing gloves

  • After contact with a person who is sick.

  • After blowing your nose, coughing, or sneezing

  • After touching garbage

  • After accepting deliveries or collecting mail

  • After contacting a high-touch object in a public place

Personal Protective Equipment (PPE)

PPE is the last line of defense and depends on the user to select the appropriate type of PPE for the activity. For PPE to be used effectively, it must be functioning, be used as it was designed to be used, and fit properly.

Gloves

Wearing gloves is not a substitute for frequent hand washing and the need to avoid touching

your face. Gloves should be disposable, and made of protective rubber, PVC, nitrile or latex.

Gloves are best used in the following situations:

  • When you need to protect your hands from chemicals while cleaning or disinfecting.

  • While caring for someone who is sick.

  • When you may come in contact with blood, stool, or body fluids, such as saliva, mucus, vomit, and urine.

  • After using disposable gloves, throw them out in a lined trash can.

  • Do not disinfect or reuse disposable gloves.

  • Wash your hands after you have removed the gloves.

Vaccination

Vaccination for mpox is effective and available - however, resources are currently in short supply. Check with your local health department regarding vaccination availability. PASS is currently working with local public health departments to see if we can get vaccine priority for our industry workers.

For updated information about mpox vaccines, please visit our resource page.
Additionally, those who have received the Smallpox vaccine (ACAM2000) have some protection against mpox. The Smallpox vaccine is often identified by a scar left at the injection site. Please check your vaccine records for indication on whether or not you received the Smallpox vaccine. For more information about the two vaccines that protect against mpox infection visit: https://www.cdc.gov/poxvirus/Monkeypox/considerations-for-Monkeypox-vaccination.html

IV. Cleaning and Disinfecting

Cleaning and disinfecting are two distinct processes.

Cleaning with soap and water reduces the germs, dirt, and impurities on the surface.

Disinfecting kills germs on clean surfaces. Disinfecting can be ineffective if the cleaning step is

not performed properly.

The EPA has a list of registered disinfectants for use against Mpox and other emergent diseases.

Preventative Cleaning & Disinfecting

  • Consider removing all non-essential equipment and objects from the site to reduce the number of high-touch surfaces that may be exposed and will need to be cleaned and disinfected.

  • Clean and disinfect all high-touch surfaces and any areas that may have bodily fluids on them.

  • Clean surfaces with soap and water using a clean cloth, wiping in one direction over each surface to be cleaned.

  • Disinfect cleaned surfaces using an EPA-registered disinfectant.

    • Follow the instructions on the product label to ensure safe and effective use.

    • Keep the surface wet for the recommended minimum period of time (typically 5 – 10 minutes).

    • If the EPA-registered disinfectants are not available, diluted household bleach solutions or an alcohol solution with at least 70% alcohol may also be used if appropriate for the surface. Check the label to see if the bleach is intended for disinfection, as those designed for safe use on colored clothing or for whitening may not be suitable. Ensure the product is not past its expiration date. Leave the diluted bleach solution on the surface for at least 1 minute.

    • Precaution: Never mix household bleach with ammonia or any other cleanser.

  • Do not dry dust or sweep as this may spread infectious particles

    • Wet cleaning methods are preferred such as disinfectant wipes, sprays, and mopping.

    • Vacuuming is acceptable using a vacuum with a high-efficiency air filter. If not available, ensure the person vacuuming wears a well-fitting mask or respirator. 

See Appendix for details on cleaning different surfaces or objects.

Other Considerations

  • Use proper personal protective equipment (depending on the product) when cleaning.

    • Safety glasses with side shields, goggles, or face shields.

    • Gloves – protective nitrile or latex suitable for the specific disinfectant being used.

  • Cleaning staff should wash hands often, including immediately after removing gloves. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains at least 60% alcohol may be used.

  • Avoid contact with eyes and skin when handling cleaning products.

  • Maintain good ventilation when using harsh products.

  • Comply with all warnings and precautions for use.

  • Do not mix different cleaning products.

Waste Management

Waste management should continue as normal. Municipal waste management systems routinely collect and dispose of waste materials from individuals with infectious diseases and can do so safely using existing procedures. 

Waste from possible cases and cleaning of areas where confirmed cases have been identified should be handled as follows:

  • Any gloves, bandages, or other waste and disposable items that have been in direct contact with skin should be placed in a sealed plastic bag, then thrown away in the dedicated trash can

  • Place waste in a plastic trash bag and tie when full. Wear a new pair of gloves for handling the bag.

  • The plastic bag should then be placed in a second trash bag and tied.

Appendix - Cleaning Surfaces and Objects

Porous Surfaces

For porous surfaces such as carpets, rugs, and drapes:

  • Vacuum carpets or rugs as usual and consider these additional precautions:

    • Remove smaller rugs or carpets from the area completely, so there is less that needs to be vacuumed.

    • Use a vacuum equipped with a high-efficiency particulate air (HEPA) filter, if available.

  • Wait until the room or space is vacant to vacuum.

  • If possible, turn off room fans and HVAC systems while vacuuming so particles that escape from vacuuming will not circulate throughout the building.

Laundry  

Used or contaminated clothing, linens and bedding materials, towels, and other fabric items should be contained until laundering. When at all possible, people with mpox should handle and launder their own soiled laundry. Laundry should not be mixed with that of other members of the household.  

Follow these laundering procedures: 

  • Handle soiled laundry according to standard practices, avoiding contact with contaminants from the rash that may be present on the laundry.

  • Soiled laundry should never be shaken or handled in a manner that may spread infectious particles.

  • In-home laundry facilities:

    • Transfer soiled laundry items to be laundered in an impermeable container or bag that can be disinfected afterwards. Alternatively, a fabric bag may be used that can also be laundered along with the soiled items. 

    • Wash laundry in a standard washing machine with detergent, following label instructions. Laundry sanitizers may be used but are not necessary.

  • In-home laundry facilities not available: 

    • When in-home laundry facilities (facilities not shared with other households) are not available, individuals should coordinate with their local public health department to determine appropriate laundering options

Non-Porous Surfaces

  • Clean surfaces with a detergent or soap and water to remove visible dirt prior to disinfecting.

  • Use diluted household bleach, alcohol solutions with at least 70% alcohol, or an EPA-registered disinfectant.

  • Use disposable cloths or paper towel and disposable mop heads to clean all hard surfaces.

  • Soak cloths, mops, etc. with disinfectant or bleach solution and avoid spray applications which may create splashes.

  • Wipe tabletops, desks, benches or other horizontal surfaces with human contact with disinfectant or the prepared bleach solution at the beginning and again at the end of the cleaning.

  • Damp mop floors with a disinfectant floor cleaner and clean walls and window coverings if visibly dirty.

  • Disinfect non-porous cleaning equipment by soaking in disinfectant or bleach solution.

  • Disinfect equipment used in one room before using for other rooms. If possible, keep the disinfecting equipment separated from other routine equipment.

Electronics

  • Electronics to consider include cameras, lighting controls, sound boards, audio equipment, tablets, touch screens, keyboards, and remote controls.

  • Consider putting a wipeable cover on electronics.

  • Follow manufacturer’s instructions for cleaning and disinfecting or, if no guidance is available, use alcohol-based wipes or sprays containing at least 70% alcohol and dry surfaces thoroughly.

Outdoor Areas

  • Outdoor areas generally require normal routine cleaning and do not require disinfection.

  • If practical, high-touch surfaces made of plastic or metal, such as grab bars and railings should be cleaned routinely.

Wooden Surfaces

  • Cleaning and disinfection of wooden surfaces (play structures, benches, tables) or ground cover (mulch, sand) is not recommended.