Risk Alert 109 - Mpox – Guidance for shipboard operations

Transmission

Mpox can be transmitted through:

• Face-to-face interaction: Respiratory droplets from talking or breathing in close proximity to an infected person.

• Skin-to-skin contact: Any form of direct contact with an infected person.

• Contaminated objects: Contact with contaminated clothing, linens, or working tools.

If a crew member is infected, the virus could potentially spread to other crew members.

Signs and Symptoms

Identifying Mpox can be challenging as its symptoms may resemble other infections. Symptoms usually appear within a week but can start anytime between 1–21 days after exposure. They typically last 2–4 weeks, although some may persist longer due to a weakened immune system. Common symptoms include:

• Rash

• Fever

• Sore throat

• Headache

• Muscle aches

• Back pain

• Low energy

• Swollen lymph nodes

For infected crew members, the first symptom may be a rash, although fever, muscle aches, and sore throat can also be initial symptoms. The Mpox rash often begins on the face and spreads over the body, including the palms and soles. It evolves over 2-4 weeks through stages: macules, papules, vesicles, and pustules. The rash starts as flat sores that develop into blisters filled with liquid, which may be itchy or painful. Lesions dip in the center before drying up and crusting over, with scabs eventually falling off. Swollen lymph nodes (lymphadenopathy) are a classic feature of Mpox. Some people may be infected without developing any symptoms.

Mpox - NHS (www.nhs.uk)
Mpox (who.int)

Prevention on Board Ships 
Disease outbreaks – advice for shipping (imo.org)

Crew Awareness

• Education: Ensure all crew members are well-informed about the risks of Mpox, including symptoms, transmission methods, and preventive measures. Provide regular updates and training sessions.

• Vigilance: Encourage crew members to remain vigilant, especially when interacting with visitors or considering shore leave. Emphasize the importance of avoiding contact with potentially infected individuals.

• Reporting: Make sure crew members are familiar with the reporting requirements of local authorities and know how to report suspected cases promptly.

Hygiene Procedures

• Hand Hygiene: Promote frequent hand washing with soap and water or the use of hand sanitizers, especially after touching potentially contaminated surfaces.

• Surface Cleaning: Regularly sanitize commonly touched surfaces, such as door handles, railings, and shared equipment, to reduce the risk of contamination.

Personal Protective Equipment (PPE)

• Availability: Ensure an adequate supply of appropriate PPE, such as gloves and masks, is available on board, especially when trading to regions with suspected Mpox cases.

• Usage: Train crew members on the correct use and disposal of PPE to maximize its effectiveness

Isolation Procedures

• Isolation Spaces: Designate well-ventilated isolation spaces for infected crew members to minimize the risk of spreading the virus.

• Hygiene Practices: Infected individuals should practice frequent hand washing and avoid touching sores. Provide them with necessary supplies, such as soap and hand sanitizer.

If crew members suspect they have Mpox symptoms, they should take the following steps:

Immediate Actions

1. Report Symptoms: Inform the ship’s medical officer or designated health personnel immediately.

2. Isolate: Begin self-isolation in a well-ventilated space to prevent spreading the virus to others.

3. Hygiene: Practice frequent hand washing with soap and water, especially after touching any sores.

Medical Evaluation

4. Seek Medical Advice: Follow the guidance of the ship’s medical officer or contact a healthcare provider for a proper diagnosis and treatment plan.

5. Monitor Symptoms: Keep track of symptoms and report any changes or worsening conditions to the medical officer.

Preventive Measures

6. Avoid Contact: Refrain from close contact with other crew members and avoid sharing personal items.

7. Use PPE: Wear appropriate personal protective equipment (PPE), such as masks and gloves, to reduce the risk of transmission.

Cleaning and Disinfection Protocols

General Cleaning

1. Initial Cleaning: Remove any visible dirt or debris from surfaces using detergent or soap and water.

2. Disinfection: Apply an appropriate disinfectant, such as diluted household bleach solutions, alcohol solutions with at least 70% alcohol, or EPA-registered disinfectants. Follow the manufacturer’s instructions for application and proper ventilation.

High-Touch Surfaces

3. Frequent Disinfection: Regularly disinfect high-touch surfaces such as door handles, light switches, remote controls, and bed rails.

4. Effective Products: Use disinfectants that are effective against viruses, ensuring they are used according to the manufacturer’s guidelines.

Soft, Porous Surfaces

5. Cleaning Soft Surfaces: Clean soft surfaces like carpets, rugs, and upholstery with appropriate cleaners. If possible, launder items using the warmest appropriate water setting and dry them completely.

Specific Areas

6. Sleeping Quarters: Focus on disinfecting areas where crew members sleep, including mattresses, pillows, and bedding. Use disinfectant sprays suitable for fabrics.

7. Isolation Areas: If a cabin has been used by an infected person, close it off and wait at least 24 hours before cleaning and disinfecting.

Personal Protective Equipment (PPE)

8. PPE for Cleaning Staff: Ensure that cleaning staff wear appropriate PPE, such as gloves and masks, while cleaning and disinfecting cabins.

Waste Disposal

9. Safe Disposal: Dispose of cleaning materials and PPE safely to prevent contamination. Use double-bagging for waste disposal and label it as biohazardous if necessary.

Waste Disposal Protocols

Isolation Area Waste

1. Dedicated Trash Can: Use a dedicated, lined trash can in the isolation area for the person with Mpox.

2. Sealed Bags: Collect soiled waste, such as bandages, paper towels, and food packaging, in sealed bags before disposal.

General Waste

3. Double Bagging: Place waste in a plastic bag, seal it, and then place it in a second bag to ensure containment.

4. Labelling: Clearly label the waste bags as biohazardous to alert waste handlers.

Personal Protective Equipment (PPE)

5. PPE for Handling Waste: Ensure that anyone handling waste wears appropriate PPE, such as gloves and masks, to minimize exposure risk.

Disposal

6. Follow Local Regulations: Dispose of waste according to local health and safety regulations, which may include incineration or other approved methods for biohazardous waste

Principles for control of non-HCID Mpox in the UK: 4 nations consensus statement - GOV.UK (www.gov.uk)

Waste Management from Patients Being Treated for Mpox Virus | NETEC

Further, Club Members are advised to contact their local agents and Club correspondents for details of any local health authorities’ requirements and guidance when trading in, to or having previously traded to an affected region, and particularly in the event of there being any suspected or confirmed cases of Mpox on board.

The above guidelines have been developed in consultation with the Club’s independent UK-based medical consultants, Medical Rescue International (MRI), with the intent of assisting seafarers to stay safe on board their ships.