Monkeypox Update August 29th 2022


An earlier recommendation of the International Hygiene Advisory Committee (IHAC) on the transmission risk of the Monkeypox virus is dated from May 23rd last. On request of CINET, today the IHAC provides an update based upon recent research on international publications and data, including those of CDC, ECDC and the Dutch RIVM. This concerns answers to below questions:

  • To what extend is Monkeypox (MPX) contagious?
  • Are the existing guidelines regarding COVID19 sufficient or should they be altered?
  • What other recommendations can IHAC provide for safe treatment for laundry employees and customers using linen?

The conclusions are summarized below. Further relevant background information is enclosed.

To what extend is Monkeypox contagious?

  • The MPX virus is an enveloped virus (like the Corona virus) and should not be mixed up with smallpox. It has to be mentioned here that the last case of the sometimes fatal infectious disease smallpox has been observed in 1977 in Somalia.
  • There can be a significant aerosolization of the MPX virus during specific activities. In general the risks of getting infected via aerosol seem small, but can’t be ruled out.
  • Transmission can take place when small lesions are present on the skin. Even when wounds are not visible to the naked eye.
  • The chance that the MPX virus survives the recommended disinfecting wash process is nope. Dosing of a disinfecting bleach creates an additional safety barrier.
  • Handling of infected linen should always be taken seriously.

Recommendations and Guidelines

As for Monkeypox: the existing COVID19 guidelines and laundry protocols are applicable to prevent contamination of staff as well as textiles, with the exception of the storage of contaminated textiles. That  5 day storage rule is not recommended here..

  1. The infected linen should be packed by the healthcare customer[s] in recognisable clearly colour coded bags .
  2. Face masks are highly recommended when sorting the linen and when loading the washing machines.
  3. Wearing gloves when working in the sorting department or when loading the washing machines – is essential in preventing infection with the virus. This vital recommendation is part of the EN 14065 RABC as well as  CERCLEAN Quality Management System. Next to wearing face masks and protective work wear.
  4. Wearing gloves is crucial, because transmission can take place when small lesions are present on the skin. Even when wounds are not visible to the naked eye!
  5. Recommended Cleaning processes:


The Monkeypox virus is a so-called enveloped virus.  And from the COVID19 pandemic we know that most enveloped viruses can be destroyed by thermal disinfection or chemo-thermal disinfection.
On top of that it has to be mentioned here that these enveloped viruses are sensitive to high pH and surface-active agents. Both parameters being present in the pre wash of all healthcare wash processes. So, the MPXV de-activation already starts in the first minute of the dedicated wash process.
In short: the chance that this monkeypox virus survives the recommended disinfecting wash process is nope.
Dosage of a listed disinfecting bleach creates an additional safety barrier.

Exception to the above: effective disinfecting wash processes for fabrics that can’t be washed at high temperature [such as clothing] or fabrics that can’t withstand high pH, need an extra safeguard. We recommend that you discuss this with your detergent supplier. Dosing a product based on 6-phthalimido peroxy hexanoic acid [PAP] sounds the most logical route to follow.

Storage of MPX contaminated textiles and linen is not recommended.

Further relevant data:
Monkeypox and handling linen
The rash associated with monkeypox can be confused with other diseases that are encountered in clinical practise – such as secondary syphilis, herpes, chancroid, and varicella zoster. The  implication for healthcare workers and laundry [sorting] staff is that handling infected linen should always be taken seriously.

The dominant variant [or better clade in WHO Monkeypox terminology]  that is present in the current outbreak is known as the West African Clade (WAC) or clade IIb.
The recommendation to the [specialised] health care facilities is to:
First of all – rule out that the patient has not been travelling to the Democratic Republic of Congo, Central African Republic, Eastern Cameroon or Gabon in the prior 21 days.
Secondly –  Analyse – by PCR – which clade is present. To make sure that the patient has not been infected by clade 1 Virus, also known as the Congo Basin Clade [CBC].

The CDC recommends to vaccinate those persons that are at risk for occupational exposure. This is particularly valid for healthcare workers.
The question has been raised if the virus could be airborne by handling infected linen. Before this question is answered we found that the CDC made a remark regarding transmission via the respiratory tract. In a report of June 9th the CDC reported that the virus “may” spread through respiratory secretions when people have close face to face contacts.  Translated this implies that the risk of getting infected via aerosol in the air – for instance when handling / sorting infected linen – is small. But can’t be ruled out.
However, a recent report *** by an NHS team reported presence of the virus in the air and on healthcare staff uniforms after changing bed linen in occupied patient rooms. The conclusion of this medical team was that there is significant aerosolization of the MPX virus during specific activities.


The Department of Transport [The PHMSA in the USA] – in conjunction with OSHA – are responsible ensuring safe transportation of hazardous materials throughout the United States. These organizations state that testing is needed to ensure that the suspected case is not the Congo Basin clade of the monkeypox virus, which is classified as a Category A infectious substance and thus subject to more stringent transportation requirements under the HMR. Waste from the Congo Basin clade is not eligible to be transported as UN3291, Regulated medical waste. After consultation with the CDC, PHMSA understands that in the United States no Congo Basin cases have been identified, and laboratory testing has continued to indicate that the current outbreak is associated with the West African clade of monkeypox virus. Therefore, a patient who tests orthopox-virus positive can be assumed to be infected with the West African monkeypox virus. Waste, generated during diagnosis, treatment, and immunization of suspected or confirmed cases, can be safely transported as UN3291, regulated medical waste in accordance with the Hazardous Materials Regulations [HMR], provided that screening , mentioned earlier, indicates no risk factors for the Congo Basin Clade.

***        Air and surface sampling for monkeypox virus in UK hospitals | medRxiv


The overall objective is creating consistent recommendations for the laundries, their customers
[such as hospital, food and hospitality industry] and their staff. This in order to maximise hygiene
awareness and minimise or even better avoid any hygiene related incidents. Not only restricted to


The Advisory Committee will:

  • Not be individually or collectively liable for the independent protocols and guidelines.
  • Make sure that the PTC industry will be updated on a regular basis.
  • Prepare answers to topics like: Which linen should be handled as infectious ? and : Should laundry staff wear a mask? If yes – when ? How does the vaccination recommendation for laundry staff look like?