California Issues Its First Monkeypox Isolation Guidance

People recovering from monkeypox should wait at least 48 hours after symptoms subside before resuming activities outside the home and wear condoms during sex for 12 weeks after infection, California health officials said in their first recommendations for monkeypox isolation.

California’s isolation recommendations, posted online Thursday and discussed by state Public Health Officer Dr. Tómas Aragón on Friday, mostly align with those issued by the U.S. Centers for Disease Control and Prevention. People with monkeypox should isolate at home, in a separate room if they live with others, for the duration of symptoms and should not share bedding, towels or utensils with others in their household.

But California goes a step further by specifying when it’s safe to end isolation — at least 48 hours after lesions scab and fall off and other symptoms such as fever have resolved. And unlike the CDC, the state recommends wearing condoms for 12 weeks after infection, which is similar to the United Kingdom’s and the World Health Organization’s guidance. This is based on scientists not knowing whether or how long monkeypox DNA in the semen of an infected person can transmit the virus to others.

Similar to how SARS-CoV-2 can be detected in nasal specimens long after someone has stopped being contagious, it’s possible that monkeypox can be detected in semen for weeks after infection, but the person is no longer contagious. So recommending condom use for 12 weeks afterward is a conservative but reasonable recommendation, said UCSF infectious disease physician Dr. Peter Chin-Hong.

California’s recommendations are also more prescriptive on how to resume limited activities, including work, outside the home if someone is mostly recovered but still has lesions on parts of the body that can be covered by clothing. According to the state, people in this situation can restart activities as long as new lesions haven’t formed in the past 48 hours, other symptoms have ended for at least 48 hours and they keep unhealed lesions covered while in public. However, this does not apply to people who work in high-risk settings like hospitals, homeless shelters, nursing homes and K-12 schools; they must have all lesions healed before going back to their jobs.

“Some people have lesions that are very limited on their body, and it may take awhile for that to heal, and it may be in a part of the body where there’s no risk of exposing people,” Aragón said. “We wanted to publish those guidelines that are more practical for those situations to give people the information they need. We feel our guidance provides more specificity and practicality than the CDC guidance.”

Chin-Hong called this a harm reduction model that recognizes that many people may not be able to isolate or miss work for weeks on end. It’s reasonable for infected people who pose a low risk to others to resume their lives, with some guardrails, he said.

California’s guidance comes as new monkeypox cases are emerging statewide and in the Bay Area. As of Friday, there have been 2,660 confirmed and probable cases in the state — including 614 in San Francisco, the jurisdiction with the second-highest number of cases after Los Angeles County.

But there are signs the outbreak in the United Kingdom, Canada and New York City may be starting to slow. California health officials were hesitant to say a similar slowdown is beginning here because there is a roughly two-week delay in data reporting on new cases. That makes it hard to tell whether the epidemic curve is descending, as preliminary data suggests, because data from the last couple weeks hasn’t been finalized.

“I’m hoping we’ll begin to flatten out a little bit,” Aragón said. “New York City may be seeing some of the same trajectory. We’re hoping that’s the case. In general, the number of cases start going down when (the virus) has trouble finding susceptible people to infect. That happens in three ways. People develop immunity because they’ve been vaccinated. People develop immunity because they’ve been infected and recovered. Or people change their behavior and aren’t having as much contact. Those three things coming together is what’s going to drive the epidemic curve down.”


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