Mpox: Preventing and managing mpox in schools and learning spaces

When mpox is spreading in a community, learners, students and educational staff can be affected. Mpox spreads through close contact, making people who spend time in places where there are close interactions, such as schools, potentially more vulnerable. In schools, the spread of mpox can be reduced or prevented by putting in place measures such as handwashing, cough etiquette and surface cleaning, and raising awareness through communication.

It is critical to work together to safeguard students’ routines and learning, their development and overall well-being. Schools and learning spaces should remain open, and relevant measures to decrease exposure to the virus and reduce the risk of transmission should be strengthened.

The following key actions can ensure readiness as well as an agile response to the spread of mpox.

• Co-create a plan, messages, information, and education and communication materials with teachers, staff, caregivers and students about the need to implement preventive measures in schools and learning spaces.
• Develop a plan about how to respond when a student, teacher or staff member is thought to have mpox or is identified by health authorities as a possible or confirmed case or a close contact of a case.
• Ensure that schools and learning spaces have access to age-appropriate information and visual communication tools about mpox, including information about:
  • how mpox spreads;
  • its signs and symptoms;
  • the importance of prevention and control measures;
  • procedures for contacting local public health authorities to support the care of a student or staff member who may have mpox in a discreet and respectful manner; and
  • how to prevent stigma and discrimination.
• Reinforce infection prevention and control measures, including, but not limited to, the need for frequent hand hygiene, respiratory hygiene and cough etiquette (i.e. covering coughs and sneezes with a tissue or elbow), and cleaning of classrooms and shared spaces.
• Prepare to scale up and enhance measures when mpox transmission is likely or taking place in a school setting. For more information, refer to “Field guide: the three star approach for WASH (water, sanitation and hygiene) in schools”.
• Ensure that personal protective equipment, such as gloves, and cleaning materials, including chlorine solution, are in place and available in sufficient quantities.
• Identify in advance a space that can be used for temporary isolation, ideally a space with good ventilation, and develop and communicate the protocol for helping a person who may have mpox.
• Be prepared to introduce resources and mechanisms to allow students to continue to learn remotely or through self-paced learning while they are in isolation for mpox.
• Train teachers, educational staff and student representatives to identify early symptoms and assess ill students. Provide basic training in mental health and psychosocial support skills, and how to use these skills in schools and learning spaces.
• Build on existing hygiene promotion programmes in schools to co-create with students some messages, information, education and communication materials, and other school activities to promote hygiene and other protective measures at school and at home.
• Promote an open and transparent discussion within the school community to create trust, reduce alarm and prevent potential stigma and discrimination. Organize regular dialogues within the school community to promote prevention measures and to address doubts, concerns and rumours.

To protect themselves, students, staff, and teachers should:

• Know the symptoms of mpox, how it is spread and how to regularly check for signs and symptoms.
• Stay home when sick, especially when showing signs and symptoms of mpox. Seek guidance from local health authorities (e.g. health and care workers, public health officers or community health workers) and isolate, even when symptoms are mild.
• Avoid close contact with someone who has signs and symptoms of mpox.
• Practise frequent hand hygiene, using clean water and soap or an alcohol-based hand rub, especially before eating, after touching broken skin or coming into contact with body fluids, and when hands are dirty.
• Safely handle clothes, uniforms and other linens, such as sheets or towels.
• If symptoms develop when a student, teacher or staff member is not at school, they should stay home and they or the school can contact a health care provider or local health authorities, who can guide care and testing, further isolation measures and contact tracing, if necessary.
• Students, teachers and staff should know which practices or protocols have been agreed to, and follow the guidance if they develop symptoms while at school.
• Stigma can prevent school and community members from seeking care or sharing information. Use respectful language and treat colleagues affected by mpox with compassion and support, rather than judgment.

It is important to review and adapt measures as an outbreak evolves. Regularly assess the effectiveness of implemented measures and make necessary adjustments based on feedback and public health guidance. Consider gathering input and feedback from students, parents and staff to identify challenges to and areas for improvement in implementing measures; and update guidance and protocols as new information becomes available or as the outbreak situation changes.

A full range of measures listed below can be considered depending on local risks, feasibility, and contextual factors.

Promoting personal hygiene

• Ensure there are functional handwashing stations that have soap and clean water (or an alcohol-based hand rub), and encourage frequent handwashing, especially after using the toilet, after coughing or sneezing, before eating, after touching broken skin or coming into contact with body fluids, and when hands are visibly dirty.
• Promote respiratory hygiene and cough etiquette: cover coughs and sneezes, turn away from others and cover the mouth and nose with a tissue or elbow, and properly dispose of waste, such as tissues.
• Minimize physical contact between people and the sharing of materials and personal items whenever possible. Students and staff should be encouraged to bring their own utensils and reusable drinking bottles whenever possible.
• Ensure there are adequate spaces and facilities for students – such as those in boarding schools or physical education classes – and guidance about how to safely handle their own clothes, uniforms and other linens, such as sheets and towels.

 
Implementing surface cleaning

• Ensure that frequently touched surfaces and objects are cleaned and disinfected regularly (e.g. desks, chairs, doors, handles, sports equipment), particularly those in shared spaces (e.g. classrooms, bathrooms, cafeterias and other common areas).
• Keep classrooms and school spaces well ventilated.

 
Targeting the animal-human interface

• In places where trapped or hunted animals may carry the virus that causes mpox, ensure that meat is carefully handled and thoroughly cooked before consumption.
• Prevent live wild animals from entering school property.
• Avoid dead animals and those that are ill.
• Wash hands after touching any animals.

 
Raising awareness

Clear, fact-based messages and materials that communicate the risks and increase awareness of mpox should be readily available to the school community. They should be delivered through multiple channels, in various forms and formats, while ensuring that they are accessible to people with different literacy levels.

School administrators, teachers and staff can consider the following actions.

• Provide regular updates to students and staff, especially when new information becomes available or if the risk of infection changes.
• Promote regular dialogue within the school community to encourage the adoption of preventive measures and to dispel doubts, concerns and rumours. Proactively address any possible stigma or discrimination associated with mpox infection, including when staff or students who had mpox return to school.
• Regularly monitor information circulating in the community to promptly address any misinformation (see WHO’s course on infodemic management) and to prevent confusion and fear within the school community.
• If feasible, collaborate with health and care workers and community health workers to support these risk communication and community engagement efforts.

 
For more information refer to the WHO publication “Interim public health advice for mpox-related prevention and control measures in school settings”.

If a student, teacher or staff member has come into contact with someone who has mpox, they should monitor themself for signs and symptoms of the illness for 21 days after exposure.

As long as they remain symptom-free, they may continue their daily activities and continue to attend school or go to work. If symptoms develop, they should stay home and isolate, and the school should contact local health authorities for advice.

During the 21-day monitoring period, the contact should:

• rigorously practice hand hygiene and respiratory etiquette;
• limit their sharing of personal items, such as eating utensils, school supplies and personal hygiene products;
• receive information about what to do if symptoms appear and closely monitor their symptoms daily;
• have access to age-appropriate information;
• have their concerns addressed by designated resource persons; and
• refrain from sexual contact.

If a student, teacher, or staff member has or may have mpox, do the following:

Isolation

• The school should contact health authorities when someone becomes ill so the health care authorities can assess the situation and, if necessary, coordinate the care, testing and safe transport of the affected person from the school or learning space.
• If a student or learner becomes ill, their parent or guardian should be notified and should be able to communicate with their child if the parent or guardian is not the person taking them to the facility. In addition, parents and guardians should be put in touch with a health care provider or local health authorities to receive all necessary information and to address any concerns.
• If local health authorities are not available to assist with safe transport, parents or guardians should be advised to take the child to a nearby health facility for assessment and instructed about how to prevent transmission during transport.
• If a staff member becomes ill, discreetly ask them to move to the previously identified space and to contact a health care provider or local health authorities about how to safely access care.
• Health authorities can also advise about further isolation measures for the person who is ill, either at home or in a health care facility, in line with clinical need and local procedures, and perform contact tracing as required.

 
Surface cleaning

Strengthen the following cleaning practices.

• Ensure that cleaners wear gloves, a medical mask and close-toed shoes used only for cleaning.
• Cleaners should avoid dry sweeping or vacuuming to prevent the dispersion of particles; instead damp mopping or wiping should be used.
• If the affected individual has been to multiple classrooms or other spaces on campus, all of those spaces must be cleaned thoroughly.
• Surfaces must be washed with soapy water and then disinfected with a minimum 0.05% chlorine solution. The surface should remain damp from the chlorine solution for at least 1 minute for proper disinfection to occur.
• Cleaners should wear gloves to place any waste generated by the student or staff member into waste bags, tie them securely and dispose of them with other municipal waste.
• Gloves should be carefully removed and disposed of in a waste bin.
• Immediately after they finish, cleaners should wash their hands with soap and water or use an alcohol-based sanitizer.

 
Home care and isolation

For information about home care and isolation, refer to WHO and UNICEF’s interim operational guidance on home care and isolation.

To ensure continual learning for students or learners in isolation, the school or learning space should maintain communication with the student or learner and organize distance learning. If distance learning is not feasible due to limitations in infrastructure and resources, the school might consider arranging catch-up or remedial sessions after the student or learner has recovered.

Outbreaks of mpox can create fear of the disease and of the stigma, uncertainty and suffering that can affect everyone in the school community. These challenges can interfere with children’s routines and learning, negatively affecting their development and overall well-being. In addition to preserving access to learning, schools can serve as vital platforms for delivering accurate, age-appropriate information about an outbreak. By providing guidance on protective measures, schools can empower students to take an active role in protecting their own health and the health of their peers.

Schools can also foster a culture of care and support. To ensure that students or learners are willing to look after each other´s mental health and psychosocial well-being during times of crisis, schools and learning spaces can consider taking the following actions.

• Provide mental health and psychosocial support for children. For example, this can be achieved by creating safe opportunities for students to share their feelings and by incorporating stress-reduction activities into the classroom or learning space.
• Train and support educational personnel. Training teachers and educational personnel in basic psychosocial support skills (e.g. how to recognize and respond to stress responses, how to promote social support) allows them to help children in distress and learn more about self-care. Training should also be provided in how to offer age-appropriate information about mpox prevention and control, and positive coping strategies for addressing stigma, as well as how to promote learning by, and the well-being of, children during times of crisis. There are established recommendations for minimum training in basic psychosocial support skills.
• Support the mental health and psychosocial well-being of educational personnel. For example, this can be achieved by establishing peer-to-peer support groups or check-ins that gauge a teacher’s or staff member’s emotional well-being and need for additional support.
• Review and update referral protocols. Regularly review and update referral pathways to connect students with essential services when needed, including health, mental health, and child protection services.

For more information, please refer to UNICEF’s guidance on integrating mental health and psychosocial support into mpox response and on priorities and activities for mental health and psychosocial support during an mpox outbreak.