Guidance

Monkeypox: planning events and mass gatherings

Public health principles to support planning for events and mass gatherings during the current monkeypox outbreak.

Applies to England

Purpose

The purpose of this document is to provide public health principles to be taken into account when planning events, such as festivals, during the current monkeypox outbreak.

This guidance has been developed for local authorities, public health, and event organisers. It should be used as a guide to ensure appropriate measures are undertaken to protect public health.

This document follows the control strategy set out in the principles for monkeypox control in the UK.

Main messages

Event organisers should ensure information is available on safe behaviours for attendees, and that they have plans in place for the safe management of suspected cases and their contacts.

Event communications should reinforce the message that the following individuals should not attend the event – those who:

  • have received a confirmed or highly probable diagnosis of monkeypox, and who are currently isolating
  • have symptoms compatible with monkeypox

Background

Monkeypox is a rare viral infection, but recently there have been multiple cases in the UK and across the world. The current case definitions are available.

General information on monkeypox is also available.

Monkeypox infection mainly spreads between people through direct (skin-to-skin) contact, including sexual contact, or close contact via particles containing the monkeypox virus. Infection can also be spread via contaminated surfaces or objects such as linen and soft furnishings.

The current outbreak is primarily spreading through direct skin-to-skin contact.

Monkeypox infection is usually a self-limiting illness and most people recover within several weeks. However, severe illness can occur in young children or individuals who are pregnant or immunosuppressed.

The overall risk to the UK population is low – however gay, bisexual or other men who have sex with men are at a higher risk of acquiring monkeypox in this current outbreak.

Crowding and movement of attendees during events is likely to lead to close, prolonged contact between people which can create an opportunity for monkeypox to be transmitted to a large number of contacts. Some events may involve close contact, including sexual contact, which plays a role in the current spread of monkeypox virus.

Therefore, the size, nature and audience of the event should be factored in when evaluating the risk of transmission of monkeypox.

Key considerations to minimise the risk of monkeypox transmission

1. Event organisers

Event organisers and event medical services (EMS) should:

  • ensure they are aware of the symptoms associated with monkeypox and are familiar with current guidance
  • work closely with local authorities, UK Health Security Agency (UKHSA) health protection teams (HPTs) and the NHS to agree roles and responsibilities
  • ensure plans are in place for safe management and isolation of possible or probable monkeypox cases and any contacts that may be identified during the course of the event – this should include agreeing if there will be a dedicated place for those with symptoms to report to or if attendees should be advised to call NHS 111
  • ensure systems are in place to notify possible and probable cases of monkeypox to UKHSA
  • ensure that the correct personal protective equipment (PPE) is available for staff who may be in contact with possible and probable cases
  • provide clear communications on safe behaviours to event attendees and staff to help reduce the risk of exposure to monkeypox (see section 3)
  • ensure plans are in place for waste management and decontamination practice following best practice – cleaning to reduce risk from the environment in community settings can be effectively achieved without using specialist services or equipment

2. Local authorities

Local authorities working with HPTs should:

  • identify events in their local area where there may be an increased risk of transmission of monkeypox, taking into account:
    • the size and type of event
    • likely attendees
    • current epidemiology
    • evidence on risk factors for monkeypox transmission
  • work with event organisers, EMS and the NHS to ensure plans are in place for prompt clinical management and notification of possible and probable cases
  • agree roles and responsibilities of all partners in advance – consider developing flow charts for case and contact management with provision for responding in and out of hours
  • ensure that systems are in place to support surveillance, contact tracing and notification of monkeypox through established systems – this could include asking event organisers to create attendance lists for participants, if appropriate
  • ensure event organisers and the public are kept up to date with information on the monkeypox situation in the local area, including any local outbreaks
  • monitor and address rumours and misinformation about monkeypox via social media and other channels

3. Public engagement and communication

Event communications should reinforce the message that the following individuals should not attend the event – those who:

  • have received a confirmed or highly probable diagnosis of monkeypox, and who are currently isolating
  • have symptoms compatible with monkeypox

Event organisers should work with local authorities to provide information to attendees on symptoms and safe behaviours, including:

  • hand hygiene, respiratory hygiene and cough etiquette
  • advice on safe sexual behaviours, including asking new partners about their sexual health, refraining from sharing sex toys and keeping them clean
  • promoting condom use with messaging that they cannot offer full protection against monkeypox transmission during sexual contact
  • raising awareness of other routes of transmission, such as close physical contact and through shared bedding

Information should be communicated via posters, event websites or apps, social media and other channels appropriate to the audience. Communications should take into account the type of event and likely attendees to ensure messages are targeted.

Messaging should establish a common understanding of expectations and behaviours for all involved in the event, including attendees and workforce.

4. Infection prevention and control

Event organisers and local authorities should ensure adequate infection prevention and control measures are in place to decrease risk of transmission of monkeypox. This should include:

  • reminders to staff and event attendees about hand hygiene, respiratory hygiene and cough etiquette, including posters in prominent areas
  • regular cleaning and disinfection of frequently touched surfaces in common areas such as toilets or door handles – cleaning can be effectively achieved without using specialist services or equipment and the risk of transmission can be reduced by following cleaning methods, based on standard cleaning and disinfection
  • ensuring that the correct PPE is available for staff who are in contact with possible and probable cases with advice on correct use of this
  • ensuring safe waste management – waste management and decontamination practice should follow usual practice and be based on all the available evidence on safe handling based on current legislation

5. Management of a suspected case

Event organisers need to agree with EMS about who is responsible for examining suspected cases and ensuring adequate facilities are in place to conduct this.

Following clinical examination and history taking, suspected cases must be discussed with local infection clinicians (infectious diseases, microbiology, virology or genitourinary medicine as appropriate) to agree testing and further management of the suspected case.

Every effort should be made to transfer suspected cases safely off the site, while maintaining isolation while they are waiting for and during transportation.

There should be provision of appropriate isolation facilities and welfare checks for clinically stable suspected cases who are unable to leave the site.

6. Management of contacts

Individuals who are identified as a category 3 (high risk) or category 2 (medium risk) contact should be provided with appropriate advice. Any contacts should be notified to the local HPT as agreed in the event plan.

Contacts should be provided with the following numbers in case further information or advice is needed:

  • NHS 111 services for medical advice
  • UKHSA monkeypox helpline (non-clinical enquiries for public): 0333 242 3672

7. Post-event surveillance

Local authorities and HPTs should consider working with event organisers to develop processes to monitor cases linked to the festival that may occur following the event, taking into account the incubation period for monkeypox and the geographical dispersal of festival attendees.

Further resources

World Health Organization: Interim advice for public health authorities on summer events during the monkeypox outbreak in Europe 2022.



Published 1 July 2022
Last updated 25 July 2022 + show all updates
  1. Amended in line with the introduction of highly probable case definition.

  2. Updated advice regarding contacts of a confirmed case of monkeypox.

  3. Updated public engagement and communication section.

  4. First published.