Human Mpox Interim Guidance for Massage Spas/Therapists

Mpox is a disease that causes a rash that often follows flu-like symptoms. Human-to-human transmission of mpox occurs by direct contact with lesions or infected body fluids, or less likely, from exposure to respiratory secretions during prolonged face-to-face contact. A person is considered to be infectious from the time their symptoms start until there is full healing of the rash with formation of a fresh layer of skin.

Massage therapists are required to provide services consistent with recognized and accepted standards of the profession under Section 45(a) (7) and (18) of the Massage Licensing Act (225 ILCS 57).

The following strategies should be used to prevent mpox transmission within massage spas or among massage therapists.

• Provide clear information to staff about mpox symptoms and prevention, including the potential for transmission through work related close, sustained physical contact, such as might occur when performing a massage, or through close, sustained physical interactions outside of the workplace, including sexual activity. Keep messages fact-based to avoid introducing stigma when communicating about mpox.
• Encourage staff to stay home if ill and work to create/maintain supportive sick leave protocols to encourage this. In addition to the rash, other symptoms of mpox include fever, headaches, muscle aches, swollen lymph nodes, chills, exhaustion, and respiratory symptoms (e.g., sore throat, nasal congestion, or cough). These symptoms can appear 1 to 4 days before the onset of the rash.
  
• Screen staff daily for any symptoms of mpox. Require staff with new skin lesions of concern to be medically evaluated before they are allowed to work, including testing if indicated. Staff with suspected mpox infection should be instructed to isolate and not work until cleared by their medical provider.
  
• Any person with mpox should not work until mpox symptoms have resolved, the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed per Centers for Disease Control and Prevention (CDC) recommendations. A letter from a health care provider clearing the person for return to work is recommended. Alternatively, upon the recommendation of the local health department, staff may return once other symptoms have resolved and they should wear a well-fitted mask and cover all lesions with clothing or bandages. If lesions are located on the hands, it is advised that employees not work until new skin has formed due to their inability to clean their hands. They should not participate in events that are crowded, involve close physical contact or where a bandage can’t be worn. Suspect or confirmed cases should be immediately reported to your local health department, which will discuss with you any exposed personnel, and, if appropriate, arrange for post-exposure prophylaxis (PEP) that is currently offered through a vaccine. If given within 14 days of exposure, PEP can prevent infection and may prevent severe disease.
  
• Avoid close, skin-to-skin contact or prolonged fact-to-face contact with people who have a rash that looks like mpox.
  
• Wear personal protective equipment (PPE), including, at a minimum, gloves and an N-95 respirator (or a well-fitting medical mask, if an N95 respirator is not available or if not medically capable) if skin and face-to-face contact cannot be avoided. Gown and eye protection are also recommended, if available.
  
• If you touched skin lesions or clothing, linens, or surfaces that may have had contact with lesions suggestive of mpox, clean hands immediately with an alcohol-based hand sanitizer (ABHS) containing at least 60% alcohol, or soap and water, if ABHS is not available.
  

• Post signage and inform clientele who have exposed lesions, who have any flu-like symptoms, or who have been exposed to someone with mpox in the last 21 days that services will have to be delayed until the rash has fully healed and a fresh layer of skin has formed. Facilities are encouraged to use paper questionnaires or computer applications to screen patrons confidentially prior to the appointment.
• Clean and disinfect surfaces that were in direct contact with skin lesions using an U.S. Environmental Protection Agency (EPA)-registered disinfectant with an emerging viral pathogen claim (such as List Q) in accordance with the manufacturer’s instructions.
  
  • Ensure the required contact time is achieved. Mpox is an EPA emerging viral pathogen Tier 1 virus. The List Q site has a search function by product name that can be utilized to verify products currently in use by massage therapists are effective. Alternatively, the List Q site also contains a table that can be searched by product name. Select products from the “For use on Tier 1 viruses” column. In general, ready to use products are preferred because they do not require mixing or diluting.
    
• Wash down and disinfect massage tables, including headrests, thoroughly before and after each client visit with an EPA-registered List Q disinfectant.
  
• Never use massage linens for more than one client. Place used linens in a laundry bag and wash linens within 24 hours of each use.
  
• Discard waste and disposable items that have been in direct contact with skin in a sealed plastic bag and throw away in trash can.
  
• Avoid shaking linens, dry dusting, sweeping, or using fans that may spread infectious particles.
  

• If someone with an Mpox-like rash does end up utilizing any services, ensure that linens/towels/robes/slippers used by the client are handled without direct contact (i.e., handlers should wear disposable gowns/gloves/masks) and placed in a disposable laundry bag for washing. Laundry can be washed per manufacturer’s instructions.
• For surfaces, including toilet area items, that may have come into contact with the suspected mpox case, clean and disinfect with an EPA List Q disinfectant instead of dry dusting.
  
• Notify the local health department if services were provided to a client with suspected or confirmed mpox. The local health department will provide additional guidance for management of potential exposures and perform contact tracing.