Table. Summary of monkeypox exposures in four educational settings in chronological order, England, June–July 2022.

	Situation	Exposure period in educational setting	Case details	Exposurea	Management
1	Secondary school	5–17 May	Vesicles mainly on genital area, one lesion on wrist and ear, associated fever and feeling unwell	≥ 154 students (Cat 2/Cat 1), ≥ 100 staff (Cat 2)	Children excluded from school for 21 days from last exposure; Vaccination not offered because older children categorised as low risk of severe disease
2	Primary school	13–23 June	Muscle aches, fever, shivers, fatigue, dry throat, followed by rash a few days later, located on head, ears, chest, knee, leg and stomach	3 classes involving 38 children (Cat 2)b, 6 adults (5 Cat 2, 1 Cat 1)	Exposed children isolated from school for 21 days from last exposure; Vaccination not offered to adults as none were high-risk; Vaccine offered to 38 children; Vaccine taken by 10 children
3	Nursery	25 June–5 July	Started with blisters on tongue, followed 5 days later with fever headache, muscle pains and “swollen gland” which started at work. Rash developed on day 8, after exclusion from school.	58 children aged 2–3 years (Cat 2), 4 staff contacts (Cat 2)	Children excluded from school for 21 days from last exposure; Vaccination not offered to adults as none were high-risk; Vaccine offered to 58 children; Vaccine taken by 7 children
4	Reception year of a primary school (4–5 year-olds)	4–7 July	Fever and influenza-like symptoms, followed by vesicles on hands, arms and legs 2 days later, felt better after 3 days and was advised to return to work.	3 classes involving ca 90 children (Cat 2), 8 staff contacts (Cat 2), 2 parents who had a meeting with the case (Cat 2)	Children remained in school in class bubbles for 21 days or until end of term; One high-risk staff offered vaccine; Vaccine offered to all children (ca 90); Parents of 58 children indicated their interest in their child being vaccinated; Vaccine taken by 4 children

CAT: category.

^a Exposures were categorised in detail according to UK Health Security Agency guidance [7] – potential exposures related to educational settings included: Category 3 (high risk): direct exposure to broken skin or mucous membranes of case, their body fluids or potentially infectious material (including clothing); Category 2 (medium risk): contact within one metre with the case for at least 15 min; or, sharing a car with case; Category 1 (low risk): maintaining a distance of more than one metre from the case with no direct contact with case or their body fluids.

^b Two children were tested for suspected monkeypox because they had non-specific viral symptoms but were negative.