Health care personnel exposures to subsequently laboratory-confirmed monkeypox patients — Colorado, 2022

• DOI: 10.1111/ajt.16681
• Publication Date: 2022-11-08T12:28:18Z
• Authors: Kristen E. Marshall; Marlee Barton; Janell Nichols; Marie A. de Perio; David T. Kuhar; Emily Spence-Davizon; Meghan Barnes; Rachel K. Herlihy; Christopher A. Czaja
• Keywords: Monkeypox

This article describes 313 healthcare providers in Colorado who were exposed to patients with monkeypox and had low rates of personal protective equipment use postexposure prophylaxis vaccination. Despite this, through 21 days follow-up, none the acquired infection, suggesting risk for acquiring among U.S. is very low. reassuring data organ procurement teams are potential donors possible infection or undiagnosed skin lesions. The transmission health care personnel (HCP) caring symptomatic thought be but has not been thoroughly assessed context current global outbreak.1Zachary KC Shenoy ES Monkeypox following exposure facilities nonendemic settings: limited literature.Infect Control Hosp Epidemiol. 2022; 43 (doi:10.1017/ice.2022.152 PMID:35676244.): 920-924Crossref PubMed Scopus (18) Google Scholar typically spreads close physical (often skin-to-skin) contact lesions scabs, body fluids, respiratory secretions a person an active infection. CDC currently recommends that HCP wear gown, gloves, eye protection, N95 (or higher-level) respirator while suspected confirmed protect themselves from infection.1Zachary Scholar,2McCollum AM Damon IK Human monkeypox.Clin Infect Dis. 2014; 58 (doi:10.1093/cid/cit703 PMID:24158414.): 260-267Crossref (283) Scholar,* Department Public Health Environment (CDPHE) evaluated exposures (PPE) settings during subsequently received diagnosis Orthopoxvirus (presumptive determined by polymerase chain reaction [PCR] DNA assay) (real-time PCR assay genetic sequencing performed CDC). During May 1–July 31, 2022, total interacted diagnosed infections wearing various combinations PPE; 23% wore all recommended PPE their exposures. Twenty-eight percent considered have high- intermediate-risk therefore eligible receive (PEP) JYNNEOS vaccine†; those, 48% (12% HCP) vaccine. varied facility type: sexually transmitted (STI) clinics community centers reported highest adherence use, primary urgent lowest adherence. No developed after exposure. These results suggest Infection prevention training important settings, these findings can guide future updates recommendations classification settings. CDPHE collected on clinical nonclinical treating, being within 6 feet of, handling linens patient 2022. interviewed reviewed medical records ascertain whether present cared out-of-state lost follow-up excluded analysis. Exposure details, including types worn, interaction, amount time spent each HCP, levels assigned using assessment criteria at (low uncertain, intermediate, high). offered PEP vaccination actively monitored symptoms exposure.‡ low-risk asked self-monitor days.§ experienced notify immediately, work until resolved, testing if rash occurred. All included analysis completed 21-day monitoring period. In addition, exposure, PPE, CDPHE. administration obtained reporting Immunization Information System. summarized stratified type job title. Analyses R statistical software (version 2021.09.2; Foundation). activity was conducted consistent applicable federal law policy. ¶ 55 monkeypox, 20 high-risk, 67 intermediate-risk, 226 low- uncertain-risk (Table 1). Seven aerosol-generating procedures; three whom Overall, 273 (87%) occurred, 161 (59%) direct patient’s (gloves worn 125 exposures, 30 gloves unknown six exposures). Twenty-six (8%) linens; 23 (88%) gloves. Approximately two thirds encounters (215; 69%) lasted 5–30 min. Only one worker >3 h; this other duration exposure.TABLE 1Health patients, — Colorado, 2022ExposureNo. (subsection %)TotalCommunity STIHospitals EDsUrgent careTotal313 (100)25 (100)175 (100)113 (100)Risk classificationaRisk Care Worker Criteria. http://web.archive.org/web/20220615195256/. https://www.cdc.gov/poxvirus/monkeypox/clinicians/monitoring.html.HighbOne needlestick injury occurred STI phlebotomy “high-risk” exposure; did develop monkeypox.20 (6)2 (8)8 (5)10 (9)Intermediate67 (21)4 (16)33 (19)30 (27)Low uncertain226 (72)19 (76)134 (77)73 (65)Aerosol-generating procedurecAerosol-generating procedures intubation endoscopy. performed7 (2)0 (—)7 (4)0 (—)N95 procedure3 (43)NA3 (43)NALesions encounter273 (87)25 (100)159 (91)89 (79)Touched when present161 (59)12 (48)102 (64)47 (53)Glove use125 (78)9 (75)85 (83)31 (66)No glove use30 (19)3 (25)12 (12)15 (32)Unknown use6 (—)5 (5)1 (2)Handled linens26 (8)0 (—)23 (13)3 (3)Glove use23 (88)NA22 (96)1 (33)No use3 (12)NA1 (4)2 (67)Unknown use0 (—)NA0 (—)0 (—)Duration exposure<5 min22 (7)1 (4)12 (7)9 (8)5–30 min215 (69)14 (56)106 (61)95 (84)>30 min–3 h53 (17)6 (24)42 (24)5 (4)>3 hdThe hours entire period exposure.1 (0)0 (—)1 (1)0 (—)Abbreviations: ED, emergency department; NA, applicable; STI, infection.a Risk https://www.cdc.gov/poxvirus/monkeypox/clinicians/monitoring.html.b One monkeypox.c Aerosol-generating endoscopy.d Open table new tab Abbreviations: Among 118 (38%) treating interacting patients. 64% clinics, 50% hospitals departments (EDs), 12% (Figure 72 (23%) classified as uncertain risk. Adherence ranged 4% clinics. Clinical staff members higher than members, nurses compliance (Supplementary Table, https://stacks.cdc.gov/view/cdc/121197). intermediate- high-risk (87; 28%) vaccine (Table). 37 (43%) PEP, 10 (50%) 27 (40%) period; lesions, four nonspecific symptoms. Two tested Orthopoxvirus; both test negative, third alternative (medication reaction). United States, widespread sexual intimate contact.3Philpott D Hughes CM Alroy KA et al.Epidemiologic characteristics cases—United may 17–July 22, 2022.MMWR Morb Mortal Wkly Rep. 71 (doi:10.3201/eid2604.191164 PMID:32023204.): 1018-1022Crossref (0) occur varying contaminated materials. literature review previous outbreaks1Zachary internationally imported cases,4Rao AK Schulte J Chen TH al.Monkeypox traveler returning Nigeria—Dallas, Texas, July 2021.MMWR (doi:10.15585/mmwr.mm7114a1 PMID:35389974.): 509-516Crossref Scholar,5Costello V Sowash M Gaur A al.Imported international traveler, Maryland, USA, 2021.Emerg 28 (doi:10.3201/eid2805.220292 PMID:35263559.): 1002-1005Crossref (74) case report Kingdom outbreak,6Vaughan Aarons E Astbury al.Human-to-human virus, Kingdom, October 2018.Emerg 2020; 26 (doi:10.15585/mmwr.mm7132e3 PMID:35951487.): 782-785Crossref (133) States outbreak.7Toohey G. Nation’s First MPX Case Healthcare Exposed Job Reported L.A. County.. Los Angeles Times, 2022Google Most (72%) risk; only seven (2%) procedure. evidence occupationally unlikely adhering control precautions.SummaryWhat already known about topic?Although low, consisting monkeypox.What added report?Among receipt indicated; implications public practice?The benefit outreach regarding education training. Although monkeypox. PPE. mask common, likely because COVID-19 source recommendations, 38% respirators, 64%, 40%, 31% gowns, respectively. percentages might due lack awareness (1) before entering area, (2) transmission, (3) (4) signs atypical presentation.3Philpott opportunities exist improve frontline most see so they take steps need increased preparation apparent where lowest. became referral which explain well, more nursing members. subject least limitations. First, generalizable nationwide sites used Colorado; often informed arrived aware recommendations. Second, underreported. System verification process typographical errors names dates birth, well consented information entered into system. Third, materials incomplete, limiting ability draw conclusions route transmission. Finally, covered facemasks visits unavailable. study illustrated despite incomplete especially fewer half HCP. gaps, no underscore importance better understand circumstances prevention, education, improved, support Alexis Burakoff, Shannon O’Brien, Melissa Schaefer, Rachel Severson, Nimalie Stone, Kaitlin Wolff. Theo Abbey; Alyssa Beck; Jennifer Bernal; Tori Burket; Connor Carrillo; Mary Casey; Karen Daily; Catherine Emanuel; Sonakshee Havis; Jillian Jaskunas; Mike Kacka; Ella Keenan; Grace Nelson; Eileen Tran; Leslee Warren; Saher Yunus. authors submitted International Committee Medical Journal Editors form disclosure conflicts interest. K. Herlihy reports Council State Territorial Epidemiologists travel annual conference. interest disclosed. * https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html. † https://www.fda.gov/vaccines-blood-biologics/jynneos. ‡ https://www.cdc.gov/poxvirus/monkeypox/clinicians/monitoring.html. § those 45 C.F.R. part 46, 56; 42 U.S.C. Sect. 241(d); 5 552a; 44 3501 seq.