By Gary Evans
Although vigilance with infection control is critical, Colorado public health investigators concluded the risk of healthcare workers acquiring occupational monkeypox is “very low.”1
They meticulously identified and followed more than 300 medical staff that cared for patients who were later diagnosed with monkeypox. (See Fig. 1.)
Healthcare workers were assessed for risk and actively monitored for 21 days when indicated. None acquired monkeypox, but the caveat is some received post-exposure prophylaxis (PEP) that could have prevented infection. There was a clear need for infection control education since many healthcare workers were not wearing the recommended personal protective equipment (PPE) for monkeypox.
“During May 1-July 31, 2022, a total of 313 healthcare personnel (HCP) interacted with patients with subsequently diagnosed monkeypox infections while wearing various combinations of PPE,” investigators reported. “[Only] 23% wore all recommended PPE during their exposures. Overall, 28% of exposed HCP were considered to have had high- or intermediate-risk exposures.”
These high- and intermediate-risk workers were offered PEP with the JYNNEOS vaccine. “Among eligible HCP, 37 (43%) received PEP, including 10 (50%) with high-risk exposures and 27 (40%) with intermediate-risk exposures,” the authors wrote.
Hospital Employee Health asked for further comment on the study from lead author Kristen Marshall, PhD, MPH, an epidemiologist at the Colorado Department of Public Health and Environment (CDPHE) in Denver.
HEH: Just to clarify, in the healthcare workers who were administered PEP, we do not know if they would have developed an infection?
Marshall: We do not know if healthcare workers would have developed an infection had PEP not been given.
HEH: Was PEP given as a single-shot regimen or separated into two shots?
Marshall: PEP has been administered as both a single- and two-dose series. JYNNEOS is a two-dose vaccine meant to be administered 28 days apart. Due to rapidly rising cases and an extremely limited federal supply of vaccines, Colorado temporarily implemented a strategy prioritizing first doses to provide early protections to as many at-risk Coloradans as possible. There is no maximum allowable interval between the first and second doses of a JYNNEOS vaccine series, and the second dose can be safely administered after the recommended 28-day window without restarting the vaccination series. CDPHE contacted people who received their first dose and provided contact information to inform them that second doses are now available statewide.
HEH: Can you comment on the lack of full compliance with PPE in many exposures? Could this be an aspect of pandemic fatigue?
Marshall: Ultimately, the data did not capture why there was a lack of full compliance with recommended PPE for monkeypox. Monkeypox is a condition that most healthcare providers in Colorado had not previously seen, and many people have presented with symptoms different than in previous monkeypox outbreaks. Especially early in the outbreak, healthcare providers may not have worn all recommended personal protective equipment because they did not recognize that a patient with symptoms might have monkeypox. Healthcare workers also might not have been aware of community transmission, or they might not have been aware of the current PPE recommendations during care for monkeypox patients. Additionally, patients may have been unaware they had monkeypox or had been exposed and may not have notified their healthcare provider about relevant signs or symptoms before their arrival or during their visit to ensure that recommended infection prevention and control measures were used. Infection prevention and control training for all healthcare workers is important in all healthcare settings.
HEH: In light of reporting no transmission to healthcare workers, is it still important — perhaps more important than ever — to emphasize full PPE compliance with a suspected or confirmed monkeypox case?
Marshall: While monkeypox transmission in healthcare settings is rare, it is important for healthcare workers to take proper infection control, including donning PPE and practicing good hand hygiene. PPE should include gown, gloves, eye protection, and NIOSH-approved respirators with N95 or higher filters.
REFERENCE
- Marshall KE, Barton M, Nichols J, et al. Health care personnel exposures to subsequently laboratory-confirmed monkeypox patients — Colorado, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1216-1219.
Although vigilance with infection control is critical, Colorado public health investigators concluded the risk of healthcare workers acquiring occupational monkeypox is “very low.” They meticulously identified and followed more than 300 medical staff that cared for patients who were later diagnosed with monkeypox.
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