Study suggests healthcare personnel have a low risk of developing monkeypox when exposed to infected patients


Recently, the Colorado Department of Public Health and Environment (CDPHE) determined how health care workers (HCP) are affected when exposed to the monkeypox virus and published its findings in Morbidity and Mortality Weekly Report. They also determined the effectiveness of personal protective equipment (PPE) in protecting HCPs from infection when caring for patients suspected of having contracted the infection orthopox virus infection or monkeypox.

Study: Healthcare worker exposure in later laboratory-confirmed monkeypox patients - Colorado, 2022. Credit: Cryptographer/Shutterstock
Study: Healthcare worker exposure in later laboratory-confirmed monkeypox patients – Colorado, 2022. Credit: Cryptographer/Shutterstock

background

Typically, monkeypox is transmitted through physical contact with bodily fluids, lesions, or scabs or respiratory secretions of an infected person. The Centers of Disease Control and Prevention (CDC) recommends that HCPs wear eye protection, gowns, gloves and N95 or higher rating respirator when treating patients with suspected or confirmed monkeypox.

It is important to assess the risk of transmission of monkeypox to HCPs directly involved in the care of symptomatic patients. Although HCPs were considered to be at low risk of contracting the infection, this has not been thoroughly assessed from the perspective of a global outbreak.

About the study

In this study, CDPHE obtained clinical and non-clinical data on HCP exposure during treatment. They interviewed monkeypox patients and reviewed their medical records to determine if lesions were present when HCPs were exposed to patients.

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The type of interaction with the patients, the type of PPE worn and the time spent with the patients were analyzed. HCPs classified as high or intermediate risk of exposure were offered the JYNNEOS PEP vaccination and were monitored for 21 days.

HCPs placed in the low-risk exposure group were asked to self-monitor for symptoms of monkeypox virus infection for 21 days. All participants were asked to notify CDPHE immediately in case of symptoms.

study results

A total of 313 HCPs interacted with 55 patients diagnosed with monkeypox infection between May 1, 2022 and July 31, 2022. HCPs have been classified into exposures of high risk, medium risk, and low or uncertain risk. A total of 20 candidates were classified as high risk, 67 as intermediate risk, and 226 as low or uncertain risk.

Although all HCPs used different PPE combinations, only 23% wore the recommended PPE during exposure. 28% of the study cohort had a high to intermediate risk of exposure to monkeypox virus. These individuals were recommended post-exposure prophylaxis (PEP) with the JYNNEOS vaccine. However, only 48% of this group received the vaccine.

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Eighty-seven percent of the study cohort were exposed to patients with monkeypox lesions or rashes. Of these, 59% had direct contact with the patient’s skin or lesions. HCPs wore gloves most of the time; In some cases, however, gloves were not worn. Around two-thirds of encounters with monkeypox patients lasted between five and thirty minutes.

Thirty-eight percent wore the recommended N95 respirator while interacting with or treating monkeypox patients. The level of PPE use by HCPs varied by facility. For example, HCPs associated with sexually transmitted infection (STI) clinics and community health centers were among those most compliant with the recommended PPE. In contrast, those working in primary and emergency care showed the lowest adherence.

Only 38% of HCPs wore N95 respirators, 64% wore gloves, 40% used gowns and 31% used eye protection. These low percentages were attributed to the patient’s lack of awareness of the patient’s symptoms prior to onset and the lack of monkeypox PPE guidelines and other relevant information. This study underscores the importance of raising awareness and educating HCPs so they can take the necessary steps to protect themselves from exposure.

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Importantly, the authors observed that no HCP developed monkeypox infection 21 days after challenge. This result is extremely important as it indicates that healthcare professionals are at low risk of contracting the infection in healthcare settings.

Study Restrictions

One of the limitations of this study is its greater reliance on data from community health and STI clinics, which may not adequately represent statewide conditions. This is because these clinics are often alerted about visiting patients with suspected monkeypox. Therefore, the HCPs are mostly prepared for these patients. Another limitation of the study is the lack of PEP vaccination data. In addition, no data could be obtained on whether monkeypox patients covered lesions or wore face masks when interacting with HCPs.

Conclusions

In the current study, a minimal risk of transmission of monkeypox from infected patients to HCPs was documented. The results are consistent with other related studies conducted in the US and other countries. The study also suggests that occupationally acquired monkeypox is highly unlikely if all recommended prevention and control measures are followed.



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