Prepping Monkeypox Patients Requires Care

Since the monkeypox virus (MPXV) outbreak began in May 2022, occupationally acquired infections in healthcare personnel (HCP) have rarely been reported.

However, since the U.S. government expanded the list of HCP authorized to administer MPXV vaccines to include nurses and pharmacists on October 3, 2022, the risk of work-related exposure has increased.

The recent U.S. CDC's Morbidity and Mortality Weekly Report describes how a nurse's exposure to MPXV through a needlestick can lead to a positive case.

In August 2022, the Florida Department of Health notified the CDC of a nurse who acquired the MPXV through occupational exposure while providing care to a patient infected with monkeypox.

While obtaining swabs from a patient with suspected MPXV, the nurse used a needle to create an opening in the vesicular lesion to facilitate direct contact of the swab with fluid in the lesion.

The needlestick occurred when recapping the used needle by hand before disposal. It caused a break in the skin on the index finger through the nurse's gloved hand, accompanied by a small amount of bleeding.

The wound was immediately washed with soap and water and drenched with Betadine antiseptic solution (10% povidone-iodine). 

Later that day, the lesion swab collected from the patient by the nurse tested positive for nonvariola Orthopoxvirus using a real-time polymerase chain reaction (PCR) assay at the Florida Department of Health Bureau of Public Health Laboratories reference laboratory.

Within about 15 hours of the incident, the nurse, who had no relevant medical history or previous orthopoxvirus vaccination, received the first dose of a 2-dose JYNNEOS® (MVA-BN) vaccination series as postexposure prophylaxis.

In accordance with CDC guidance, the nurse continued to work while asymptomatic and was actively monitored by a specialist.

Ten days after the exposure, a single skin lesion formed at the site of the needlestick.

The nurse immediately began isolating at home and kept the lesion covered until it had crusted over, the scab had fallen off, and a new layer of skin had formed beneath the lesion 19 days later.

During the next 19 days, the lesion at the needlestick site increased in size (remaining <1 cm in diameter) and became pruritic, deep-seated, and umbilicated, then scabbed over and a new layer of skin formed under the scab.

Apart from this single lesion at the puncture site, no additional lesions or other clinical signs or symptoms were reported, and tecovirimat (TPOXX) was not indicated.

As of October 6, 2022, among 326 HCP in Florida who have been occupationally exposed to patients with monkeypox. Thirty-one of these 326 exposures were determined to be high risk.

However, only this nurse with a reported needlestick exposure developed a clinical MPXV infection. 

Additionally, an Early Release Research Letter published by the CDC describes MPXV transmission from a patient to a Brazilian healthcare worker through needlestick injury. A lesion appeared at the inoculation site five days after injury. 

Because few documented needlestick monkeypox cases are available, the Brazilian team could not estimate transmission risk, but instruments used on cutaneous lesions likely pose a high risk.

These CDC reports recommend careful approaches for preventing occupationally acquired MPXV infections.

Ultimately, the person's exposure risk level, their reliability in reporting symptoms that might develop, the number of persons needing monitoring, time since exposure, receipt of PEP, and available resources, are all factors when determining the type of monitoring to be used, says the CDC.

And the World Health Organization recommends postexposure prophylaxis with second or third-generation vaccines up to four days after exposure.

Other monkeypox outbreak news and research are posted at Monkeypox Today.

PrecisionVaccinations publishes fact-checked, research-based vaccine news manually translated and curated for mobile readers.