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Assiri AM, Alserehi H, Abuhasan MY, Khalil EAA, Al-Thunayan MH, Alshehri MS, Alrossais AA, Abudahish AS, Alsahafi AJ, Al-Tawfiq JA. Epidemiology, clinical presentation, and outcome of mpox: A study of 381 cases in Saudi Arabia. IJID REGIONS 2024; 11:100358. [PMID: 38590626 PMCID: PMC11000198 DOI: 10.1016/j.ijregi.2024.100358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
Objectives There are limited data on the clinical and epidemiological aspects of mpox in Saudi Arabia. This study investigates the characteristics of Mpox cases from May to September 2023. Methods A total of 381 cases of Mpox were included in this study, diagnosed based on a combination of clinical symptoms and laboratory testing. Results The majority of mpox cases were males (91.1%), with a mean age of (±SD) of 32.4 (±8.3) years; 356 (93.4%) did not report travel, 277 (72.7%) denied engaging in extra-marital sex, and 379 (99.5%) were not linked to secondary cases. Fever was reported in 371 (97.4%), whereas headache was present in 314 (82.4%). Cough (1.3%) and conjunctivitis (0.5%) were rare. The most commonly affected areas in terms of lesions were the palms and soles (297 cases, 78%), followed by the genitals (206 cases, 54%), face (198 cases, 52%), and mouth (160 cases, 42%). Of the 1325 identified contacts, 1134 (85.5%) were hospital contacts, and 191 (14.5%) were community contacts, and 393 (29.6%) were high-risk contact. Of the high-risk contacts, 284 (72.3%) accepted post-exposure vaccination. The genotyped samples were all subclade IIb (formerly the West Africa clade). Conclusions This study provides valuable insights into mpox characteristics in Saudi Arabia. The genome of monkeypox virus belonged to subclade IIb of the West Africa clade. Further analysis of the global tree sublineage is needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Dhahran Health Center, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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2
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de Perio MA, Horter L, Still W, Meh I, Persson N, Berns AL, Salinas A, Murphy K, Lafferty AG, Daltry D, Mackey S, Sockwell DC, Adams J, Rivas J, Somerville NJ, Valencia D. Evaluation of Mpox Exposures and Outcomes in Workplaces, 6 Jurisdictions, June 1-August 31, 2022. Public Health Rep 2024:333549241245655. [PMID: 38785340 DOI: 10.1177/00333549241245655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES The risk for mpox virus (MPXV) transmission in most workplaces has not been thoroughly assessed in the context of the 2022 global mpox outbreak. Our objectives were to describe mpox case patients who worked while infectious and the subsequent workplace contact tracing efforts, risk assessments, and outcomes. METHODS The Centers for Disease Control and Prevention requested information from health departments in the United States in September 2022 to identify people with confirmed or probable mpox who worked outside the home while infectious, either before or after diagnosis, from June 1 through August 31, 2022. We collected and summarized data on demographic, clinical, and workplace characteristics of case patients and workplace contact investigations. We stratified data by industry and occupation categories. RESULTS In total, 102 case patients were reported by 6 jurisdictions. The most common industries were accommodation and food services (19.8%) and professional business, management, and technical services (17.0%). Contact investigations identified 178 total contacts; 54 cases (52.9%) had no contacts identified. Of 178 contacts, 54 (30.3%) were recommended to receive postexposure prophylaxis (PEP) and 18 (10.1%) received PEP. None of the contacts developed a rash or were tested for orthopox or mpox, and none were reported to have confirmed or probable mpox. CONCLUSION Data from 6 jurisdictions suggest that the risk of MPXV transmission from workers to others in workplace settings in many industries is low. These findings might support future updates to exposure risk classifications and work activity recommendations for patients. These findings also demonstrate the importance of collecting and analyzing occupation and industry data in case reports to better understand risks in workplaces.
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Affiliation(s)
- Marie A de Perio
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Libby Horter
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William Still
- District of Columbia Department of Health, Washington, DC, USA
| | - Ie Meh
- District of Columbia Department of Health, Washington, DC, USA
| | - Nancy Persson
- Rhode Island Department of Health, Providence, RI, USA
| | - Abby L Berns
- Rhode Island Department of Health, Providence, RI, USA
| | | | | | | | | | - Skyler Mackey
- Virginia Department of Health, Alexandria, VA, USA
- Virginia Department of Health, Richmond, VA, USA
| | | | - Jeremy Adams
- Florida Department of Health, Tallahassee, FL, USA
| | | | - Nicholas J Somerville
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Diana Valencia
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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3
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Leong T, Riveros D, Delman BN, Moss MK, Javaid W, Rodriguez H, Kagetsu NJ. Frontline Practices in Response to Monkeypox Outbreak in New York City. J Am Coll Radiol 2024; 21:e7-e9. [PMID: 36195312 PMCID: PMC9534278 DOI: 10.1016/j.jacr.2022.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Tin Leong
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniela Riveros
- Department of Neurology, Mount Sinai West, New York, New York
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marie K Moss
- Department of Infection Prevention and Control, Mount Sinai Beth Israel, New York, New York
| | - Waleed Javaid
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Harold Rodriguez
- Director of Radiology-Patient Transport at Mount Sinai Beth Israel, New York, New York
| | - Nolan J Kagetsu
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Zelencik S, VanDine A, Campos-Bovee M, Goitia K, Cela V, Walblay K, Galanto D, Pacilli M, Kim DY, Black SR. Health Care Personnel Exposure Risk Assessment and Management During a Mpox Outbreak in Chicago, Illinois, 17 May to 8 July 2022. J Infect Dis 2024; 229:S207-S212. [PMID: 38019754 DOI: 10.1093/infdis/jiad531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
This report summarizes risk assessment interviews and follow-up with health care personnel (HCP) after exposure to patients with mpox disease during 17 May to 8 July 2022. HCP-case interactions were assessed using a standard questionnaire to categorize the risk associated with patient encounters. We assessed 150 interactions among 142 HCP and 30 cases. Four (2.7%) interactions were defined as high risk, 5 (3.3%) intermediate, 107 (71.3%) low, and 31 (20.7%) no risk. High and intermediate exposures were offered postexposure prophylaxis; 4 accepted. No documented mpox transmission after exposure was identified. These findings suggest transmission risk in health care settings during routine patient care is low.
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Affiliation(s)
- Shane Zelencik
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Alison VanDine
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | | | - Valbona Cela
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Kelly Walblay
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Daniel Galanto
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | - Do Young Kim
- Chicago Department of Public Health, Chicago, Illinois, USA
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McLean J, Gunaratne S, Zucker J. Update on Mpox: What the Primary Care Clinician Should Know. Med Clin North Am 2024; 108:355-371. [PMID: 38331485 PMCID: PMC10853636 DOI: 10.1016/j.mcna.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Mpox is a viral infection, which primarily caused sporadic outbreaks in West and Central Africa until causing a global epidemic in 2022. The disease has disproportionately affected people with human immunodeficiency virus and men who have sex with men. Transmission is through close physical contact, including sexual contact. Infection presents with a characteristic rash, with frequent anogenital involvement-polymerase chain reaction of skin lesions is diagnostic. Vaccination is available for primary prevention and postexposure prophylaxis. Treatment consists of supportive care, with antiviral medications available via clinical trials and/or for patients with severe disease.
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Affiliation(s)
- Jacob McLean
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA.
| | - Shauna Gunaratne
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
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Wetsch WA, Heger E, Drinhaus H, Böttiger BW, Overbeek R, Lehmann C, Fätkenheuer G, Jung N, Fischer J, Kneifel J, Zweigner J, Klein F, Wieland U. Lack of monkeypox virus (MPXV) transmission despite occupational exposure of a large number of health care workers. J Med Virol 2024; 96:e29353. [PMID: 38178611 DOI: 10.1002/jmv.29353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Wolfgang A Wetsch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Eva Heger
- Institute of Virology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hendrik Drinhaus
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Remco Overbeek
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, German Center for Infection Research Partner Side Köln-Bonn, University of Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, German Center for Infection Research Partner Side Köln-Bonn, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, German Center for Infection Research Partner Side Köln-Bonn, University of Cologne, Cologne, Germany
| | - Julia Fischer
- Department I of Internal Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, German Center for Infection Research Partner Side Köln-Bonn, University of Cologne, Cologne, Germany
| | - Jens Kneifel
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Janine Zweigner
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Florian Klein
- Institute of Virology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Ulrike Wieland
- Institute of Virology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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Mrosik S, Rasokat H, Fabri M, Bopp L. [Human monkeypox (Mpox)]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:40-47. [PMID: 38063873 DOI: 10.1007/s00105-023-05268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/12/2024]
Abstract
Until recently, human monkeypox (Mpox) were rarely observed outside of Africa, where the Mpox virus (MPXV) is endemic in some regions. In early May 2022, a global Mpox outbreak occurred. Crucial to this outbreak was human-to-human transmission during sexual activity. In particular, young men who have sex with men (MSM) became ill. In July 2022, this Mpox epidemic was declared a public health emergency of international concern by the World Health Organization. As of 26 September 2023, 90,618 confirmed cases of Mpox have been reported worldwide, with Germany accounting for around 3700 cases. The strongest increase in incidence occurred from May to mid-August 2022; since then, the number of cases has declined significantly as a result of intensive prevention efforts (education, vaccination). Currently, there are only sporadic, smaller outbreaks-in Germany (Berlin) most recently in August 2023. Despite the current calm epidemiological situation worldwide, isolated cases must therefore still be expected in Germany. The clinical picture of the "new" clade IIb-associated Mpox variant, which is mostly transmitted sexually from person to person, differs markedly from that of the "classical" Mpox (clades I and IIa), which, apart from rapidly breaking human infection chains, essentially occur as a zoonosis.
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Affiliation(s)
- Sebastian Mrosik
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Heinrich Rasokat
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Mario Fabri
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Luisa Bopp
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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8
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Decousser JW, Romano-Bertrand S, Aho Glele LS, Baron R, Carre Y, Cassier P, Dananche C, Depaix-Champagnac F, Fournier S, Racaud J, Rogues AM, Tamames C, Keita-Perse O, Parneix P, Lavigne T. Healthcare worker protection against mpox contamination: position paper of the French Society for Hospital Hygiene. J Hosp Infect 2023; 140:156-164. [PMID: 37562588 DOI: 10.1016/j.jhin.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
In the context of the recent re-emergence of mpox worldwide, the French Society for Hospital Hygiene (SF2H) performed a literature review of the transmission paths and proposed specific recommendations for healthcare workers (HCWs) caring for patients with suspected or confirmed MPXV. In developed countries, the risk of contamination among HCWs in healthcare facilities seemed to be very low, limited to contamination through needle stick injuries. Two additional contamination cases were reported and not fully explained. Beyond healthcare settings, the analysis of the literature highlighted (i) a main contamination route during sexual intercourse, mainly among men who have sex with men, and (ii) a very low secondary attack rate in other contexts, such as schools or jails. Numerous studies have reported molecular or virus identification on surfaces or in the air surrounding patients, without any association with the low secondary case incidence; moreover, the minimum infectious dose through air or mucosal exposure is still unknown. Owing to the lack of evidence of MPXV respiratory transmission in the healthcare setting, the SF2H recommends the implementation of standard and contact precautions combined with medical/surgical mask use. Owing to the lack of evidence of transcutaneous contamination, the SF2H recommends the use of gloves only if contact with cutaneous lesions or mucous membranes occurs. Regarding the risk of contamination from the environment in healthcare facilities, additional studies must be conducted to investigate this.
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Affiliation(s)
- J-W Decousser
- Equipe Opérationnelle d'Hygiène, Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris, UR DYNAMYC 7380, Faculté de Santé, Univ Paris-Est Créteil (UPEC), Enva, USC ANSES, Créteil, France.
| | - S Romano-Bertrand
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, Hospital Hygiene and Infection Control Department, University Hospital of Montpellier, Montpellier, France
| | - L S Aho Glele
- Epidémiologie et hygiène hospitalière, Centre Hospitalo-Universitaire de Dijon, hôpital d'enfants, Dijon, France
| | - R Baron
- Service Hygiène Hospitalière, Pôle Recherche et Santè Publique, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Y Carre
- CHU de Bordeaux, Pôle de Santé Publique, Infection Control Unit, Bordeaux, France
| | - P Cassier
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, Institut des Agents Infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - C Dananche
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, Service Hygiène, épidémiologie, infectiovigilance et prévention Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | | | - S Fournier
- Service Prévention du risque infectieux, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Racaud
- Service de lutte des infections nosocomiales, Centre Hospitalier Alpes-Leman, Contamine-sur-Arve, France
| | - A-M Rogues
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, CHU Bordeaux, Hygiene Hospitalière, Bordeaux, France
| | - C Tamames
- Service de Prévention et contrôle de l'infection, site Pitié Salpêtrière, Paris, France
| | - O Keita-Perse
- Service d'Epidémiologie et d'Hygiène Hospitalière, Centre Hospitalier Princesse Grace, Monaco
| | - P Parneix
- Nouvelle Aquitaine Healthcare-Associated Infection Control Centre, Bordeaux University Hospital, Bordeaux, France
| | - T Lavigne
- Service d'Hygiène Hospitalière, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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9
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Safir A, Safir M, Henig O, Nahari M, Halutz O, Levytskyi K, Mizrahi M, Yakubovsky M, Adler A, Ben-Ami R, Sprecher E, Dekel M. Nosocomial transmission of MPOX virus to health care workers -an emerging occupational hazard: A case report and review of the literature. Am J Infect Control 2023; 51:1072-1076. [PMID: 36736902 PMCID: PMC9891803 DOI: 10.1016/j.ajic.2023.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/04/2023]
Abstract
We present an unusual case of monkeypox (MPOX) virus transmission to a dermatology resident during examination of affected patients. Viral DNA sequencing led to the identification of the most likely contact. This case, along with a review of all published cases so far, emphasizes the possible hazard of MPOX transmission to health care personnel, even when wearing personal protective equipment. It also emphasizes the need for maintaining high index of suspicion when examining patients with new dermatological lesions and strict compliance with the revised Centers for Disease Control and Prevention recommendations for specimen collection from such patients.
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Affiliation(s)
- Ari Safir
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | - Margarita Safir
- Ophthalmology Department, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Oryan Henig
- Infection Prevention and Control unit, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Meital Nahari
- Infection Prevention and Control unit, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ora Halutz
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Katia Levytskyi
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Michal Mizrahi
- Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Michal Yakubovsky
- Department of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Ronen Ben-Ami
- Department of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Michal Dekel
- Department of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
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10
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Piccolo AJL, Chan J, Cohen GM, Mgbako O, Pitts RA, Postelnicu R, Wallach A, Mukherjee V. Critical Elements of an Mpox Vaccination Model at the Largest Public Health Hospital System in the United States. Vaccines (Basel) 2023; 11:1138. [PMID: 37514954 PMCID: PMC10385008 DOI: 10.3390/vaccines11071138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
In the spring of 2022, mpox spread to non-endemic countries, including the United States. In New York City (NYC), vaccine demand grew as quickly as case counts. With the leadership of the Regional Emerging Special Pathogens Treatment Center (RESPTC) at NYC Health and Hospitals/Bellevue (NYC H+H)-part of the largest public hospital system in the United States-an innovative vaccination model was established that overcame challenges involving health inequities, inadequate access, and lack of vaccine uptake, to successfully administer JYNNEOS vaccines to over 12,000 patients. Transmission has slowed since its peak in August 2022, which has been attributed to successful vaccination campaigns, infection-induced immunity, and behavioral changes among those at highest risk; however, a Centers for Disease Control and Prevention (CDC) assessment released on 4 April 2023 suggests jurisdictions with low vaccination levels (<35%) remain at risk for an mpox resurgence. Here, we summarize the critical aspects of our mpox vaccination model in NYC, which include integration into routine clinical care, prioritization of health equity, and reutilization of COVID-19 vaccination systems, to provide valuable insights for healthcare institutions as we move into the next stage of this ongoing outbreak.
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Affiliation(s)
- Anthony J Lo Piccolo
- Division of Infectious Diseases & Immunology, NYU Langone Health, New York, NY 10016, USA
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
| | - Justin Chan
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Gabriel M Cohen
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Ofole Mgbako
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Robert A Pitts
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Radu Postelnicu
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Andrew Wallach
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Vikramjit Mukherjee
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
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11
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Wang Y, Leng P, Zhou H. Global transmission of monkeypox virus-a potential threat under the COVID-19 pandemic. Front Immunol 2023; 14:1174223. [PMID: 37215147 PMCID: PMC10198437 DOI: 10.3389/fimmu.2023.1174223] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Monkeypox virus (MPXV) cases have increased dramatically worldwide since May 2022. The Atlanta Center for Disease Control and Prevention (Atlanta CDC) had reported a total of 85,922 cases as of February 20th, 2023. During the COVID-19 pandemic, MPXV has emerged as a potential public threat. MPXV transmission and prevalence must be closely monitored. In this comprehensive review, we explained the basic characteristics and transmission routes of MPXV, individuals susceptible to it, as well as highlight the impact of the behavior of men who have sex with men (MSM) and airline traveling on recent outbreaks of MPXV. We also describe the clinical implications, the prevention of MPXV, and clinical measures of viral detection.
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Teo CT, Wu JS, Chan K, Ng SWB, Somani J, Loh W. What does the anesthesiologist need to know about monkeypox? Can J Anaesth 2023; 70:893-900. [PMID: 36899136 PMCID: PMC10005856 DOI: 10.1007/s12630-023-02441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 03/12/2023] Open
Abstract
PURPOSE Monkeypox (or "mpox" as preferred by the World Health Organization) is an emerging infectious disease with sustained global transmission occurring outside of West Africa and the Democratic Republic of Congo. The recent 2022 mpox outbreak has involved widespread atypical presentations. Infected patients requiring surgery can increase the exposure of health care professionals and other patients to the virus. As it is a relatively new infectious disease internationally, there is less familiarity in managing this risk, especially in the surgical and anesthesia setting. This paper aims to provide information about mpox and how to manage suspected or confirmed cases. SOURCE Various authorities such as the World Health Organization, Infection Prevention and Control Canada, Public Health Agency of Canada, the Centers for Disease Control and Prevention (USA), and the National Centre for Infectious Diseases (Singapore) have recommended that public health and hospital systems prepare to recognize, isolate, and care for suspected and confirmed cases appropriately, as well as manage any possible exposure of staff and patients. PRINCIPAL FINDINGS Local authorities and hospitals should set up protocols for health care providers (HCPs) to minimize nosocomial transmission and risk to HCPs. Antivirals used in patients with more severe disease may cause renal or hepatic impairment and thus anesthetic drug pharmacology. Anesthesiologists and surgeons should be able to recognize mpox, and work with local infection control and epidemiologic programs to familiarize themselves with relevant infection prevention guidelines. CONCLUSION Essential measures include clear protocols for transferring and managing surgical patients who are suspected or confirmed to be infected with the virus. Care in use of personal protective equipment and handling contaminated material is necessary to prevent inadvertent exposure. Risk stratification after exposure should be done to determine need for post-exposure prophylaxis for staff.
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Affiliation(s)
- Chao Tong Teo
- Department of Anesthesia, National University Hospital, Singapore, Singapore.
- Department of Anesthesia, National University Hospital, Level 3, Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Jiawei Sean Wu
- Division of Infectious Diseases, National University Hospital, Singapore, Singapore
| | - Karen Chan
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Su Wei Bryan Ng
- Department of Anesthesia, National University Hospital, Singapore, Singapore
| | - Jyoti Somani
- Division of Infectious Diseases, National University Hospital, Singapore, Singapore
- National University Hospital, Singapore, Singapore
| | - Will Loh
- Department of Anesthesia, National University Hospital, Singapore, Singapore
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13
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Pinto P, Costa MA, Gonçalves MFM, Rodrigues AG, Lisboa C. Mpox Person-to-Person Transmission-Where Have We Got So Far? A Systematic Review. Viruses 2023; 15:v15051074. [PMID: 37243160 DOI: 10.3390/v15051074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
The recent multi-country outbreak of Mpox (Monkeypox disease) constituted a public health emergency. Although animal-to-human transmission is known to be the primary way of transmission, an increasing number of cases transmitted by person-to-person contact have been reported. During the recent Mpox outbreak sexual or intimate contact has been considered the most important way of transmission. However, other routes of transmission must not be ignored. The knowledge of how the Monkeypox Virus (MPXV) spreads is crucial to implement adequate measures to contain the spread of the disease. Therefore, this systematic review aimed to collect scientific data published concerning other implicated sources of infection beyond sexual interaction, such as the involvement of respiratory particles, contact with contaminated surfaces and skin-to-skin contact. The current study was performed using the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Publications analyzing contacts of Mpox index cases and their outcome after contact were included. A total of 7319 person-to-person contacts were surveyed and 273 of them became positive cases. Positive secondary transmission of MPXV was verified after contact with people cohabiting in the same household, with family members, with healthcare workers, or within healthcare facilities, and sexual contact or contact with contaminated surfaces. Using the same cup, sharing the same dishes, and sleeping in the same room or bed were also positively associated with transmission. Five studies showed no evidence of transmission despite contact with surfaces, skin-to-skin contact, or through airway particles within healthcare facilities where containment measures were taken. These records support the case for person-to-person transmission and suggest that other types of contact beyond sexual contact pose a significant risk of acquiring the infection. Further investigation is crucial to elucidate MPXV transmission dynamics, and to implement adequate measures to contain the spread of the infection.
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Affiliation(s)
- Pedro Pinto
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Miguel Alves Costa
- Department of Dermatology and Venereology, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Porto, Portugal
| | - Micael F M Gonçalves
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Acácio Gonçalves Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Centre for Health Technology and Services Research/Rede de Investigação em Saúde (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Carmen Lisboa
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Centre for Health Technology and Services Research/Rede de Investigação em Saúde (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Dermatology and Venereology, University Hospital Centre of São João, 4200-319 Porto, Portugal
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14
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Beeson A, Styczynski A, Hutson CL, Whitehill F, Angelo KM, Minhaj FS, Morgan C, Ciampaglio K, Reynolds MG, McCollum AM, Guagliardo SAJ. Mpox respiratory transmission: the state of the evidence. THE LANCET. MICROBE 2023; 4:e277-e283. [PMID: 36898398 PMCID: PMC9991082 DOI: 10.1016/s2666-5247(23)00034-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/09/2023]
Abstract
The relative contribution of the respiratory route to transmission of mpox (formerly known as monkeypox) is unclear. We review the evidence for respiratory transmission of monkeypox virus (MPXV), examining key works from animal models, human outbreaks and case reports, and environmental studies. Laboratory experiments have initiated MPXV infection in animals via respiratory routes. Some animal-to-animal respiratory transmission has been shown in controlled studies, and environmental sampling studies have detected airborne MPXV. Reports from real-life outbreaks demonstrate that transmission is associated with close contact, and although it is difficult to infer the route of MPXV acquisition in individual case reports, so far respiratory transmission has not been specifically implicated. Based on the available evidence, the likelihood of human-to-human MPXV respiratory transmission appears to be low; however, studies should continue to assess this possibility.
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Affiliation(s)
- Amy Beeson
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ashley Styczynski
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina L Hutson
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Florence Whitehill
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina M Angelo
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Faisal S Minhaj
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clint Morgan
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kaitlyn Ciampaglio
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary G Reynolds
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrea M McCollum
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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Szkiela M, Wiszniewska M, Lipińska-Ojrzanowska A. Monkeypox (Mpox) and Occupational Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5087. [PMID: 36981996 PMCID: PMC10049490 DOI: 10.3390/ijerph20065087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Recently, there has been a significant increase in interest in biological risk factors, which are increasingly perceived as an important problem in occupational medicine. Exposure to harmful biological agents may be associated with the deliberate use of microorganisms in the work process or with unintentional exposure resulting from the presence of biological risk factors in the work environment. Monkeypox (mpox) is a viral infectious disease that may afflict humans and non-human primates. Since May 2022, mpox has occurred in Europe, North and South America, Asia, Australia and Africa, with some 76,713 cases (75,822 in locations that have not historically reported mpox) and 29 total deaths reported to date. Between 2018 and 2021, several cases of mpox were reported worldwide in high-income countries (Israel, Singapore, United Kingdom, United States: Texas and Maryland). We conducted a literature search in PubMed and Google Scholar web databases for occupational exposure to mpox. The highest work-related risk for mpox transmission has been noted among healthcare professionals, people working with animals, and sex workers. There is general agreement that a paramount issue to avoid transmission of infection in occupational settings is an appropriate decontamination of often-touched surfaces and usage of appropriate personal protective equipment by the workers at high risk of infection. The group that should especially protect themselves and be educated in the field of early symptoms of the disease and prevention are dentists, who are often the first to detect the symptoms of the disease on the oral mucosa.
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16
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Kumar AM, Chen ST, Merola JF, Mostaghimi A, Zhou XA, Fett N, Smith GP, Saavedra AP, Noe MH, Rosenbach M. Monkeypox outbreak, vaccination, and treatment implications for the dermatologic patient: Review and interim guidance from the Medical Dermatology Society. J Am Acad Dermatol 2023; 88:623-631. [PMID: 36528266 PMCID: PMC9749826 DOI: 10.1016/j.jaad.2022.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/15/2022]
Abstract
Rapid human-to-human transmission of monkeypox has created a public health emergency requiring prompt, multidisciplinary attention. Dermatologists are at the forefront of diagnosis due to the disease-defining skin lesions. Moreover, patients with pre-existing skin disease and those who are on immunosuppressive medications for skin disease may be at increased risk of severe infection. In this review, a panel of authors with expertise in complex medical dermatology and managing patients on immunosuppression reviews the literature and provides initial guidance for diagnosis and management in dermatology practices. Though there are knowledge gaps due to a lack of controlled studies, we support use of replication-deficit vaccines in all dermatologic patients who meet qualifying risk or exposure criteria. We offer strategies to optimize vaccine efficacy in patients with immunosuppression. We discuss alternative post-exposure treatments and their safety profiles. Finally, we outline supportive care recommendations for cutaneous manifestations of monkeypox. Large scale epidemiologic investigations and clinical trials will ultimately revise and extend our guidance.
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Affiliation(s)
- Anusha M Kumar
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xiaolong A Zhou
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nicole Fett
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Gideon P Smith
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Arturo P Saavedra
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
| | - Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Misha Rosenbach
- Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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17
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Ford ES, Papanicolaou GA, Dadwal SS, Pergam S, Spallone A. Frequently Asked Questions about Mpox (Formerly Monkeypox Disease) for Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T Cell Recipients from the American Society for Transplantation and Cellular Therapy. Transplant Cell Ther 2023; 29:289-292. [PMID: 36746374 PMCID: PMC9899127 DOI: 10.1016/j.jtct.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Emily S Ford
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington; Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | | | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California
| | - Steve Pergam
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington; Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Amy Spallone
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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18
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Alarcón J, Kim M, Balanji N, Davis A, Mata F, Karan A, Finn LE, Guerrero A, Walters M, Terashita D, Balter SE. Occupational Monkeypox Virus Transmission to Healthcare Worker, California, USA, 2022. Emerg Infect Dis 2023; 29:435-437. [PMID: 36469326 PMCID: PMC9881796 DOI: 10.3201/eid2902.221750] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Risk for transmission of monkeypox virus (MPXV) (clade IIb) to healthcare workers (HCWs) is low. Although many cases have been reported among HCW, only a few have been occupationally acquired. We report a case of non-needle stick MPXV transmission to an HCW in the United States.
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19
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Mitjà O, Ogoina D, Titanji BK, Galvan C, Muyembe JJ, Marks M, Orkin CM. Monkeypox. Lancet 2023; 401:60-74. [PMID: 36403582 PMCID: PMC9671644 DOI: 10.1016/s0140-6736(22)02075-x] [Citation(s) in RCA: 120] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
Abstract
Monkeypox is a zoonotic illness caused by the monkeypox virus, an Orthopoxvirus in the same genus as the variola, vaccinia, and cowpox viruses. Since the detection of the first human case in the Democratic Republic of the Congo in 1970, the disease has caused sporadic infections and outbreaks, mainly restricted to some countries in west and central Africa. In July, 2022, WHO declared monkeypox a Public Health Emergency of International Concern, on account of the unprecedented global spread of the disease outside previously endemic countries in Africa and the need for global solidarity to address this previously neglected disease. The 2022 outbreak has been primarily associated with close intimate contact (including sexual activity) and most cases have been diagnosed among men who have sex with men, who often present with novel epidemiological and clinical characteristics. In the 2022 outbreak, the incubation period ranges from 7 days to 10 days and most patients present with a systemic illness that includes fever and myalgia and a characteristic rash, with papules that evolve to vesicles, pustules, and crusts in the genital, anal, or oral regions and often involve the mucosa. Complications that require medical treatment (eg, antiviral therapy, antibacterials, and pain control) occur in up to 40% of patients and include rectal pain, odynophagia, penile oedema, and skin and anorectal abscesses. Most patients have a self-limited illness; between 1% and 13% require hospital admission (for treatment or isolation), and the case-fatality rate is less than 0·1%. A diagnosis can be made through the presence of Orthopoxvirus DNA in PCRs from lesion swabs or body fluids. Patients with severe manifestations and people at risk of severe disease (eg, immunosuppressed people) could benefit from antiviral treatment (eg, tecovirimat). The current strategy for post-exposure prophylaxis or pre-exposure prophylaxis for people at high risk is vaccination with the non-replicating modified vaccinia Ankara. Antiviral treatment and vaccines are not yet available in endemic countries in Africa.
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Affiliation(s)
- Oriol Mitjà
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections section, Hospital Universitari Germans Trías i Pujol, Badalona, Spain; Fight Infectious Diseases Foundation, Badalona, Spain; School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
| | - Dimie Ogoina
- Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University and Niger Delta University Teaching Hospital, Bayelsa, Nigeria
| | - Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Medecins du Cameroun (Medcamer), Yaoundé, Cameroon
| | | | - Jean-Jacques Muyembe
- Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | - Michael Marks
- London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK; Division of Infection and Immunology, University College London, London, UK
| | - Chloe M Orkin
- Centre for Immunobiology, Blizard Institute, Queen Mary University, London, UK
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20
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Sheek-Hussein M, Alsuwaidi AR, Davies EA, Abu-Zidan FM. Monkeypox: A current emergency global health threat. Turk J Emerg Med 2023; 23:5-16. [PMID: 36818951 PMCID: PMC9930390 DOI: 10.4103/2452-2473.366487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 02/24/2023] Open
Abstract
Monkeypox (MPXV) is an emerging zoonotic disease carrying a global health threat. Using a multi-disciplinary approach, we review the current MPXV virus infection outbreak including virology, prevention, clinical presentation, and disaster management. MPXV is caused by a double-stranded deoxyribonucleic acid virus. Despite its clinical similarities with smallpox, it is less severe with low mortality. Human-to-human transmission occurs through prolonged direct or close contact, or through blood, body fluids, or mucosal lesions. Risk groups include frontline health workers who care for MPXV patients, household members of an infected patient, and men who have sex with men. Skin lesions are usually, but not always, at the same stage. They may affect the face followed by the distal extremities with fewer lesions on the trunk (centrifugal distribution). Lesions may involve the mouth, genitalia, conjunctiva, and rectum. The majority of cases are mild. Nevertheless, the disease may have long-term effects on the skin, the neurological system, and the eye. Vaccination against MPXV is available but meanwhile should be limited to those who are at high risk. Those vaccinated against smallpox (usually older than 40 years) might be immune against MPXV. Infectious diseases are without borders. If proper action is not taken, there is considerable risk that MPXV will be entrenched worldwide. Our world has a delicate balance between animals, environment, and humans reflecting the need for a "one globe, one health approach" to address this risk. Following the principles of disaster management and using the lessons we have learned from the COVID-19 pandemic will reduce the impact of the MPXV outbreak.
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Affiliation(s)
- Mohamud Sheek-Hussein
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Emma A. Davies
- Department of Virology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fikri M. Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates,Address for correspondence: Prof. Fikri M. Abu-Zidan, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates. E-mail:
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21
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Commentary. Ann Emerg Med 2023; 81:34-35. [PMID: 36543484 DOI: 10.1016/j.annemergmed.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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22
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Castanares GG, D'Assumpcao C, Fang M, McPheeters R, Heidari A. Primary Mpox and Secondary Syphilis in an HIV Patient: A Community Hospital Experience. J Investig Med High Impact Case Rep 2023; 11:23247096231165739. [PMID: 37052123 PMCID: PMC10102933 DOI: 10.1177/23247096231165739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Mpox was an emerging outbreak in California in 2022, primarily in major metropolitan areas, as part of the global mpox outbreak declared by World Health Organization in July 2022. Community hospitals outside of major metropolitan areas have seen fewer cases to date, so they may be less equipped to diagnose and treat patients with mpox. They may have limited public health resources commensurate with the area's population density. Mpox may also be superimposed on ongoing local outbreaks of other sexually transmitted infections. We present a case of a person with HIV who contracted mpox and also developed secondary syphilis. Early detection can be beneficial for prompt treatment, decreased burden of disease for the individual, and prevention of further spread of the infection.
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Abstract
This article summarizes the ACP/Annals virtual forum held on 11 October 2022.
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Affiliation(s)
| | - Darilyn V Moyer
- Executive Vice President and Chief Executive Officer, American College of Physicians
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24
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Mendoza R, Petras JK, Jenkins P, Gorensek MJ, Mableson S, Lee PA, Carpenter A, Jones H, de Perio MA, Chisty Z, Brueck S, Rao AK, Salzer JS, Stanek D, Blackmore C. Monkeypox Virus Infection Resulting from an Occupational Needlestick - Florida, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1348-1349. [PMID: 36264845 PMCID: PMC9590296 DOI: 10.15585/mmwr.mm7142e2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In August 2022, the Florida Department of Health notified CDC of a nurse who acquired monkeypox through an occupational exposure while providing care to a patient with monkeypox. To date, occupationally acquired Monkeypox virus (MPXV) infections in health care personnel (HCP) have been rarely reported during the 2022 multinational outbreak (1,2). This report describes the first reported U.S. case and recommends approaches for preventing occupationally acquired MPXV infections in HCP.
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