Providers prepare for monkeypox, discuss infection control practices

Infectious disease experts and health systems across the country are ensuring facilities are well-equipped and prepared to deal with potential monkeypox cases and prevent further outbreaks.

There have been 45 confirmed cases of monkeypox in the U.S. this year and more than 1,300 cases worldwide, according to data from the Centers for Disease Control and Prevention. The U.S. government is waiting on the delivery of 300,000 doses of the monkeypox vaccine Jynneos, and has ordered another 500,000 doses to be delivered later this year, the Associated Press reported Friday.

Hospitals are making their own preparations.

“Recent lessons learned during the COVID-19 pandemic—when conducting case finding, contact tracing, deploying vaccination teams and communicating messages to the public—will be helpful in managing this outbreak,” said Dr. Bernard Camins, medical director for infection prevention at New York City’s Mount Sinai Health System.

Just like other communicable infectious diseases such as measles, chicken pox, influenza and COVID-19, quickly identifying and isolating individuals with monkeypox is essential in slowing or stopping the disease’s transmission, Camins said. Providers should screen patients for symptoms such as fevers, rashes, swollen lymph nodes and skin lesions as well as possible exposure to cases of monkeypox and their travel history, he said.

Monkeypox seems to be most readily transmitted by large droplets, through touching bodily fluids and skin lesions, often for prolonged periods of time, said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. As a result, providers may need to be more diligent about decontamination and cleaning surfaces or any areas where fluid might have spread, she said.

Camins recommended surgical gowns, N-95 masks and gloves are recommended for healthcare workers interacting with patients suspected to have monkeypox.

In the event of a confirmed case, healthcare organizations should communicate with local and state level public health departments to report the case and coordinate testing, treatment and community monitoring, said Graham Snyder, medical director of hospital epidemiology and infection prevention at UPMC. On Friday, the AP reported that doctors have been alerted to watch for cases and states and municipalities had been sent more than 1,400 vaccine courses and more than 110 treatment courses.

Camins said one challenge with monkeypox is its long incubation period, meaning those with high-risk exposure to the illness will likely need to quarantine for 21 days or longer. According to the CDC, the disease is not typically considered contagious until after the incubation period when individuals begin developing symptoms.

Monkeypox is significantly less severe than COVID-19 or smallpox, and rarely deadly, although providers will have to differentiate between those with the disease that need additional clinical care, and those who can safely be sent home to isolate, Foster said.

If exposure to monkeypox is caught early on, individuals may be able to receive a vaccine as a way to boost their immune response and increase their chances of only having a mild case without more extreme symptoms, said Akin Demehin, senior director of quality and patient safety policy at the AHA.

At Atrium Health facilities in the Charlotte, North Carolina area, which are near an international airport and a large metropolitan population, it is likely that providers will encounter a person under investigation for monkeypox or a confirmed case in the near future, said Dr. Katie Passaretti, vice president and enterprise chief epidemiologist at Atrium Health.

However, the health system isn’t anticipating a significant impact on inpatient hospital capacity, as many monkeypox patients just need supportive care to and recover at home, Passaretti said.

Active education and engaging the public will be major components in preventing any large scale transmission in the U.S., she said. Additionally, while a lot of initial monkeypox cases involve men who have sex with men, Passaretti said healthcare entities should avoid generalizing certain populations as being at risk.

“As a society, as healthcare, we need to be very cautious about messaging and make sure we’re aware that this virus can certainly impact anyone and we need to treat everyone respectfully,” Passaretti said.