Key Takeaways

  • The risk of transmission of monkeypox in healthcare settings has important implications for infection prevention and control strategies, and for management of exposures
  • A review of articles published in the medical literature over the past two decades revealed only a single reported case of transmission of monkeypox following exposure in healthcare settings outside endemic regions

BOSTON – With the COVID-19 pandemic still ongoing, another public health threat has emerged in the form of an outbreak of monkeypox in multiple countries where the virus is not endemic, or normally present.  

The diagnosis of the first case in the United States associated with this outbreak, on May 18th at Massachusetts General Hospital (MGH), prompted the need better to understand the risk of transmission in healthcare settings, in order to effectively counsel healthcare personnel.

Researchers from MGH reviewed the available literature over the past two decades and found only one documented case of transmission of monkeypox following exposure in healthcare settings outside endemic regions.

“In our study published in Infection Control & Hospital Epidemiology, we searched the literature dating back to 2000 and found 12 studies, outside endemic areas, describing nosocomial—or healthcare-associated—exposure and subsequent management,” says co-author Kimon C. Zachary, MD, Assistant Chief of MGH’s Infection Control Unit and an Assistant Professor of Medicine at Harvard Medical School.

“Although it is reassuring that there was just a single case of a higher risk exposure resulting in transmission to a healthcare worker, the studies used variable definitions of exposures and reported very limited details regarding the nature of the exposures and the personal protective equipment used. Therefore, it is difficult to quantify precisely the risk of transmission under a given set of circumstances.”

Continued evaluations of the experience of healthcare facilities during the current global outbreak may provide additional information that could help guide strategies to prevent transmission, including the use of vaccines for both pre- and post-exposure prophylaxis.

“While the findings support a low risk of nosocomial transmission to date, it will be very important to learn from the experiences of facilities managing patients around the world during the current outbreak, including documented exposures in healthcare settings and any subsequent transmission events,” says co-author Erica S. Shenoy, MD, PhD, Associate Chief of MGH’s Infection Control Unit and an Associate Professor of Medicine at Harvard Medical School.

“These data will be critical to inform definition of exposure, as well as risk stratification and indications for post-exposure prophylaxis."

This work was supported by US Assistant Secretary for Preparedness and Response (grant no. 6 U3REP150548-05-08 to ESS) and department funds (K.Z.).

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.