October 20, 2022

Report Describes First U.S. Case of Occupationally Acquired Monkeypox

The first reported case of occupationally acquired Monkeypox virus (MPXV) in the U.S resulted from a needlestick, according to a new report published this week by CDC. An emergency department nurse in Florida was exposed to MPXV in July while obtaining swabs from a patient with suspected monkeypox. The nurse, who was wearing gloves, used a needle to create an opening in a vesicular lesion to facilitate direct contact of the swab with the fluid in the lesion, the CDC report explains. The needlestick occurred when the nurse was recapping the used needle prior to disposal, causing a break in the skin of the nurse’s index finger. The wound was washed with soap and water and drenched with Betadine antiseptic solution. Swabs from the patient’s lesion later tested positive for nonvariola Orthopoxvirus and the Clade II variant of MPXV. The nurse then received the first dose of a two-dose JYNNEOS vaccination series as postexposure prophylaxis and continued to work while asymptomatic wearing a surgical mask and medical gloves.

A single lesion formed at the puncture site 10 days after the nurse was exposed via needlestick. Swabs from the nurse’s lesion tested positive for Orthopoxvirus and MPXV. The nurse isolated until after the lesion had crusted over, the scab had fallen off, and a new layer of skin formed beneath it, which took 19 days. According to the report, the nurse did not develop additional lesions or any other symptoms.

CDC’s report urges healthcare workers against using sharp instruments for monkeypox testing due to the risk for sharps injuries and stresses that unroofing, opening, or aspirating monkeypox lesions is not necessary.

“Because of the reliability and sensitivity of real-time [polymerase chain reaction] assays used [during the current monkeypox outbreak], vigorous swabbing of the outer surface of a lesion is adequate to collect enough viral material for testing and will minimize the potential for needlesticks,” the report states.

More information is available in CDC’s report. Guidance for collecting and handling specimens for monkeypox testing can be found elsewhere on the agency’s website.