Cargando…

Mpox exposure on a congregate inpatient psychiatry unit: Description of the investigation and outcomes—New York City, 2022

Background: In May 2022, New York City (NYC) experienced a large outbreak of human mpox (clade IIb). Data on mpox transmission following exposure in healthcare facilities in nonendemic settings are limited. Because mpox was previously not seen in NYC, our healthcare staff may not always recognize a...

Descripción completa

Detalles Bibliográficos
Autores principales: Malik, Waleed, Chan, Justin, Dosovitz, Simon, Gilmore, Clyde, Cosico, Jeanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10594355/
http://dx.doi.org/10.1017/ash.2023.315
_version_ 1785124631294771200
author Malik, Waleed
Chan, Justin
Dosovitz, Simon
Gilmore, Clyde
Cosico, Jeanne
author_facet Malik, Waleed
Chan, Justin
Dosovitz, Simon
Gilmore, Clyde
Cosico, Jeanne
author_sort Malik, Waleed
collection PubMed
description Background: In May 2022, New York City (NYC) experienced a large outbreak of human mpox (clade IIb). Data on mpox transmission following exposure in healthcare facilities in nonendemic settings are limited. Because mpox was previously not seen in NYC, our healthcare staff may not always recognize a suspected case and therefore may neglect to implement timely infection prevention and control measures, leading to infectious exposures. The risk of transmission from unrecognized mpox may be higher in inpatient psychiatric units where direct physical contact is more common in the setting of common spaces for patients. In July 2022, a patient was admitted to NYC Health + Hospitals–Bellevue (Bellevue) psychiatry with signs and symptoms of mpox that were not recognized for 4 days, at which point the patient was tested for mpox and was isolated. We describe the investigation of staff and patients exposed during the 4 days prior to diagnosis and isolation of the index patient, and we report on the outcome mpox infection among those exposed. Methods: This study was a retrospective chart review of adult patients admitted to and staff working on an inpatient psychiatric unit where the patient with mpox was admitted to Bellevue, the largest municipal hospital in NYC. Each individual was classified regarding degree of exposure, based on criteria from the CDC, and was offered postexposure mpox vaccination where indicated. We describe the nature of contact with the patient for those with high-risk exposures. The outcome of interest was development of mpox infection during 21 days after last exposure. Results: In total, 29 patients and 84 staff members were identified to have been on the psychiatric unit prior to isolation of the index case of mpox. All exposed individuals were monitored for signs and symptoms of mpox for 21 days after last exposure. The exposed and unexposed patients were kept apart in the psychiatric unit. All patients who had contact were classified as having a low-to-intermediate risk exposure. Among 23 staff members exposed, 8 had high-risk exposures, 4 had intermediate-risk exposures, and 11 had low-risk exposures. Those with high-risk exposures were offered Jynneos as postexposure vaccination, but they declined. None of the exposed staff or patients developed mpox during the follow-up period. Conclusions: Mpox transmission was not observed despite several exposures in a congregate psychiatry unit. Given limited data, further studies are needed to better understand transmission risk in congregate healthcare settings. Disclosures: None
format Online
Article
Text
id pubmed-10594355
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cambridge University Press
record_format MEDLINE/PubMed
spelling pubmed-105943552023-10-25 Mpox exposure on a congregate inpatient psychiatry unit: Description of the investigation and outcomes—New York City, 2022 Malik, Waleed Chan, Justin Dosovitz, Simon Gilmore, Clyde Cosico, Jeanne Antimicrob Steward Healthc Epidemiol Emerging Pathogens Background: In May 2022, New York City (NYC) experienced a large outbreak of human mpox (clade IIb). Data on mpox transmission following exposure in healthcare facilities in nonendemic settings are limited. Because mpox was previously not seen in NYC, our healthcare staff may not always recognize a suspected case and therefore may neglect to implement timely infection prevention and control measures, leading to infectious exposures. The risk of transmission from unrecognized mpox may be higher in inpatient psychiatric units where direct physical contact is more common in the setting of common spaces for patients. In July 2022, a patient was admitted to NYC Health + Hospitals–Bellevue (Bellevue) psychiatry with signs and symptoms of mpox that were not recognized for 4 days, at which point the patient was tested for mpox and was isolated. We describe the investigation of staff and patients exposed during the 4 days prior to diagnosis and isolation of the index patient, and we report on the outcome mpox infection among those exposed. Methods: This study was a retrospective chart review of adult patients admitted to and staff working on an inpatient psychiatric unit where the patient with mpox was admitted to Bellevue, the largest municipal hospital in NYC. Each individual was classified regarding degree of exposure, based on criteria from the CDC, and was offered postexposure mpox vaccination where indicated. We describe the nature of contact with the patient for those with high-risk exposures. The outcome of interest was development of mpox infection during 21 days after last exposure. Results: In total, 29 patients and 84 staff members were identified to have been on the psychiatric unit prior to isolation of the index case of mpox. All exposed individuals were monitored for signs and symptoms of mpox for 21 days after last exposure. The exposed and unexposed patients were kept apart in the psychiatric unit. All patients who had contact were classified as having a low-to-intermediate risk exposure. Among 23 staff members exposed, 8 had high-risk exposures, 4 had intermediate-risk exposures, and 11 had low-risk exposures. Those with high-risk exposures were offered Jynneos as postexposure vaccination, but they declined. None of the exposed staff or patients developed mpox during the follow-up period. Conclusions: Mpox transmission was not observed despite several exposures in a congregate psychiatry unit. Given limited data, further studies are needed to better understand transmission risk in congregate healthcare settings. Disclosures: None Cambridge University Press 2023-09-29 /pmc/articles/PMC10594355/ http://dx.doi.org/10.1017/ash.2023.315 Text en © The Society for Healthcare Epidemiology of America 2023 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Emerging Pathogens
Malik, Waleed
Chan, Justin
Dosovitz, Simon
Gilmore, Clyde
Cosico, Jeanne
Mpox exposure on a congregate inpatient psychiatry unit: Description of the investigation and outcomes—New York City, 2022
title Mpox exposure on a congregate inpatient psychiatry unit: Description of the investigation and outcomes—New York City, 2022
title_full Mpox exposure on a congregate inpatient psychiatry unit: Description of the investigation and outcomes—New York City, 2022
title_fullStr Mpox exposure on a congregate inpatient psychiatry unit: Description of the investigation and outcomes—New York City, 2022
title_full_unstemmed Mpox exposure on a congregate inpatient psychiatry unit: Description of the investigation and outcomes—New York City, 2022
title_short Mpox exposure on a congregate inpatient psychiatry unit: Description of the investigation and outcomes—New York City, 2022
title_sort mpox exposure on a congregate inpatient psychiatry unit: description of the investigation and outcomes—new york city, 2022
topic Emerging Pathogens
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10594355/
http://dx.doi.org/10.1017/ash.2023.315
work_keys_str_mv AT malikwaleed mpoxexposureonacongregateinpatientpsychiatryunitdescriptionoftheinvestigationandoutcomesnewyorkcity2022
AT chanjustin mpoxexposureonacongregateinpatientpsychiatryunitdescriptionoftheinvestigationandoutcomesnewyorkcity2022
AT dosovitzsimon mpoxexposureonacongregateinpatientpsychiatryunitdescriptionoftheinvestigationandoutcomesnewyorkcity2022
AT gilmoreclyde mpoxexposureonacongregateinpatientpsychiatryunitdescriptionoftheinvestigationandoutcomesnewyorkcity2022
AT cosicojeanne mpoxexposureonacongregateinpatientpsychiatryunitdescriptionoftheinvestigationandoutcomesnewyorkcity2022