Monkeypox & COVID-19 Underscore the Importance of Contact Tracing

By Madison Pittman

More than 1600 monkeypox cases were confirmed in at least 35 countries by mid-June, 2022.

And though experts agree that monkeypox – a viral illness that causes fever, swollen lymph nodes, flu-like symptoms and a rash – is unlikely to cause death or disruption of the kind triggered by COVID-19, the illness is underscoring the importance of contact tracing and infection control.

Monkeypox on the Move

Although outbreaks of monkeypox have been noted previously, the virus and associated illness haven’t historically been much of a threat in Europe or the United States. In fact, the first documented case of monkeypox outside of Africa occurred in a three-year-old Wisconsin girl in 2003. The girl had been bitten by her pet prairie dog about a week and a half earlier, and researchers determined that the animal was likely infected by a rodent imported from Ghana while the animals were housed together before being distributed to pet stores and homes. 

The virus primarily spreads via close contact and contact with items that have been contaminated with body fluids or pus from the pox sores. Within two months, approximately 70 other people in the U.S. (including both of the girl’s parents) had suspected or confirmed cases of monkeypox. 

The current monkeypox outbreak was first noticed in Europe, with infection clusters reported in the U.K., Spain, Portugal, and Canada. The first confirmed U.S. case occurred in a Massachusetts man who’d recently traveled to Canada. According to the Boston Herald, viral sequencing revealed that the man was infected with a monkeypox strain similar to one detected in a patient in Portugal (even though the patients had no known contact). 

Monkeypox has since been detected in at least 16 U.S. states and the District of Columbia. 

Contact Tracing Protects Healthcare Workers & Prevents the Spread of Infection

Soon after health experts confirmed the first Massachusetts monkeypox case, they identified and began monitoring 200 people who had been in recent contact with the man. The “vast majority” of the contacts were healthcare workers, according to the Boston Herald

Healthcare workers almost always find themselves on the frontlines of infectious disease outbreaks, as patients seek medical attention for symptoms. Prompt identification of exposed healthcare workers allows public health officials to offer them vaccination or prophylactic medication, if needed and available. Because a monkeypox vaccine is available, Massachusetts General Hospital, which treated the first known case of monkeypox in the U.S. in 2022, offered vaccination to employees who were in close contact with the patient. 

Getting vaccines to those who most wanted and needed prophylaxis was “quite labor intensive,” according to Paul Biddinger, MD, chief preparedness and continuity officer. The Boston Herald reports that hospital officials “separated potentially exposed workers into groups based on risk levels.” 

Technology Can Speed Contract Tracing 

Technology can speed up and facilitate that painstaking process.

The Clean Hands-Safe Hands electronic hand hygiene system has helped dozens of hospitals quickly and effectively conduct contact tracing. The system automatically generates Performance Bubble Plots, a visual display that indicates which providers spent the most time in particular rooms. Staffers who spent a lot of time in contact with the patient are represented by large bubbles; less time equals smaller bubbles. The color of the bubble represents hand hygiene performance: darker green represents better hand hygiene, while red is linked to less-than-ideal hand hygiene.

 A “red” staff member who spent considerable time with a patient with monkeypox could benefit from vaccination. A billing clerk who briefly stepped into a patient’s room to inquire about health insurance coverage probably does not need to undergo monkeypox vaccination, while the nurse who assessed and dressed the patient’s sores may want to consider vaccination. 

Monkeypox doesn’t seem to be nearly as infectious (or potentially deadly) as SARS-CoV-2, the virus that causes COVID-19, so the CDC and WHO have both said that healthcare providers exposed to monkeypox virus do not need to isolate if they do not have symptoms. That’s good news for hospital systems, as they probably won’t need to send home apparently healthy staffers, as they did during the COVID-19 pandemic, to prevent the spread of infection.

If the monkeypox virus mutates into a more virulent strain, though – or another virus threatens the well-being of the world – it may once again become necessary to isolate exposed healthcare workers. Accurate, efficient contact tracing is key to protecting public health. 

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