Table 1.

Healthcare-Associated Monkeypox Exposures, Management, and Risk of Transmission in Nonendemic Countries, 2000–2022

Year	Country	Description	Definition of HCP Exposure	Methods to Assess for Monkeypox Infection Following Exposure	Outcomes, Including Risk Assessment, Nosocomial Transmission, and Administration of Postexposure Prophylaxis (PEP)	Reference
2003	United States, Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin	Describes exposure investigation after 3 monkeypox patients identified as part of the 2003 prairie dog outbreak were admitted to hospital	HCP entered 2 m radius of the patient	Symptom monitoring; serology	81 HCP exposed; 57 (70%) participated; 40 of 57 (70%) had ≥ 1 unprotected exposure defined as not using gloves, gown, and either surgical mask or N95 respirator; no symptoms reported; 31 (54%) of 57 reported some history of prior smallpox vaccination; 1 HCP had antiorthopoxvirus IgM detected and had been vaccinated <6 mo prior; no transmissions reported.	Fleischauer et al 8
		Summary of the 2003 prairie dog outbreak with a total of 71 cases (suspected and confirmed), including use of pre-exposure prophylaxis and PEP in HCP	Not provided	Not provided	Details of patient to HCP exposures not provided; among 30 individuals (HCP and non-HCP) in whom smallpox vaccine was administered, 2 HCP received vaccine as part of pre-exposure prophylaxis, and 10 HCP as PEP; no transmissions reported.	Gross 9 MMWR update 10
2018	United Kingdom	Two travel-related cases; case 1 initially presented to general practitioner and later admitted to hospital; case 2 presented to an ED and was admitted to hospital	Different criteria used for case 1 (southwest England) and case 2 (northwest England)	Symptom monitoring; HCP who developed symptoms were directed to phone their designated public health and to stop working until they were assessed by the imported fever service (IFS).	High risk: 5 (5 received PEP); intermediate risk: 125 (84 received PEP); low risk: 158 (0 received PEP); 1 HCP in high-risk category developed infection; HCP described as having changed bedding without respiratory protection during period when monkeypox patient had active lesions prior to isolation; received PEP with attenuated nonreplicating vaccinia vaccine >4 d after exposure	Vaughan et al 4 Vaughan et al 11
2018	Israel	Travel-related case; patient presented to an ED and admitted to hospital	Not provided	No details provided; only that all contacts were followed up for 21 d; no transmission was detected	11 HCP identified as exposed without details; all offered PEP with one HCP vaccinated; no transmissions reported.	Erez et al 12
2019	Singapore	Travel-related case; patient presented to an ED and admitted to hospital	Due to up front suspicion for monkeypox, all HCP were wearing PPE; Ambulance HCP: N95 respirator, gown, gloves, no eye protection; HCP at hospital: N95 respirator, gown, gloves, eye protection); patient placed in AIIR	Symptom monitoring	No HCP were exposed; all asymptomatic; no transmissions; 27 HCP identified, but all with appropriate PPE. 13 Contact tracing of community exposures including 23 “close contacts” within 2 m of the patient for >30 min or had physical contact with patient or surfaces or materials contaminated by secretions (19 individuals who attended the same conference and 4 hotel staff) and 8 lower risk without definition of lower risk; 14 of 22 close contacts (1 of 23 had left the country) received PEP with with live, attenuated vaccinia virus (2 had contraindications and 6 declined)	Kyaw et al 13 Ng et al 14 Yong et al 15
2021	United States, Texas	Travel-related case; patient presented to the ED and admitted to hospital	High, intermediate, low/uncertain, no risk; reports on mostly nonhealthcare exposures; based on CDC published exposure guidelines (since updated)	Symptom monitoring	High: 0; intermediate: 31 non HCF; 3 lab; low/uncertain: 146 non HCF; 43 HCP (care with gown, gloves, eye protection, N95 respirator or equivalent); no transmissions reported.	Rao et al 16
2021	United States, Maryland	Travel-related case; patient presented to the ED and admitted to hospital	High, intermediate, low/uncertain, no risk; reports on mostly nonhealthcare exposures; based on CDC published exposure guidelines (since updated)	Symptom monitoring	40 HCP identified as contacts; none in high-risk group according to contemporary CDC guidelines; no PEP administered; no transmissions reported.	Costello et al 17
2021	United Kingdom	Travel-related case resulting secondary transmission to 2 family members; case 1 presented to an ED and was initially discharged but then admitted to hospital the next day; entire household eventually admitted for observation after case 2 (child) developed symptoms; case 3 (adult member of family) was admitted at the time of symptom onset per above	High (direct contact with skin/mucous membranes; no FFP3 respirator), intermediate (not specified), low (physical contact with appropriate PPE)	Symptom monitoring; low risk: passive surveillance; intermediate or high risk: active surveillance daily	No. of exposed HCP not provided; no transmissions outside the household were reported.	Hobson et al 18

Note. HCP, healthcare personnel; HCF, healthcare facility; AIIR, airborne infection isolation room; PEP, postexposure prophylaxis with vaccine; ED, emergency department; CDC, Centers for Disease Control and Prevention; PPE, personal protective equipment; FFP3 respirator, filtering facepiece respirator class P3.