Accidental needlestick makes Florida nurse first case of occupationally acquire MPX

By Emma Bascom

A Florida nurse has developed monkeypox infection after an accidental needlestick exposure in the first case of occupationally acquired monkeypox during the U.S. outbreak, according to health officials.

The case was published in CDC’s Mortality and Morbidity Weekly Report.

“Employers should ensure that HCP are trained in proper specimen collection methods, follow recommended infection prevention and control precautions for the care of patients with monkeypox, and implement safety practices for managing sharps if they are used during other aspects of patient care,” Rafael Mendoza, MPH, director of the department of epidemiology at the Florida Department of Health in Broward County, and colleagues wrote in the MMWR.

The incident occurred July 12 as the nurse was recapping a needle that had been used to obtain swabs from a patient with suspected monkeypox for disposal. The needle broke through the glove and skin on the nurse’s index finger and caused a small amount of bleeding, according to the report.

As of Oct. 6, of the 326 health care personnel in Florida who have been occupationally exposed to monkeypox patients, this case is the only one in which a health care worker contracted the virus.

The nurse received the first dose of a two-dose vaccination series as postexposure prophylaxis within 15 hours of the incident. They then followed CDC guidance and continued to work while asymptomatic, wearing gloves and a surgical mask, until a skin lesion formed on the 10th day after exposure. Once this appeared, the nurse isolated until the lesion was gone and the skin healed 19 days later.

The authors also noted that monkeypox polymerase chain reaction (PCR) assay testing cycle threshold values from mucosal lesion specimens and swabbed skin “have been very low, indicating that surface swabbing collects sufficient amounts of viral material without a need to unroof lesions.”

“Because of the reliability and sensitivity of real-time PCR assays used 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,” they wrote.

Mendoza and colleagues wrote that, because of the risk for injuries, “CDC advises against unroofing, opening or aspirating monkeypox lesions with sharp instruments” like needles.

“Overall, with routine adherence to standard infection control practices, among U.S. HCP with non-percutaneous exposure to monkeypox patients, the risk for acquiring monkeypox appears to be low,” they wrote.

In the case of exposure, Mendoza and colleagues wrote that personnel “should be evaluated promptly to ensure postexposure recommendations are implemented.”