An investigation into an occupational mpox infection in a California physician found multiple possibilities for transmission, including contact with contaminated surfaces. Investigators from the Centers for Disease Control and Prevention and their partners in California detailed their findings yesterday in a letter in Emerging Infectious Diseases.
They note that many mpox infections have been reported in healthcare workers, but only a few were due to occupational exposure.
The 40-year-old woman's symptoms began in August with muscle aches, fatigue, and headache. Over the next week, she developed small raised lesions along with fever and sore throat, and a swab sample was positive for mpox. She was received a 2-week course of tecovirimat (Tpoxx) and recovered with no complications.
An investigation revealed that she works at two clinics that mainly serve LGBTQ+ patients and those with HIV. The doctor regularly sees patients with mpox, and during those visits, she wears full personal protective equipment (PPE). However, during her incubation she met with two patients with suspected infections, during which she wore a surgical mask and gloves. When she learned that the patients had suspected mpox symptoms, in both instances she left the exam room and donned PPE before swabbing the patients' lesions.
Samples from both patients were positive for mpox. A review of 159 other patients she saw during her incubation period found that three were tested for mpox. One was positive, but the patient's lesions had healed before the exam date.
As part of the investigation, researchers made a site visit to a clinic. They said the doctor's mpox infection could have been acquired through inadvertent contamination during specimen collection, contact with contaminated environmental surfaces in the exam room or bathroom, or skin contamination during glove doffing.