# Monkeypox in Healthcare Settings: A Narrative Review of Transmission, Exposure, and Protection Among Healthcare Workers

## TL;DR

This paper reviews how healthcare workers are at risk of monkeypox through exposure to infected patients and contaminated materials, and highlights the importance of infection control measures to prevent transmission.

## Contribution

The study provides insights into transmission routes and preventive strategies for monkeypox among healthcare workers based on a narrative review of case reports and series.

## Key findings

- Percutaneous exposure, especially needlestick injuries, is the primary transmission route for monkeypox among healthcare workers.
- Fomite exposure accounts for a significant portion of cases, emphasizing the risk of contaminated surfaces and equipment.
- Post-exposure vaccination and antiviral treatment are effective in preventing monkeypox spread among exposed individuals.

## Abstract

Monkeypox, caused by an Orthopoxvirus, poses a significant occupational risk to healthcare workers due to their frequent contact with infected patients and contaminated materials. This risk is increased by potential lapses in infection control protocols in hospitals, such as a lack of personal protective equipment (PPE), improper hand hygiene, and other issues, making hospitals a key site for occupational transmission of monkeypox. The objective of the study was to evaluate monkeypox transmission among healthcare workers and identify critical preventive strategies. A comprehensive literature search was conducted using PubMed, focusing on case reports and series published between 2000 and 2024. Eight studies comprising seven case reports and one case series, documenting a total of nine patients, were selected based on predefined inclusion criteria. Data regarding transmission routes, risk factors, and preventive measures were extracted and analyzed.

The primary mode of monkeypox transmission among healthcare workers was percutaneous exposure, notably from needlestick injuries during the care of patients with active lesions. Fomite exposure accounted for 22.22% (2) of cases, highlighting the risk posed by contaminated surfaces and medical equipment. Respiratory transmission was suspected in some cases, though conclusive evidence remains limited. Key risk factors included inadequate use of PPE and breaches in infection control protocols. Post-exposure vaccination was administered to 33.33% (3) of patients, and post-exposure medication was given to 66.66% (6) of patients.

Although respiratory transmission is not evident, asymptomatic or mildly symptomatic individuals may contribute to disease transmission. This highlights the need for improved surveillance and enhanced infection control protocols, including PPE utilization, hand hygiene, and avoidance of needlestick injuries. Post-exposure vaccination and antiviral treatment of exposed individuals effectively curb the spread of monkeypox.