Harvard Medical School and Regional Emerging Special Pathogens Treatment Center, Infection Control Unit, and Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (E.S.S., K.C.Z.).
Harvard Medical School and Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, and Division of Infection Prevention and Control, Beth Israel Lahey Health, Cambridge, Massachusetts (S.B.W.).
Ann Intern Med. 2022 Dec;175(12):1639-1647. doi: 10.7326/M22-2721. Epub 2022 Nov 8.
In May 2022, the first case of monkeypox virus (MPXV) infection in the United States in the current global outbreak was identified. As part of the public health and health care facility response, a contact tracing and exposure investigation was done.
To describe the contact tracing, exposure identification, risk stratification, administration of postexposure prophylaxis (PEP), and exposure period monitoring for contacts of the index patient, including evaluation of persons who developed symptoms possibly consistent with MPXV infection.
Contact tracing and exposure investigation.
Multiple health care facilities and community settings in Massachusetts.
Persons identified as contacts of the index patient.
Contact notification, risk stratification, and symptom monitoring; PEP administration in a subset of contacts.
Epidemiologic and clinical data collected through standard surveillance procedures at each facility and then aggregated and analyzed.
There were 37 community and 129 health care contacts identified, with 4 at high risk, 49 at intermediate risk, and 113 at low or uncertain risk. Fifteen health care contacts developed symptoms during the monitoring period. Three met criteria for MPXV testing, with negative results. Two community contacts developed symptoms. Neither met criteria for MPXV testing, and neither showed disease progression consistent with monkeypox. Among 4 persons with high-risk exposures offered PEP, 3 elected to receive PEP. Among 10 HCP with intermediate-risk exposures for which PEP was offered as part of informed clinical decision making, 2 elected to receive PEP. No transmissions were identified at the conclusion of the 21-day monitoring period, despite the delay in recognition of monkeypox in the index patient.
Descriptions of exposures are subject to recall bias, which affects risk stratification.
In a contact tracing investigation involving 166 community and health care contacts of a patient with monkeypox, no secondary cases were identified.
None.
2022 年 5 月，美国发现了当前全球猴痘疫情中的首例猴痘病毒（MPXV）感染病例。作为公共卫生和医疗机构应对措施的一部分，开展了接触者追踪和暴露情况调查。
描述对该病例的接触者追踪、暴露识别、风险分层、接触后预防（PEP）管理和接触者暴露期监测，包括评估出现可能与 MPXV 感染一致的症状的人员。
接触者追踪和暴露情况调查。
马萨诸塞州的多个医疗保健机构和社区场所。
确定为该病例接触者的人员。
接触者通知、风险分层和症状监测；在部分接触者中给予 PEP。
通过每个机构的标准监测程序收集的流行病学和临床数据，然后进行汇总和分析。
共确定了 37 名社区接触者和 129 名医疗保健接触者，其中 4 人属于高风险，49 人属于中风险，113 人属于低风险或不确定风险。在监测期间，有 15 名医疗保健接触者出现症状。3 名符合 MPXV 检测标准的人进行了检测，结果均为阴性。2 名社区接触者出现症状。这 2 人均不符合 MPXV 检测标准，且疾病进展不符合猴痘特征。在 4 名高风险暴露者中，有 3 人选择接受 PEP。在 10 名因医疗决策而有中风险暴露者中，有 2 人选择接受 PEP。尽管该病例的猴痘识别出现延迟，但在 21 天监测期结束时未发现传播。
暴露描述可能存在回忆偏倚，这会影响风险分层。
在对一名猴痘患者的 166 名社区和医疗保健接触者进行的接触者追踪调查中，未发现继发病例。
无。
