Hot Topics in Infection Prevention: COVID-19, Ebola Outbreak, and Ocular and Needlestick Monkeypox

Saskia v. Popescu, PhD, MPH, MA, CIC, covers updates on COVID-19 in frontline workers, an Ebola outbreak in Uganda, and ocular and needlestick monkeypox.

COVID-19 infection

A new study was released regarding frontline workers that sheds some light on symptoms, viral load, and the impact of vaccines. Pulling from the HEROES-RECOVER network, which is a large prospective cohort of frontline workers (health care personnel, first responders, and other essential services such as educational, food processing, transportation, etc, across 6 states), the research team evaluated the association between the second and third doses of mRNA COVID vaccines. Since December 14, 2020, 1119 participants were evaluated, and stratification included SARS-CoV-2 strain and vaccination status.

What did they find? During this long study period, most individuals were infected with Omicron (62%), and per the investigators, “Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; odds ratio (OR), 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, −6.1 [95% CI, −11.8 to −0.4] days).”

This means that asymptomatic cases were more closely linked to Omicron infections. Of those with symptoms, the longest duration was for those with Delta—16.4 days. Workers with a second vaccine dose prior to a Delta infection were much less likely than those unvaccinated to have symptoms. For those individuals with 3 doses and ended up experiencing symptoms, they were less likely to experience a fever or chills and, ultimately, had symptoms for fewer days. Last little tidbit, with Omicron-infected workers, that third dose made a much more significant difference in ensuring mild symptoms, and ultimately, they found that those symptomatic participants had much higher viral loads than those asymptomatic cases. The lowest viral loads? Workers who were given their second dose and had either Delta or Omicron infections when compared to their unvaccinated counterparts.

Ebola Outbreak in Uganda

Total cases are now at 80 with 44 deaths. Uganda’s Health Ministry has initiated a 3-week lockdown for 2 districts most heavily impacted, and there has been a new isolation facility established in Madudu with support from partners like Doctors Without Borders. Stay vigilant, folks: Relevant travel and symptoms will be key as this is the Sudan strain, and there are no vaccines or treatments approved for it.

Ocular and Needlestick Monkeypox

In not particularly surprising, but nonetheless important news, the Centers for Disease Control and Prevention has reported a few unique cases of monkeypox disease and transmission in the latest Morbidity and Mortality Weekly Report (MMWR). Two studies were reviewed: One discussed 5 cases of ocular monkeypox that involved vision impact and worry for long-term vision issues. Four out of the 5 cases involved hospitalization. Ultimately, the authors emphasized that in the event of ocular monkeypox, hand hygiene becomes key—just another reason to wash your hands! The second case study from the MMWR emphasized occupational exposures through the lens of a nurse who was infection via a needlestick injury. The emergency department nurse had the exposure when capping the needle used to swap the rash of a monkeypox patient. Despite being given the first dose of the Jynneos vaccine within 15 hours of the event, she developed a lesion at the site of the needlestick puncture 10 days later. This serves as a painful, but important reminder of not only needlestick injuries, but how unique needle-swabbing practices may be a source for risk in those unusual outbreaks or situations.