Is There a Risk of Monkeypox Workplace Transmission?

Key Points:

• In today’s Recommendation for Industry, we discuss if there is a risk of monkeypox transmission within the workplace. Read more below.
• Moderna announces US contract for 66 million bivalent booster doses. Moderna announced a deal worth $1.76 billion with the US government to supply an initial 66 million doses for a new COVID-19 vaccine booster that targets the Omicron subvariant. Moderna’s bivalent shot covers the original SARS-CoV-2 and BA.4 and BA.5 subvariants. In a statement, Moderna said the contract also includes an option to buy 234 million additional booster doses. The company is developing two bivalent boosters, one for BA.4/BA.5, as recommended earlier this month by the US Food and Drug Administration (FDA), and the other for the BA.1 Omicron strain. The doses are projected to be available by mid-October, but efforts are underway to make the doses available sooner.
• ‘Living with COVID’: Where the pandemic could go next. Experts recently discussed that there could be up to a million infections a day during the winter in the United States. Questions are on the rise regarding when countries will move out of the COVID emergency phase and into a state of endemic disease where communities with high vaccination rates see smaller outbreaks. Many experts believed there would be a transition beginning in early 2022, but with the new variants of Omicron they were proven to be incorrect. The WHO has said each country still needs to approach new waves with all the tools in the pandemic armory- from vaccinations to interventions, such as testing and social distancing or masking.
• Fewer pregnant women had severe COVID amid Omicron, after vaccination. Investigators from South Korea retrospectively examined the electronic medical records of 224 pregnant women who tested positive for COVID-19 and 82 quarantine deliveries from Nov 1, 2020, to Mar 7, 2022, at a single hospital. Of the 224 women, 39 (17%) were vaccinated, and 185 (83%) were unvaccinated against COVID-19. Of the 224 women, 42% tested positive for COVID-19 amid Omicron, and 4.1% of vaccinated women and 25% of their unvaccinated counterparts in this period had severe illness. A total of 2.6% and 16.2%, respectively, required supplemental oxygen. Rates of moderate or severe maternal illness fell from 30.0% amid Delta to 10.6% amid Omicron, as did rates of infection (27.7% to 13.8%). The need for supplemental oxygen also dropped from 20.0% to 5.3%.

Public Health & Food Safety:

• Monkeypox:
  • San Francisco, New York declare monkeypox emergencies. Both San Francisco and New York City have declared monkeypox emergencies as the cities continue to see cases surge among men who have sex with men (MSM) and a high demand for vaccines. On July 28^th alone, New York City reported 1,251 new cases of monkeypox. San Francisco’s case count currently sits at 261 confirmed cases. The United States has a total case count of 4,907 within 48 states.  Globally, there are more than 20,300 cases confirmed in non-endemic countries. Recorded last weekend, Brazil, Spain, and India all recorded the first monkeypox deaths outside of endemic countries in Central and West Africa. Spain recorded two deaths, with Brazil and India each recording a single death. So far in the current outbreak, there have been 10 deaths from the poxvirus.
  • HHS promises 1.1 million monkeypox vaccines in coming weeks. In the coming weeks, 1.1 million doses of the Jynneos monkeypox vaccine will have been made available for many Americans. The four most common symptoms seen by US clinicians are rash, malaise, fever, and swollen lymph nodes. The CDC announced that monkeypox will now be a nationally notifiable disease as of Aug 1. This means states will be required to report confirmed or suspected monkeypox cases to the CDC within 24 hours of discovery.
• FDA releases updates to Cyclospora action plan: The U.S. Food and Drug Administration has released new updates detailing the agency’s Cyclospora prevention and research efforts. The action plan was developed by the agency’s Cyclospora Task Force and details the FDA’s strategy for reducing the public health burden of foodborne cyclosporiasis in the United States. It also defines the agency’s priorities for Cyclospora food safety research and supports ongoing efforts to combat foodborne illness. A full listing of the task force’s latest accomplishments and their current Cyclosporaprevention and research efforts along with an updated factsheet on Cyclosporiasis and Fresh Produce can be found here.
• Cereals and grains top of FAO and WHO’s risk ranking. Based on a request from the Codex Committee on Food Hygiene (CCFH), the Food and Agriculture Organization of the United Nations (FAO) and World Health Organization (WHO) ranked the foods of greatest concern from a microbiological food safety perspective. Cereals and grains scored highly across all the criteria. This is not surprising given the importance of the commodities and products in this category as staples in the global food supply, said the report. For cereals and grains, the most common interventions were dry heat treatments, chemical treatments, and irradiation. Spices and dried herbs were also reported on having microbiological hazards. Salmonella and the spore-forming organisms Bacillus cereus and Clostridium perfringens were considered foodborne pathogens of particular concern. It covered chili and red pepper, cinnamon, turmeric, cumin, black pepper, oregano, nutmeg, rosemary, saffron, and basil.
• CDC finds rare bacterium behind melioidosis in US soil, water. The bacterium, Burkholderia pseudomallei, was identified through soil and water sampling in the Gulf Coast region of Mississippi, the Centers for Disease Control and Prevention (CDC) said in a news release. Melioidosis is incredibly rare in the United States, with roughly 12 cases a year reported, and most cases occur in people who have travelled to regions of the world where B pseudomallei is commonly found in soil and water. The CDC says B pseudomallei has likely been in the region since 2020 and is now considered locally endemic, and their modeling suggests the environmental conditions of the Gulf Coast states are conducive to the growth of the bacterium. But more environmental sampling is needed to determine where else it might be found in the country. Although the risk to the general population is considered very low, the CDC said residents of the Gulf Coast of Mississippi who have conditions that could put them at higher risk of severe melioidosis infection or death—such as diabetes, chronic kidney disease, chronic lung disease, and excessive alcohol use—should avoid contact with soil or muddy water and protect open wounds.
• Salmonella in poultry, the issues and solutions, hearing from the experts. Salmonella serotype Enteritidis and Typhimurium are responsible for multiple cases linked to poultry and in recent years Salmonella Infantis has become a re-occurring, emerging and persistent serotype. FSIS has a list of strategies in order to prevent Salmonella in poultry that can be found here. Also discussed was how utilizing serotype and quantification data to address Salmonella in poultry can be a factor for solution. A reasoning for the contaminated poultry was due to a study that hypothesized that the international trade of infected breeding stocks causes the global spread of the pathogen.

Recommendations for Industry

Is There a Risk of Monkeypox Workplace Transmission?

Although monkeypox can be transmitted person-to-person, non-healthcare workplace transmission is not likely as it requires prolonged or intimate contact with a symptomatic person, direct contact with their skin lesions, or contact with clothing or linens that previously touched the rash or body fluids. It also is theoretically possible for the virus to be transmitted from one person to another through droplets from coughing or sneezing – but only with prolonged direct, very close contact.

Additionally, monkeypox can only be spread by those who have symptoms; those without symptoms cannot spread the virus. This provides additional rationale for businesses to maintain symptom screening and monitoring. With many of the monkeypox symptoms – fever, headache, muscle aches, sore throat, chills, and fatigue – similar to symptoms of COVID and the flu, ensuring that workers stay out when ill with any symptoms is essential to keeping your workforce healthy.

In the rare event that someone is diagnosed in a workplace and had been working while symptomatic, disinfecting surfaces in areas where the person worked is recommended.  The CDC has developed a document on surface disinfection for monkeypox.  Cleaning protocols should be similar to those originally used to disinfect surfaces during COVID.  Because transmission requires sustained close contact, contact tracing and notification in normal workplace settings isn’t currently recommended.  However, if household members of the infected employee are also employees, they should be evaluated by a healthcare provider before coming to work to ensure they’re not potentially infected. 

While it is ideal that anyone who is affected by coughing or sneezing stay home, the reality is that these can also be caused by allergies, sinus pressure, and other non-viral issues, and that there are times that individuals need to venture from the home despite mild illness. In such cases, it may be a good idea for these individuals to wear a mask to protect others in case the illness is of a more critical nature than originally thought.

In case you missed it:

• In last Thursday’s Recommendation for Industry, we discussed COVID becoming an endemic virus. Read more here.
• COVID hot spots shift; studies add evidence for Wuhan market origin. In its weekly update, the WHO said about 6.6 million new cases were reported last week, about the same as the previous week. However, cases rose in three WHO regions: the Western Pacific, the Eastern Mediterranean, and Southeast Asia. BA.4 and BA.5 continue to be the dominant variant among individuals currently. Two studies, one performed at University of Arizona and the other at University of California, San Diego, both point to the Huanan market as the epicenter for the emergence of SARS-CoV-2. The two groups said SARS-CoV-2 was very likely present in live animals such as red foxes, hog badgers, and raccoon dogs sold in late 2019 at the market, where it likely spilled over to people working and shopping there in two separate virus introductions.
• Persistent brain fog, hair loss highlighted in long-COVID studies. Two new studies describe long-COVID symptoms, with one finding that 53% of hospitalized COVID-19 patients still had cognitive impairment (“brain fog”) 13 months after infection, and another adding conditions such as hair loss and sexual dysfunction to the list of persistent symptoms among outpatients. Among COVID-19 survivors, the risk factors for long COVID included female sex, younger age, non-White ethnicity, socioeconomic deprivation, smoking, obesity, and a wide range of underlying illnesses. Sixty-two symptoms were significantly linked to long COVID, with the largest adjusted hazard ratios (aHRs) for loss of smell (aHR, 6.49), hair loss (3.99), sneezing (2.77), ejaculation difficulty (2.63), and reduced libido (2.36).
• Few Parents Intend to Have Very Young Children Vaccinated Against COVID. In a new survey, 43 percent of parents of children ages 6 months through 4 years said they would refuse the shots for their kids. An additional 27 percent were uncertain. A majority of parents polled said they considered the vaccine a greater risk to their children than the coronavirus itself. The parents’ chief concerns were about potential side effects of the vaccine, its relative newness and what they felt was a lack of sufficient research. How a child will fare if COVID is contracted is unpredictable, which emphasizes experts’ opinions in why they believe the best option is to receive the vaccine.
• COVID in China: Million in lockdown in Wuhan after four cases– China follows a “zero COVID” strategy, including mass testing, strict isolation rules and local lockdowns. Travel decisions, sport choices, the timing of a day’s activities and, in some cases, even the ability to find work are all dependent on COVID.

Public Health & Food Safety:

• Push to rename monkeypox to fight growing stigma. NYC Health is asking the World Health Organization if monkeypox can be renamed as soon as possible. NYC Health informed WHO that they had concern around the name of the virus due to its stigma and painful and racist history within which terminology like this comes from communities of color. To expand, experts noted that the virus does not originate from monkeys and was only named as such because of an infection seen in research primates. WHO had been discussing the change of the virus name, but recently dropped the topic until NYC Health sent them a letter expressing their concerns. The total case count globally sits at 18,000 cases in 78 countries, 70% of which are within Europe. The US currently has more monkeypox cases than any other non-endemic country. The case count is currently at 3,487 with more than 500 new cases being reported on July 25^th.
• CDC says 17-state Jif peanut butter Salmonella outbreak is over. The whole Jif peanut butter outbreak consisted of 21 individuals being infected throughout 17 states, four of which required hospitalizations. Additionally, no deaths were reported from any of the illnesses. J.M. Smucker Company voluntarily recalled certain Jif brand peanut butter and many other companies that used the peanut butter as an ingredient in their products also issued recalls. For consumers the FDA continues to urge them to check to see if they have the recalled peanut butter on hand or if they have used the recalled Jif brand peanut butter that have lot code numbers 1274425 through 2140425 and the first seven digits end with 425.
• Dole recalls Simply Nature and Marketside salad mixes over toxic nightshade. Dole Fresh Vegetables Inc is recalling Simply Nature Organic Spring Mix 16 oz., and Walmart’s Marketside Spring Mix 11 oz. and 5 oz. because of its potential to contain hairy nightshade. According to Colorado State University’s “Guide to Poisonous Plants,” nightshades may contain steroidal alkaloids such as solanine and have atropine-like effects on the nervous system inhibiting the enzyme acetylcholinesterase. Some nightshades also contain irritants such as saponins that cause salivation and diarrhea. Nightshades may also accumulate toxic levels of nitrate. Recalled products are located in Ohio, Illinois, Indiana, and Tennessee.
• Some city water utilities have bad news for customers because of ‘forever chemicals’. City water utilities across the country are scrambling to explain they are still selling a safe product to consumers. This is a result of the advisory basis from the US Environmental Protection Agency (EPA) for acceptable levels of PFAS in drinking water. One type of PFAS reduced to just .004 parts per trillion, down from 70 ppt. Another compound is cut to .02 ppt, down from 2.0 ppt. EPA will release the National Primary Drinking Water Regulation in the fall of 2022. An example of what is being said to consumers in areas in which PFAS levels may be in tight levels is the following: Neither EPA nor Colorado’s Department of Public Health and Environment recommends Thorton water users switch over to bottled water. Still, they suggest it may be the right time to invest in an in-home treatment and filtering system.
• Canada sets regulations for some romaine grown in certain parts of California. The Canadian Food Inspection Agency (CFIA) has announced the fall 2022 import requirements for U.S. romaine lettuce with special requirements for certain lettuce produced in California’s Salinas Valley. Whole-head romaine lettuce and products containing romaine lettuce such as bagged salads that were produced in the four Salinas Valley counties of Santa Cruz, Santa Clara, San Benito, and Monterey must “submit an attestation form and Certificates of Analysis for each shipment to demonstrate that the romaine lettuce does not contain detectable levels of E. coli O157:H7,” according to the Canadian Food Inspection Agency (CFIA). The requirements are the same as 2021, but the enforcement timeframe is shifted. The dates for the requirement this year are from September 28- December 22.