Monkeypox Case Investigation — Cook County Jail, Chicago, Illinois, July–August 2022

Chicago, Illinois, July-August 2022

Liesl M. Hagan, MPH; Amy Beeson, MD; Sarah Hughes, MPH; Rashida Hassan, MSPH; Lauren Tietje, MPH; Ashley A. Meehan, MPH; Hillary Spencer, MD; Janice Turner, MPH; Morgan Richardson, MFA; Jourdan Howard, MPH; Anne Schultz, MPH; Salma Ali, MPH; Margaret Mary Butler, MSN; Diana Arce Garza, MS; Clint N. Morgan, MS; Chantal Kling; Nicolle Baird, PhD; Michael B. Townsend, PhD; William C. Carson; David Lowe, PhD; Nhien T. Wynn, MS; Stephanie R. Black, MD; Janna L. Kerins, VMD; Josh Rafinski, MBA; Andrew Defuniak, MD; Priscilla Auguston, MD; Emily Mosites, PhD; Isaac Ghinai, MBBS; Chad Zawitz, MD

Disclosures

Morbidity and Mortality Weekly Report. 2022;71(40):1271-1277.

Abstract and Introduction

Introduction

Knowledge about monkeypox transmission risk in congregate settings is limited. In July 2022, the Chicago Department of Public Health (CDPH) confirmed a case of monkeypox in a person detained in Cook County Jail (CCJ) in Chicago, Illinois. This case was the first identified in a correctional setting in the United States and reported to CDC during the 2022 multinational monkeypox outbreak. CDPH collaborated with CCJ, the Illinois Department of Public Health (IDPH), and CDC to evaluate transmission risk within the facility. Fifty-seven residents were classified as having intermediate-risk exposures to the patient with monkeypox during the 7-day interval between the patient's symptom onset and his isolation. (Intermediate-risk exposure was defined as potentially being within 6 ft of the patient with monkeypox for a total of ≥3 hours cumulatively, without wearing a surgical mask or respirator, or potentially having contact between their own intact skin or clothing and the skin lesions or body fluids from the patient or with materials that were in contact with the patient's skin lesions or body fluids.) No secondary cases were identified among a subset of 62% of these potentially exposed residents who received symptom monitoring, serologic testing, or both. Thirteen residents accepted postexposure prophylaxis (PEP), with higher acceptance among those who were offered counseling individually or in small groups than among those who were offered PEP together in a large group. Monkeypox virus (MPXV) DNA, but no viable virus, was detected on one surface in a dormitory where the patient had been housed with other residents before he was isolated. Although monkeypox transmission might be limited in similar congregate settings in the absence of higher-risk exposures, congregate facilities should maintain recommended infection control practices in response to monkeypox cases, including placing the person with monkeypox in medical isolation and promptly and thoroughly cleaning and disinfecting spaces where the person has spent time. In addition, officials should provide information to residents and staff members about monkeypox symptoms and transmission modes, facilitate confidential monkeypox risk and symptom disclosure and prompt medical evaluation for symptoms that are reported, and provide PEP counseling in a private setting.

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Table. Characteristics of residents potentially exposed to *Monkeypox virus* and who participated in elements of a field investigation (N = 57) — Cook County Jail, Chicago, Illinois, July–August 2022
Characteristic	No. (%)
Characteristic	Potentially exposed*	Offered PEP^†	Accepted PEP^†	Accepted testing	Individually interviewed
Total	57	36	13	14	16
Age, yrs, median (range)	38 (21–63)	38 (21–62)	33 (22–58)	38 (21–62)	43 (21–62)
No. of nights potentially exposed, median (range)	5 (1–7)	5 (1–7)	5 (1–6)	5 (1–7)	5 (1–7)
Sex
Male	57 (100)	36 (100)	13 (100)	14 (100)	16 (100)
Race or ethnicity
Black or African American, non-Hispanic	30 (53)	18 (50)	4 (31)	7 (50)	9 (56)
White or Caucasian, non-Hispanic	17 (30)	12 (33)	4 (31)	4 (29)	4 (25)
Hispanic or Latino	8 (14)	5 (14)	4 (31)	2 (14)	2 (13)
Asian, non-Hispanic	2 (4)	1 (3)	1 (8)	1 (7)	1 (6)

Abbreviation: PEP = postexposure prophylaxis.
*Classified as having intermediate-risk exposure to the patient with monkeypox (i.e., were potentially within 6 ft of the patient for a cumulative period of ≥3 hours without wearing a surgical mask or respirator, or potentially had contact between their own intact skin or clothing and the skin lesions or body fluids from the patient with monkeypox or with materials that were in contact with the patient's skin lesions or body fluids).
^†JYNNEOS vaccine.

Box. Public health messages related to monkeypox prevention in correctional settings — United States, 2022
When monkeypox is suspected, promptly isolate the affected person, evaluate them for testing, and alert the health department for further support and guidance (https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html). • Multiple residents with confirmed monkeypox can be housed together. • Persons entering the isolation space or handling laundry from persons with monkeypox should wear recommended PPE (https://www.cdc.gov/poxvirus/monkeypox/community/congregate.html). Patients should wear a mask and cover lesions if they leave the isolation space. • Collect and contain soiled laundry and linens from a person with monkeypox in a container that can be disinfected, or a laundry bag that can be laundered along with the soiled items from the person with monkeypox. Do not shake or handle laundry in a manner that might disperse infectious material. Launder separately from other residents' laundry using regular detergent. • Support patients' mental health during isolation, and ensure they have regular access to showers, hygiene supplies, and clean clothing and linens. *Surface contamination with Monkeypox virus* can occur and can contribute to transmission. • Ensure prompt and thorough cleaning and disinfection in spaces where a person with monkeypox has spent time. Include all surfaces that someone with monkeypox might have touched or places they might have stored or placed soiled clothing, towels, or linens. • Perform disinfection using an EPA-registered disinfectant with an Emerging Viral Pathogens claim (https://www.epa.gov/coronavirus/what-emerging-viral-pathogen-claim) found on EPA's List Q (https://www.epa.gov/pesticide-registration/disinfectants-emerging-viral-pathogens-evps-list-q), according to instructions on the product label. • Provide sufficient training, supplies, oversight, and PPE (https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html) to residents and staff members responsible for cleaning and disinfection. For more information, see Workplace Solutions: Safe and Proper Use of Disinfectants to Reduce Viral Surface Contamination in Correctional Facilities (https://www.cdc.gov/niosh/docs/wp-solutions/2021-121/). Contact tracing can help to prevent further transmission. However, persons exposed to Monkeypox virus do not need to quarantine if they do not have signs or symptoms consistent with monkeypox. Confidentially inform residents and staff members of potential exposure to prevent stigma and to encourage disclosure of high-risk contact that might have occurred (https://www.cdc.gov/poxvirus/monkeypox/clinicians/monitoring.html). Follow health department guidance for symptom monitoring and PEP for residents and staff members who have been exposed. Ensure that residents and staff members know the symptoms of monkeypox and ensure that residents can confidentially report symptoms or contact with a person with monkeypox. Evaluate residents promptly when they report symptoms. When indicated, offer PEP as soon as possible after exposure to prevent loss to follow-up (especially in high-throughput settings like jails) and to best prevent infection. • For maximum effectiveness, PEP should be offered within 4 days of exposure. • Discuss options with the health department for offering PrEP vaccination to residents who might be at increased risk for monkeypox in the facility or after release (https://www.cdc.gov/poxvirus/monkeypox/vaccines/vaccine-basics.html). • PEP acceptability might be lower in some correctional environments than in other settings and can be supported through individual, confidential discussions between residents and trusted communicators, such as medical providers. Facilitate disclosure of a known monkeypox diagnosis, symptoms, or risk factors at intake by asking screening questions in private spaces. Residents and staff members might not have adequate information about monkeypox or adequate access to hygiene and cleaning supplies to protect themselves. Provide correctional facility residents with no-cost supplies to enable them to wash their hands and clean their living areas frequently and provide information about avoiding skin-to-skin and sexual contact in custody settings and avoiding common interactions that could lead to exposure, such as sharing personal items, clothing, linens, eating utensils, cups, and bowls. Abbreviations:** EPA = Environmental Protection Agency; PEP = postexposure prophylaxis; PPE = personal protective equipment; PrEP = preexposure prophylaxis.

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Monkeypox Case Investigation — Cook County Jail, Chicago, Illinois, July–August 2022

Chicago, Illinois, July-August 2022

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