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


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

In This Article

Public Health Response

CDPH recommended PEP and daily symptom monitoring for 21 days after last exposure for all 57 potentially exposed residents.*** CCJ notified the residents of their potential exposure and, out of an abundance of caution, placed them under quarantine precautions within dormitories A and B. One resident reported a rash on investigation day 22 and was evaluated the same day; test results for NVO were negative. Among the 57 residents, 35 (61%) remained in detention for their full 21-day monitoring period (33 in CCJ and two transferred to a state prison). The remaining 22 (39%) residents were discharged to the community before conclusion of their 21-day monitoring period and were lost to follow-up. However, CDPH cross-checked the names of the discharged residents with the Illinois state testing database and confirmed that none had a record of monkeypox testing in the 30 days after their last potential exposure in CCJ.†††

On investigation day 15, PEP with JYNNEOS vaccine was offered to the 36 (63%) potentially exposed residents who were still in detention at that time (the same 36 residents who were also offered serologic testing on day 15 as part of the investigation). Dormitory B residents received PEP information as a large group, followed by a public roll call offering PEP to each resident. Staff members reported difficulty communicating effectively in the large group; only three of 25 (12%) residents who were offered PEP in this setting accepted. In subsequent individual interviews, several dormitory B residents indicated they did not want to receive the vaccine in front of others, did not know enough about the vaccine or potential side effects, or thought they were being offered a COVID-19 vaccine. In contrast, dormitory A residents were escorted to a separate room individually or in groups of two, where they were counseled and offered PEP; six of 11 offered PEP in this setting accepted. On day 22, PEP was reoffered individually to eight residents from dormitories A and B participating in individual interviews who had declined the first PEP offer; four accepted. Overall, 13 (23%) of 57 residents received PEP 7–14 days after their last potential exposure (median = 12 days).

In early August, CCJ added monkeypox screening questions (presence of rash or known close contact with someone with monkeypox) to the intake process for new residents entering CCJ. Shortly thereafter, a newly detained resident answered "no" to all screening questions but later, in a private exam room with a medical provider, disclosed that he had been hospitalized with monkeypox 2 weeks before his arrest.

***Nursing staff members checked vital signs and asked residents about symptoms once daily. During days 11–13, monitoring included symptoms of influenza-like illness and COVID-19; on day 15, new-onset rash was added. Staff members who worked in dormitories A or B were determined to have lower-risk exposures and were not offered PEP or advised to self-monitor for symptoms.
†††Telephone numbers were available for 17 of the 22 potentially exposed residents discharged to the community before their 21-day monitoring period ended. CDPH staff members called all 17 numbers but were unable to reach any of the discharged residents to ask about monkeypox symptoms they might have experienced during the monitoring period.