Wellness Programs: Using Healthcare Analytics to Support Employee Health

Most well-designed corporate wellness programs are successful, but we’ve all seen well-intended short-lived efforts come and go over the years. The challenge is defining “well-designed” and “successful.” This third edition will focus on practical considerations for using employee healthcare analytics in your business setting to support employee health and wellness. But first, a brief background on employer-based wellness programs.

A thriving “culture of health” at any organization relies on many factors, from leadership support at all levels to shared corporate values, to formal and informal systems reinforcing healthy behaviors, to accurate, reliable, and reproducible tools to measure all aspects of the culture of health.

It’s been well-documented that custom-designed wellness products can support corporate performance, both in dollars and human capital. Examples of highly developed wellness models include the ACOEM Corporate Health Achievement Award or CHAA, HERO Employee Health and Well-Being Best Practices Scorecard, Health Risk Assessments, The Health Project C. Everett Koop National Health Awards, and health & wellness “contracts” using The Transtheoretical Model (Stages of Change) model.

Studies have shown a link between stock market price growth, financial performance, and having a great employee health program (CHAA, Koop Award). Employers attesting to comprehensive wellness programs outperformed the S&P index at rates ranging from 7-16 percentage points per year, representing a nearly doubling or tripling of earnings.

  • Stock performance is tied to companies with high ratings for corporate social responsibility, employee job satisfaction, spending on human resources and acknowledged as a best place to work
  • Stock values for a portfolio of companies that received high corporate health & wellness scores appreciated by 235% compared to the S&P Index of 159% over a six-year period
  • Investing in funds to develop a great wellness program will not make stock prices go down
  • Great wellness programs may be reliable indicators of future stock performance
  • Investing in funds to create a great wellness program will not make stock prices go down
  • Great wellness programs may be reliable indicators of future stock performance
  • A 2018 UK study by Glassdoor of over 35,000 reviews across 164 employers found those with more satisfied employees returned ~16% more than those with less satisfied employees
  • Koop Award companies outperformed the S&P Index over a 14-year period (2000-2014)

It’s also important to understand the practical concepts regarding CDC: Clinical Prevention Models. Most corporate wellness programs focus on primary and secondary prevention.

  • Primary prevention aims to prevent disease or injury before it ever occurs.
  • Secondary prevention focuses on early diagnosis to prompt timely interventions to prevent or minimize morbidity, reduced productivity and additional costs.
  • Tertiary prevention addresses effective interventions and employee disposition once disease or impairment is evident.

Most cookie-cutter wellness programs, despite great intentions, are often doomed to failure. You can create customized, focused programs that “learn” as they grow using well-designed analytics tools to harness your unique populations’ health data. Tap into those databases we discussed in an earlier blog, such as indemnity and workers’ compensation claims, demographics, HRAs and employee surveys to customize your wellness programs for maximal impacts on your bottom line and employee health, well-being, retention and productivity.

Stay tuned for further predictive healthcare analytics blogs covering a variety of other common and important business topics.


About the Author:

Dr. Joe Mignogna is Acuity’s Chief Medical Officer.  Connect with him at jmignogna@acuityinternational.com

Dr. Joe Mignogna, MD, MPH, CIME, FACOEM, Chief Medical Officer

Predictive Health Analytics in the Workplace: Observation, Prediction, and Control

Knowledge is Power, Power provides Information; Information leads to Education, Education breeds Wisdom; Wisdom is Liberation.”Israelmore Ayivor

Who hasn’t watched world-class cyclists aggressively competing in the Tour de France? Cycling at high speed in tight packs on winding roads, they have an uncanny ability to quickly identify opportunities to gain an edge, predict the response of their competitors and the pack as they make their move, and effectively gain control and take the lead (and hopefully the yellow jersey). How do they do that?

Observation, Prediction, and Control

The scientific method includes generating hypotheses from observations of the world, which are then deployed to test their reliability or accuracy. The best way to test reliability is to predict an effect before it occurs. If we can manipulate the independent variables (the efficient causes) that make it occur, then the ability to predict makes it possible to control. Such control helps to isolate the relevant variables. Control also refers to a comparison condition, conducted to see what would have happened if we had not deployed the key ingredient of the hypothesis: scientific knowledge only accrues when we compare what happens in one condition against what happens in another.

Using Predictive Analytics to Improve Healthcare

The past century’s advancements in healthcare have resulted in an ever-increasing knowledge base of biomedical data for healthcare providers to access while diagnosing and treating their patients. Multi-platform interoperability and artificial intelligence (AI) are helping to corral those living and growing databases of biometrics and health outcomes.

According to a study by the American Medical Informatics Association (AMIA) on “The Future State of Clinical Data Capture and Documentation,” global healthcare data added up to around 500 petabytes in the year 2012 and was expected to reach around 25,000 petabytes by the year 2020. Despite this wealth of information, it also creates a problem: accessibility. The main purpose of documentation should be to support patient care and improved outcomes for individuals and populations according to an AMIA Health Policy Meeting. This is where predictive analytics come into play, allowing the healthcare community to focus on finding innovative ways to enhance people and population health without having to manually examine a large amount of unwieldy data.

Observation: Gather and monitor demographic, biometric, and health outcome data.
Prediction: Identify relevant, high-yield opportunities to impact employee health, well-being, productivity, and business success.
Control: Implement focused interventions while continuously monitoring preferred impacts on your population and business; monitor and adjust as appropriate.

Here are a few examples of focused, IT-budget friendly excursions into the world of predictive healthcare analytics which can be applied in a corporate setting:

  1. Identify key readily available attributes of your population’s demographics (age, gender, dependents, ethnicity, median income, etc.) to design targeted health information newsletters and resources relevant to your business.
  2. Using data gleaned from indemnity and workers’ compensation claims, identify opportunities to modify health benefits plans to proactively address high-risk behaviors or diagnoses. In other words, focus on primary and secondary prevention interventions.
  3. Using a Health Risk Assessment (HRA) tool, confidentially survey your population for their healthcare challenges, both personal and work-related. Does the data match up with your benefits plans and claims data? Recruitment and retention?

7 Ways Predictive Analytics Can Improve Healthcare

  1. Increased accuracy of diagnoses.
  2. Improved preventive medicine and public health.
  3. Provide physicians with answers they are seeking for individual patients.
  4. Provide employers and hospitals with predictions concerning insurance product costs.
  5. Allow researchers to develop prediction models that do not require thousands of cases and that can become more accurate over time.
  6. Pharmaceutical companies can use predictive analytics to best meet the needs of the public for medications.
  7. Patients have the potential benefit of better outcomes due to predictive analytics.

If you’re interested in learning more, consider these resources for additional reading:

  1. Caitlin M. Cusack. “The future state of clinical data capture and documentation: a report from AMIA’s 2011 Policy Meeting.” Journal of the American Medical Informatics Association, Volume 20, Issue 1, January 2013, Pages 134–140.
  2. Nghi Tran-Hoang-Phuong. “7 Ways Predictive Analysis Can Improve Healthcare.” July 15, 2021.
  3. Shantanu Chaturvedi. “7 Ways Predictive Analysis Can Improve Healthcare.” Digital Health Today. November 8, 2017.


About the Author

Dr. Joe Mignogna is Acuity’s Chief Medical Officer.  Connect with him at jmignogna@acuityinternational.com

Dr. Joe Mignogna, MD, MPH, CIME, FACOEM, Chief Medical Officer

How Construction Partnering Can Save Time and Money During Change Order Estimation

By Mike Norman, Senior Cost Engineer

Government construction projects are frequently subject to amendments to the original contract. When this occurs, the contractor must prepare a change order and quote the price for the extra work.

But too often, change order proposals lack clarity and the amended scope is not well quantified. As a result, establishing a mutual understanding of scope between the owner and contractor can be challenging. The result is an overblown schedule and cost overruns.

However, these scenarios can be remediated. The change order pricing process can be successfully streamlined with construction partnering, which creates greater efficiencies and helps organizations save time and money.

The issue: Efficient change order pricing

Before I address what construction partnering is, and why it’s important, let’s talk a little about the current processes it’s meant to replace.

Scoping out a change order requires a complete set of project documents that carefully define the new scope of work and its impact on the construction schedule and performance. Unfortunately, this often overlooked detail has considerable impact.

When an owner orders a change to the contract – yet fails to provide extensive quantitative information (let’s call this “qualitative” scope) – it can take more time to resolve scope issues and develop the estimate. The lack of information may lead to many questions among estimators. To find answers, they will formally request more information from all bidders. This exchange takes time and leads to increased costs, delays, and inefficiencies.

The challenge for federal owners

This process is especially burdensome when government construction projects are at stake. Consider a scenario where the building owner is a public agency. In many cases, policy and/or law require these agencies to develop independent estimates of change order costs. In the federal government, and agency rules also require that the owner generates an Independent Government Cost Estimate (IGCE).

When defining the scope of a “qualitative” change, government estimators must inevitably make scope assumptions. This second-guessing can have a significant impact on the estimate.

But a contractor must also make assumptions. This begs the question: “Will the contractor’s assumptions match those made by the government?” Based on my experience, the answer is “no.”

Government estimators have an additional task. They must analyze each contractor’s estimate, compare it to the IGCE, and attempt to resolve the differences created by differing scope assumptions – a process that can take hundreds of hours. Meanwhile, contractors (and subcontractors) spend equal time developing a price for the work. Negotiating a settlement then adds more time to the process – the further apart the estimates, the more hours spent negotiating.

It is often the norm for this to happen, which can result in the failure to negotiate an agreed price, the issuing of a unilateral change order, or the reissue of the proposed change.

The solution: Construction partnering

What is Construction Partnering?

Contractors and government agencies can overcome these roadblocks and frustrations by implementing a limited form of construction partnering. One in which the stated intent is to develop a common understanding of scope and assumptions.

Construction partnering is a structured process that brings together project stakeholders to set goals, develop processes, discuss and resolve scope issues, and improve project outcomes. Successful partnering can reduce project costs, expedite schedules, reduce changes and claims, and improve communication.

Construction partnering achieves this by furnishing an environment conducive to the free exchange of information and open communication. It involves a single, facilitated meeting between parties. It also minimizes the “gotcha” attitude sometimes displayed by owners and contractors that arises from concealing information.

Because decision makers (notably subject matter experts and contracting officers) are in the same room, they can propose real-time solutions that reduce the government’s cost to analyze and resolve differences between the IGCE and the contractor’s scoping and assumptions.

Construction partnering and change order scope

To amplify the effectiveness of this meeting and achieve accord, several elements are key.

First, the agency and the contractor must do their homework. Prior to the meeting, each entity should develop and exchange their understanding of the scope. At a minimum, this must include the following:

  • A summary description of the presumed scope
  • A list of scope issues prioritized by importance
  • A list of assumptions

Next, both parties must review each other’s submissions and prepare to discuss the various issues in detail.

The meeting should be governed by a set agenda that has been reviewed and accepted by the agency and the contractor. During the interaction, both parties must be prepared to focus on resolving differences so they can proceed with pricing based on mutual understanding.

Overcoming objections

It’s not unheard of for government contracting officers to express fear that a collaborative approach to the change order process crosses the line separating “what is scope” from “dictating the contractor’s method of executing work.” However, a properly facilitated construction partnering meeting that includes contracting officers should alleviate that concern – while providing a forum for the parties to explain their respective approaches.

As a guideline, a partnered meeting could resemble the following agenda:

  • 8:00 am: The facilitator opens the meeting. Each participant introduces themselves and their role in the process.
  • 8:30 am: The facilitator sets forth the meeting logistics and rules (e.g., only one speaker at a time).
  • 8:45 am: Leaders are asked to state their respective goals and share scope understandings and assumptions that the government and contractor agree upon.
  • 9:00 am: To break the ice and set up an atmosphere of trust and openness, the facilitator guides the group through an exercise…
  • 9:15 am: As a group or assembled in subgroups, participants address the issues in order of importance (the “homework” discussed above will include ranking the issues in order of importance). Subgroups can be formed in a variety of ways. Ideally, the most knowledgeable SMEs are included in the appropriate subgroup.
  • 12:00 pm: The group or subgroups report their results. The facilitator will issue a written report memorializing the results.


Ordinarily, a construction partnering meeting will not resolve all issues, and any outstanding issues and resolution timeline should be noted. However, this is not acceptable. For estimators to begin work on a change order, it is crucial that all issues are resolved during the change order scoping meeting. If they are not, the SMEs and contracting officer should try and reach consensus.

Improved communication, improved strategy, and issue resolution

Is four hours sufficient time to yield efficiency in the case of “qualitative” change? Even if the meeting is extended to eight hours, I argue in the affirmative.

For instance, in the case of a proposed change with a seven- or eight-figure value, an agency might spend hundreds of hours generating a Class 3 IGCE and just as much time again analyzing the contractor’s proposal.

To resolve this issue, a partnership meeting might include ten to twelve stakeholders – this equates to 48 hours of cumulative people time. Even this short amount of time can generate labor savings far exceeding 48 hours. Such a meeting also saves money, while simultaneously building trust between parties who have long resisted coming to the table.

Construction partnering is a win-win for all involved.


About the Author

Mike Norman is a Senior Cost Engineer currently leading a team of estimating professionals completing cost, schedule, and risk analysis tasks for the Department of Energy.

Connect with Mike at mike.norman@acuityinternational.com.

High Threat Security Protection in a Fast-Changing World

Over the past 20 years, the imperative of keeping people, assets, resources, and commodities safe in high threat environments has taken on new meaning. The terrorist bombings of U.S. embassies and installations, the 9/11 attacks, and the wars in Iraq, Afghanistan, and now Ukraine have significantly increased the challenges of securing infrastructure and protecting diplomats and government officials.

For example, when US officials visit high threat locations such as embassies or airbases, they must be protected from the moment they wake up, travel to the facility, perform their duties, and return safely at the end of the day. Whether mobile or static, any threats must be detected, mitigated, and deterred – without impinging on that person’s ability to operate freely, no matter how high the threat level.

High Threat Security and Protection in Action

Acuity’s Global Missions Solutions team understands the need to balance security with mission objectives. We are a trusted partner for risk management solutions that detect and deter a full spectrum of threats, including active shooters, explosives, kidnapping, facility breaches, and other incidents.

Our strategic leadership team has more than 250 years of experience in various risk management and mitigation fields in dangerous and austere environments, including defense operations, law enforcement, logistics and base operations, and more.

Furthermore, our high-threat protective services personnel are the best in the world. Before any assignment, they must meet stringent mental, physical, and moral qualifications, have proper security clearances, and undertake extensive standards-driven training.

Together, we integrate operation and mission planning, risk assessment, security services, and state-of-the-art technology and cyber operations to enhance situational awareness, manage client movement, secure critical infrastructure, and deploy quick-reaction personnel.

Wherever the mission takes a client, we are one step ahead with a full-scope analysis. In addition to conducting a threat intelligence assessment of the destination, we pinpoint enroute egress points, nearby medical facilities, safe place locations, and friendly allies in the vicinity. Our security teams know the blood types and medical conditions of the individuals under their protection and are accompanied by highly trained rapid response medical teams. They are also well-equipped to quickly remove our at-risk individuals, no matter how mobility-challenged they may be.

Navigating New Realities

One of our strengths services is our ability to adapt to changing realities. For example, during the pandemic, when commercial air travel was halted, we chartered private aircraft so that we could quickly deploy our teams at limited notice to support and secure the ongoing missions of our clients.

The results speak for themselves. We can report no significant incidents since the inception of our protective services.

Making, and Exceeding, the Grade

We also consistently exceed Program Management Review (PMR) and Contractor Performance Assessment Review (CPAR) requirements and are credited for the best practices that we implement.

Furthermore, we are the first U.S. company to meet worldwide ANSI/ASIS PSC.1-2012 standards, which ensure the quality of private security operations in support of international defense and diplomatic security missions.

Making the grade is a vital part of our commitment to our clients and why we’re consistently recognized as one of the world’s preeminent high threat security solutions providers to a broad array of government agencies.

Work With Us

Learn more about Acuity’s Global Mission Solutions or contact us today to discuss partnership opportunities.


About the Author:

Mike Reynolds is a Practice Leader and has more than 36 years of experience of executing and aligning law enforcement and protective services with business objectives. Mike joined Acuity in 2020 as a program manager for risk management, supporting U.S. Department of State task orders in Erbil, Iraq, and Mogadishu, Somalia. Prior to joining Acuity, his roles included Law Enforcement Police Commander (Retired), Department of Defense Operations, and Program Manager for U.S. Department of State Security Forces at the U.S. Embassy in Kabul, Afghanistan. He also served as the Deputy Program Manager for U.S. Security Forces at the U.S. Embassy in Iraq.

Connect with him at michael.reynolds@acuityinternational.com.

Acuity Spotlight: Lalith Priyanka Wijewickrama Athapattu, Sri Lankan Army

The Acuity Spotlight is our way of highlighting some of the incredibly talented individuals that we’re lucky enough to have on our team. At Acuity, we value diversity and inclusion and focus our attention on bringing candidates who have a wide range of backgrounds and experiences onboard. Our mission is to build enduring relationships that provide secure, stable, and long-term predictable outcomes and we are grateful for the men and women of Acuity who embody our corporate values in everything they do.

Which branch of the military did you serve in?
I served as a member of the Sri Lanka Army Commando Regiment for 14 years which is one of two special operations units of the Sri Lankan Army.

What are some of the things you remember about adapting to military life?
Some of the things I remember as part of my adaptation to military life were the discipline required to be a member of the unit and the teamwork that was emphasized throughout the training and continued once assigned to the unit. In addition, the arduous physical and mental training/preparation that I was required to maintain as a member of the unit along with high standards of moral conduct and good behavior that are expected of each member of the regiment. Something that was hard for my family was that they had to adapt and learn that assignment to the regiment meant I would not be at home for long periods of time.

When did you leave the military? What were your first few months out of the service like?
I completed my tour with the Sri Lanka Army in August of 2010. My first few months were hectic because I had to learn how to adapt to civilian life. After leaving the military, I realized the freedom I had and appreciated the opportunity to spend more time with my family.

How would you describe the work you do at Acuity and the impact it is making?
I am happy to be a part of the Acuity team. I have worked as a member of the Balad team for seven years in several different positions in different departments. I enjoy the opportunity to work with people from different cultures who speak different languages.

What is your proudest career moment?
The proudest moment of my military career was when the war ended in Sri Lanka in 2009.


About the Author

Lalith Priyanka Wijewickrama Athapattu, Balad Air Base Life Support/Security Services Project, Sri Lankan Army

Acuity Spotlight: Kevin Jackson-Beleski, The United States Air Force

The Acuity Spotlight is our way of highlighting some of the incredibly talented individuals that we’re lucky enough to have on our team. At Acuity, we value diversity and inclusion and focus our attention on bringing candidates who have a wide range of backgrounds and experiences onboard. Our mission is to build enduring relationships that provide secure, stable, and long-term predictable outcomes and we are grateful for the men and women of Acuity who embody our corporate values in everything they do.

Which branch of the military did you serve in?
I served in The US Army

What are some of the things you remember about adapting to military life?
The hardest part of adapting to the Army was learning to cope with the strict regimen. It truly felt like I was starting a new life after graduating from high school. Eight months later I was deployed to Iraq in support of the US mission set. I learned to adapt over time, but it was a definite change.

When did you leave the military? What were your first few months out of the service like?
I got out of the military in June of 2016. The first month was slow; I took time to readjust myself. I took the time to develop a plan and establish priorities for what I wanted to do with my life. I ended up finding the perfect balance of traveling, using my military experience, and being financially stable through the contracting world.

How would you describe the work you do at Acuity and the impact it is making?
I think the work I do at Acuity benefits the relations between Iraq and the United States as well as helps facilitate the demise of terrorist organizations that both countries suffer the effects of.

What is your proudest career moment?
My proudest career moment I would have to say is being afforded the opportunity to progress from one department to another and further use my previous career’s tools and knowledge. The skillsets and knowledge I learned from The US Army were ideal for my transition to the contracting world.

About the Author

Kevin Jackson-Beleski, Balad Air Base Life Support/Security Services Project, Security Directorate, Quick Reaction Force (QRF) Team Member, The United States Air Force

Monkeypox: What We Know So Far and Ways to Prevent Transmission

Updated June 20, 2022

As previously stated, monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name “monkeypox.” In 1970, when smallpox was nearly eradicated, the previously unrecognized orthopoxvirus named monkeypox was identified in humans. The first known human case occurred in Zaire (now known as the Democratic Republic of Congo) when a 9-year-old boy developed a smallpox-like illness, which was eventually confirmed as human monkeypox by the World Health Organization. Retrospectively, similar cases were also occurring in 1970-1971 in the Ivory Coast, Liberia, Nigeria, and Sierra Leone.

Monkeypox was limited to the rain forests of central and western Africa until 2003 when the first cases in the Western Hemisphere were reported. In late spring 2003, multiple persons were identified in the midwestern United States who had developed fever, rash, respiratory symptoms, and lymphadenopathy following exposure to ill pet prairie dogs infected with the monkeypox virus. In July 2021, the first U.S. case of monkeypox was reported in Dallas, Texas by a traveler from Nigeria. The exact potential for human-to-human transmission and human-to-animal transmission remains unknown, although it is not currently considered to be easily transmitted. Monkeypox is NOT a sexually transmitted disease (STI), although it spreads by close physical contact that could include sex. Transmission may also occur via respiratory droplets (and possibly short-range aerosols) or contact with contaminated materials (e.g., linens, bedding, electronics, clothing). The vast majority of cases have been in males. In the African epidemics, 90% of the patients were children younger than 15 years.

As of June 17, 2022, there were over 2500 total confirmed monkeypox cases in 47 non-endemic countries, including 100 cases across 20 U.S. states and the District of Columbia, with over 90 lab-confirmed cases being reported daily. To date, there have been no reported monkeypox fatalities in the United States. Although patients generally feel poorly, the disease is usually mild and self-limited with resolution in 2-4 weeks. “All the cases we’ve seen to date in this outbreak are related to direct contact, either through skin-to-skin contact or through bed sheets,” said CDC Director Rochelle Walensky.

Outbreaks in western and central Africa have been linked to exposure to rats, rabbits, squirrels, monkeys, porcupines, and gazelles. Inhabitants of remote tropical rain forests may become infected from direct contact while capturing, slaughtering, and/or preparing these animals for food; ingestion has also been linked to infection. Consumption of such so-called “bush meat” is particularly hazardous because the flesh is often undercooked. Because of the diversity of animals eaten by local inhabitants, conclusions about the relative risk of meat sources are not known with certainty.

Investigation of the exotic pet industry by state and federal authorities was triggered by the 2003 outbreak. The FDA lifted its restrictions on pet prairie dogs in 2008. The FDA consulted with the CDC and determined that the domestic restrictions placed on certain African rodents, prairie dogs, and certain other animals were no longer needed. However, the CDC restriction on the importation of all African rodents remains in effect to prevent further reintroduction of the monkeypox virus into the United States.

Although WHO considers airborne transmission a possibility, per Dr. Walensky, “We have not seen documentation of that through our experience with this virus or with prior similar viruses.” Epidemiologists are following this unusual outbreak very closely.

The CDC and the Association of American Medical Colleges (AAMC) have asked for each state medical board’s assistance in sharing guidance with health care practitioners licensed in their state or territory. The guidance includes the latest information and resources to plan and prepare for monkeypox virus outbreaks.

The 6-13-22 CDC / AAMC Resource Guide on Monkeypox provides information and resources regarding symptoms, diagnosis, specimen collection, isolation, positive test results, treatment protocols, and patient information.

Update as of June 2, 2022

As we all follow the evolving monkeypox situation, here are some recent updates. Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name “monkeypox.” The natural reservoir of monkeypox remains unknown. However, African rodents and non-human primates (like monkeys) may harbor the virus and infect people.

The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox. Since then, monkeypox has been reported in humans in other central and western African countries.

To date, more than 750 community-based cases have been confirmed in 31 countries, increasing daily; the CDC advises that the risk to the general US population remains low, with 19 confirmed cases. There are currently no recommended travel restrictions, and no transmission was ever detected on aircraft while smallpox was circulating years ago.

Although monkeypox is not a sexually transmitted disease (not transmitted through seminal or vaginal fluids), the high incidence among young men who identify as gay, bisexual, or men who have sex with men supports the evidence that the virus can spread by viral droplets during close contact as well as from direct skin exposure to active lesions. The virus can also cross the placenta from the mother to her fetus.

Although there is no commercial assay to detect the monkeypox virus, diagnostic testing for Orthopoxviruses (which includes the monkeypox virus) is available at LRN laboratories (CDC’s Laboratory Response Network) located throughout the United States and abroad. Newly developed PCR assays will improve the rapid detection and differentiation of monkeypox infections from other rash illnesses. State and local health departments should be contacted before contacting the CDC. To date, no deaths have been reported in European cases, and infections have been mild.

The incubation period is typically 3 to 16 days, with many cases presenting with atypical features including very mild prodromal symptoms of a rash starting in the genital and perianal areas, fever, headache, muscle aches, and back pain, swollen lymph nodes, chills, and fatigue.

This is followed by a uniformly evolving blistering rash, which progresses from macules to papules, vesicles, and pustules and then to scabs and scars (in contrast to chicken pox or syphilis rash that appears in various stages of development). The patient is no longer infectious after the scabs fall off, which may take several weeks.

In the U.S., public health officials are in the process of releasing the two-dose Jynneos smallpox vaccine from the Strategic National Stockpile to protect some high-risk Americans who have been in contact with current monkeypox patients. It is approved to treat both monkeypox and smallpox.

New smallpox/monkeypox Vaccine Information Statement (VIS) dated 6-1-22 is now available from the CDC.


Original Post

In the recent news, there have been talks about the monkeypox cases in Europe and now the United States. President Biden called it something “to be concerned about” and is being very closely monitored here and internationally. Monkeypox was first identified in 1970 in the Democratic Republic of the Congo and has since expanded over the last 10 years to many other African nations. Despite the name, monkeys, like humans, are accidental hosts. The wild animal reservoir remains unknown.

Here is some current information on the situation and monkeypox in general.

From the CDC About Monkeypox | Monkeypox | Poxvirus | CDC as of today:

  • A patient was confirmed in Massachusetts to be infected with a West African strain after returning to the US from Canada, they are currently being isolated and pose no risk to the public. See 2022 United States Monkeypox Case | Monkeypox | Poxvirus | CDC for more information.
  • Monkeypox is a rare viral disease. The virus belongs to the same family and genus as variola virus (causing smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox. The rash is indistinguishable from smallpox.
  • CDC is also tracking multiple clusters of monkeypox cases reported in several countries that don’t normally report monkeypox, including in Europe and North America.
  • The rash associated with monkeypox involves vesicles or pustules that are deep-seated, firm or hard, well-circumscribed, and grow synchronously (all lesions at the same stage as the disease progresses, as opposed to chickenpox); the lesions may umbilicate or become confluent and progress over time to scabs.
  • Presenting symptoms typically include fever, chills, a distinctive rash, or new lymphadenopathy (swollen lymph nodes).
  • The rash associated with monkeypox can be confused with other diseases that are encountered in clinical practice (e.g., secondary syphilis, herpes, chancroid, and varicella-zoster).
  • The illness typically lasts for 2−4 weeks. Although rare, in Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.
  • Based on the limited information available at this time, the risk to the public appears low.


  • Transmission of monkeypox virus occurs when a person comes into contact with the virus from an animal, human, or materials contaminated with the virus. The virus enters the body through broken skin (even if not visible), respiratory tract, or mucous membranes (eyes, nose, or mouth).
  • Human-to-human transmission is thought to occur primarily through large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.
  • Other human-to-human methods of transmission include direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens.
  • The secondary attack rate is estimated at 10% in contacts unvaccinated against smallpox.


  • The vaccine JYNNEOSTM (also known as Imvamune or Imvanex) has been approved by the U.S. Food and Drug Administration for the prevention of monkeypox. The Advisory Committee on Immunization Practices (ACIP) is currently evaluating JYNNEOSTM for the protection of people at risk of occupational exposure to other orthopoxviruses such as smallpox and monkeypox in a pre-event setting.
  • Smallpox (vaccinia) and monkeypox vaccines are effective at protecting people against monkeypox when given before exposure to monkeypox. Experts also believe that vaccination after a monkeypox exposure may help prevent the disease or make it less severe. In addition to the smallpox vaccine, vaccinia immune globulin and some limited use medications are available for monkeypox outbreak control.
  • Routine vaccination of the American public against smallpox stopped in 1972 after the disease was eradicated in the United States and is no longer available to the public. Those that are old enough have a faded but unique vaccination scar on their left upper arm.


About the Author

Dr. Joe Mignogna is Acuity’s Chief Medical Officer.  Connect with him at jmignogna@acuityinternational.com

Dr. Joe Mignogna, MD, MPH, CIME, FACOEM, Chief Medical Officer

Acuity Spotlight: Christopher Hendricks, The United States Air Force

The Acuity Spotlight is our way of highlighting some of the incredibly talented individuals that we’re lucky enough to have on our team. At Acuity, we value diversity and inclusion and focus our attention on bringing candidates who have a wide range of backgrounds and experiences onboard. Our mission is to build enduring relationships that provide secure, stable, and long-term predictable outcomes and we are grateful for the men and women of Acuity who embody our corporate values in everything they do.

Which branch of the military did you serve in?
I served 20 years in The United States Air Force as a member of their security forces.

What are some of the things you remember about adapting to military life?
The whole process of transitioning from being a civilian to becoming a military member was challenging. Going through basic training and tech school (which included having a very strict daily agenda) to getting my first duty station and adapting to being in another country while performing my duties as a US Air Force airman was an adjustment.

When did you leave the military? What were your first few months out of the service like?
I retired from The United States Air Force in 2014.  My first few months out of the service were “odd” to say the least.  Being able to plan and schedule things and no longer having to follow a set schedule established around mission requirements allowed me to decompress from the military life. At first, it proved to be a hard adjustment, even though I found the change both therapeutic and refreshing. I took the time to travel domestically visiting family, and friends and exploring different locations that I didn’t get to visit while I was in the military.

How would you describe the work you do at Acuity and the impact it is making?
The work that I do at Acuity has been phenomenal and it’s something related to what I did in The United States Air Force as a Security Forces member. I’d like to thank Acuity for providing me with my first job as a civilian after serving in The United States Air Force.  Always and forever grateful.

What is your proudest career moment?
My proudest career moment was being part of the Phoenix Raven Program as a team member and then as a team leader. Getting selected as the Phoenix Raven Team Leader of the Year at a US Air Force headquarters was amazing and completed unexpected.

Being able to fly on different aircraft to different locations all over the world providing security support was incredible and something that I put my heart and soul into. I will always be thankful, grateful, and blessed to have been given the opportunity to be a part of, and experience, something of that magnitude.  My dream was to see the world and meet people from all walks of life; The United States Air Force was able to make that dream and vision a reality. I feel such a sense of accomplishment because of my experience, and I’d like to thank The United States Air Force for helping me become the person that I am today.


Christopher Hendricks, Balad Air Base Life Support/Security Services Project, Security Directorate, Flight Line Security Chief, The United States Air Force

Acuity Spotlight: Jacqueline Rodriguez Valdes, Chief Nursing Officer

The Acuity Spotlight is our way of highlighting some of the incredibly talented individuals that we’re lucky enough to have on our team. At Acuity, we value diversity and inclusion and focus our attention on bringing candidates who have a wide range of backgrounds and experiences onboard. Our mission is to build enduring relationships that provide secure, stable, and long-term predictable outcomes and we are grateful for the men and women of Acuity who embody our corporate values in everything they do.

When and why did you decide to become a nurse? What do you like most about being a nurse?

When I was fifteen, I realized the desire to provide care for others was innate. Caring for others is a passion and my driving force for choosing the nursing profession. Being there for my patients at their most vulnerable times and advocating for their well-being was all I wanted to do at an early age.

When I provide bedside care for patients and their loved ones, I take on the role of a family member, always upholding their best interests at the forefront. My aunt encouraged me to become a nurse leader to serve and motivate nurses who in turn will share in this altruistic vision. As a nurse leader, I have the privilege to mentor, motivate, and foster innovation and passion amongst our nursing team.

Can you describe a situation where you felt proud of your healthcare team?

In April 2020, we created a field hospital in New York City during the worst COVID-19 wave in the United States at the time. Nurses from all over the country came to the emergent call for help. This selfless team left their loved ones and the comfort of their homes to serve these critical patients by quickly making the altruistic decision to get on a plane and travel to the unknown that was waiting on the other side. This brave team arrived in New York with a variety of nursing backgrounds, training, and experience focused on one mission, to save lives. It was astonishing to see how this team of professionals melded to form a unified medical unit to provide compassionate nursing care during this most challenging, testing time.

How would you describe the work you do at Acuity and the impact it is making?

I have worked in this organization for five years and during this time we have provided high-quality nursing excellence in a variety of clinical environments. The nursing team champions lead the execution of medical programs such as shelter services, COVID-19 field hospitals, COVID-19 testing centers, emergency response support following natural disasters, mobile medical units, medical reviews, and performing occupational health exams in austere environments. The care provided by our nursing professionals cultivates evidence-based practices, and holistic and compassionate care, which is essential for providing clinical excellence for our examinees and patients.


Jacqueline Rodriguez Valdes, MSN, ARNP, FNP-BC, COHC, is the Chief Nursing Officer. You can connect with her at jrodriguezv@acuityinternational.com.