Monkeypox (MPX) Resources for Providers

What are the symptoms of MPX?

• Fever
• Headache
• Muscle aches and backache
• Swollen lymph nodes
• Chills
• Exhaustion
• A rash that can look like pimples or blisters that appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. The rash goes through different stages before healing completely. The illness typically lasts two to four weeks. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.

How does MPX spread?

MPX is spread through symptomatic individuals through close contact with lesions, bodily fluid or respiratory secretions and objects that have had contact with lesion crusts or bodily fluids (e.g., contaminated linens, bandages, dishes.

Refer to the CDC's Clinician FAQs for current information on MPX transmission, risk and strains.

How can MPX be prevented?

Refer to the CDC's Clinician FAQs for current information on what you can advise patients to do to reduce transmission of MPX.

Individuals can take the following steps to prevent getting MPX:

• Avoid close, skin-to-skin contact with people who have a rash that looks like MPX.
  • Do not touch the rash or scabs of a person with MPX.
  • Do not kiss, hug, cuddle or have sex with someone with MPX. Refer to the Centers of Disease Control and Prevention's (CDC's) Monkeypox and Safer Sex flyer (PDF) for more information.
• Avoid contact with objects and materials that a person with MPX has used.
  • Do not share eating utensils or cups with a person with MPX.
  • Do not handle or touch the bedding, towels, or clothing of a person with MPX.
• Wash your hands often with soap and water or use an alcohol-based hand sanitizer.

What vaccines are available to prevent MPX?

Refer to the CDC's Clinician FAQs for current information vaccines and treatment for MPX.

Because MPX and smallpox viruses are genetically similar, vaccines developed to protect against smallpox viruses may be used to prevent MPX infections.

JYNNEOS™ and ACAM2000 are currently licensed vaccines in the United States to prevent smallpox.

These vaccines may be recommended for people who have had or may have contact with someone who has MPX, or for health care and public health workers who may be exposed to the virus.

Who should get the MPX vaccine?

The CDC recommends vaccination for people who have been exposed to MPX and people who may be more likely to get MPX.

People more likely to get MPX include those who:

• Have been identified by public health officials as a contact of someone with MPX.
• Are aware that one of their sexual partners in the past two weeks has been diagnosed with MPX.
• Had multiple sexual partners in the past two weeks in an area with known MPX.
• Have jobs that may expose them to orthopoxviruses.

What about receiving the MPX vaccine after exposure to the virus?

The CDC recommends that the vaccine be given within four days from the date of exposure to prevent onset of the disease. If given between four and 14 days after the date of exposure, vaccination may reduce the symptoms of the disease, but may not prevent the disease.

How should someone get tested for MPX?

If you are treating a patient who should be tested, please work with the patient to collect the specimens and send them to a laboratory for testing.

Currently, California has 10 public health laboratories, called Laboratory Response Network (LRN-B) labs, that can test for MPX, including the California Department of Public Health (CDPH) Viral and Rickettsial Disease Laboratory (VRDL). The CDPH is exploring options to increase testing availability in California.

For more information on lab testing, visit the CDPH website.

Providers should also check with their local health department for more information on case reporting and treatment options available.

Provider Health Alerts

Providers can refer to the Provider Health Alerts page for recent advisories from public health agencies and/or other organization to help promote awareness.

California Department of Public Health

• MPX (symptoms, transmission, prevention, diagnosis, California data and more)
• MPX toolkit

Centers for Disease Control and Prevention

• MPX
• Signs and symptoms
• Prevention
• Considerations for MPX Vaccination
• Treatment

Toolkit for providers

The following resources from public health agencies and have been pulled together for providers to use and/or share with their patients to help them understand MPX.

• Information created by and for gay, bisexual men, and transgender people who have sex with men – English (PDF)
• Information created by and for gay, bisexual men, and transgender people who have sex with men – En Español (Spanish) (PDF)
• Disinfection Home and Other Non-Healthcare Settings – CDC
• Monkeypox and Safer Sex – CDC (PDF)
• Monkeypox Fast Facts – TPOXX (tecovirimat) – U.S. Food & Drug Administration (PDF)
• Los Angeles County-specific resources
  • Sexual Health Clinic Registration Schedule (PDF)
  • Home Isolation Instructions for People with Monkeypox Infection (PDF)
  • What Pet Owners Should Know About Monkeypox (PDF)
  • Guidance for Individuals Who Have Been Exposed to Monkeypox (PDF)

Added October 6, 2022

On September 29, 2022, the Centers for Disease Control and Prevention (CDC) Health Alert Network (HAN) issued a health advisory to inform health care providers that:

1. Severe manifestations of monkeypox (MPX) have been observed in the United States in the current outbreak.
2. People who are immunocompromised due to HIV or other conditions are at higher risk for severe manifestations of MPX than people who are immunocompetent.
3. Because people with HIV-associated immunocompromise are at risk for severe manifestations of MPX, the HIV status of all sexually active adults and adolescents with suspected or confirmed MPX should be determined.
4. There are diagnostic and clinical management strategies that may help address severe manifestations of MPX.

Providers can access the full health advisory (PDF) for:

• Additional background information.
• Recommendations for health care providers.
• Recommendation for public health jurisdictions.
• Recommendation and information for the general public.

August 18, 2022

The Los Angeles County Department of Public Health (LAC DPH) has provided an updated guidelines on expedited testing for persons experiencing homelessness (PEH) and alternative JYNNEOS dosing in regards to the monkeypox virus.

Help control the spread of monkeypox by testing for PEH

The following actions were adapted from the LAC DPH Health Update: Monkeypox Updates Including Expedited Testing for PEH and Alternative JYNNEOS Dosing, published on August 12, 2022. Please view the update in full for additional details and information, including contact information for clinical consultations or to request approval for monkeypox testing.

• Test the rash of any patient with suspected monkeypox.
  
  This includes any patient with a new characteristic rash and patients with risk factors for monkeypox and a new rash. The rash associated with monkeypox can be confused with other rashes encountered in clinical practice including herpes, syphilis, and varicella and co-infections have been reported.
  
  
• Submit specimens for monkeypox testing through commercial labs with the exception of specimens from PEH.
  
  If you suspect monkeypox in a person experiencing homelessness, submit specimens to the LAC DPH Public Health Laboratory (PHL) to expedite test results and decisions on PEH placement needs. Providers who do not have access to commercial orthopoxvirus testing may submit samples from suspect cases to the LAC DPH PHL. Consultation and approval is required before submitting specimens for testing at the LAC DPH PHL.
  
  
• Instruct patients with suspected monkeypox to isolate immediately pending test results.
  
  If an alternative diagnosis is made, isolation can be discontinued. Patients with confirmed monkeypox should continue to isolate in accordance with LAC DPH monkeypox isolation instructions (PDF).
  
  
• Report all Los Angeles County residents with orthopoxvirus-positive and/or presumptive positive test results if using a commercial lab.
  
  See the Reporting section of the Healthcare Provider Monkeypox Hub for information on secure online reporting and other options. It is not necessary to report results of tests processed by LAC DPH PHL.

Authorized emergency use of JYNNEOS

To make the limited supplies of JYNNEOS vaccine available to more people, the FDA authorized JYNNEOS to be administered as:

• An injection volume of 0.1mL intradermally as a 2-dose series to individuals 18 years of age and older at high risk of monkeypox infection who do not have a history of keloid formation.
• An injection volume of 0.5mL subcutaneously as a two-dose series to individuals under the age of 18 who are at high risk of monkeypox infection. This regimen is also available for individuals ages 18 and over who have a history of keloid formation.

Refer to the Monkeypox Vaccine Provider website for further guidance and training.

For information on monkeypox vaccination, including eligibility and how to refer patients for vaccination, see Monkeypox Vaccination and Post Exposure Prophylaxis.

Health care providers should adhere to the Centers for Disease Control and Prevention (CDC) recommendations to reduce risk of MPX virus transmission to health care personnel (HCP) during collection of specimens from lesions for laboratory diagnosis of MPX.

The California Department of Public Health (CDPH) recommends HCP adhere to all CDC recommended infection prevention and control measures to reduce the risk of MPX virus transmission in health care settings, including recommended PPE and the following guidance for safe collection of MPX lesion specimens (PDF) for diagnostic testing:

1. At triage, screen patients by asking questions about presence of MPX risk factors and if they have any new lesions concerning for infection on their body. If they answer yes to either question, place the patient in a single occupancy room and flag the encounter for the HCP to ensure use of recommended PPE.
2. Before entering the room of a person who may need to be tested for MPX or when the decision to perform testing is made for a patient who was not flagged, perform hand hygiene, and don the recommended PPE: N95 respirator, eye protection (goggles or face shield), gown, and gloves.
3. Explain to the patient the process of specimen collection to ensure cooperation and minimize unexpected movement.
4. Vigorously swab each lesion, avoiding contamination of gloved hands, to ensure adequate viral DNA is collected. Do NOT de-roof or aspirate the lesion. Do NOT use sharps. Vigorous swabbing of lesions maximizes the probability of achieving accurate diagnostic results. Use of sharps, (e.g., needles, scalpels, lancets) is not necessary and has a risk of a sharps injury to the HCP.
5. Insert each swab into a sterile container. Do not use glass containers. Carefully bend to break the swab's shaft to fit inside the sterile container (if applicable or place the entire swab into the container). After completely securing the lid, wipe the container with an Environmental Protection Agency (EPA)-approved disinfectant for emerging viral pathogens. Placing parafilm around the lid of the container is recommended for additional leak-proof protection, but not required. Remove gloves, perform hand hygiene, and don a new pair of gloves.
6. Cover all exposed lesions, (e.g., hands, arms, face) with gloves, bandages or dressings. Cover any draining lesions that may not be exposed, (e.g., genital, feet) with a dressing.
7. After the patient leaves the room, wipe down the exam table and other high touch surfaces using an EPA-registered disinfectant (List Q).

HCP can also refer to the CDC's print out for additional tips on specimen collection.

For more information and resources on specimen collection, refer to the CDPH Healthcare Provider Advisory: Guidance for Safe Specimen Collection From Monkeypox (MPX).