Latest Updates

September 2022 - Monkeypox update (JAMA)

As with all infectious disease outbreaks, please expect rapid changes as we learn more about monkeypox. Please reach out to your local ID consultant or Dr. Ben Kruskal (bkruskal [at] neqca.org) with any questions. 

Infection Control/PPE

  • PPE Health care setting: Gown, gloves, mask, eye protection
  • No special disinfection needed; any ordinary healthcare disinfectant is appropriate
  • Transmission primarily through skin-to-skin or mucosa-to-mucosa contact
  • Rarely respiratory droplets; airborne or via fomites

Treatment

  • Post-exposure prophylaxis—see under Vaccines, Prevention
  • Treatment with experimental antiviral tecovirimat may be available through CDC  for patients with:
    • Severe disease (hemorrhagic lesions, confluent lesions, sepsis syndrome, encephalitis or other severity requiring hospital admission)
    • Complications such as secondary bacterial skin or soft tissue infections, GI symptoms including severe nausea/vomiting or diarrhea), pneumonia
    • Lesions in high-risk anatomic location (eyes, mouth, genitals, anus)
    • High risk of severe disease (pregnancy/breastfeeding, immunocompromised, age < 8 y/o, atopic dermatitis or other exfoliative dermatologic conditions)
  • https://www.cdc.gov/poxvirus/monkeypox/clinicians/obtaining-tecovirimat.html

Diagnostic Testing 

 

  • Commercial labs including Quest and Labcorp are now able to do monkeypox testing. Swabs from up to 2 different lesions may be submitted.
  • Lesions should be swabbed with synthetic (NOT cotton) tipped swabs with plastic (NOT wooden) shafts; lesions need NOT be opened or unroofed, just swab the intact lesion vigorously. If a lesion is open or opens during swabbing, collecting fluid on the swab is desirable.
  • Please see these links for detailed instructions on specimen submission: some labs provide specific specimen collection kits, some can use standard materials.
  • In addition to commercial labs, testing is available through the State Lab without preapproval for patients meeting these criteria:
    • Clinically compatible with known risk factor
    • Hospitalized patients and have strong clinical suspicion of monkeypox
    • High risk of severe disease (immunocompromise, pregnancy, children < 8 y/o or significant comorbidities)
    • Patients living in a congregate setting and who have strong clinical suspicion of monkeypox
    • Patients for whom cost of commercial testing is a concern.
  • These are risk factors for monkeypox:
    • Close contact with a person with known or suspected monkeypox;
    • Close contact with a person with a similar rash;
    • Man who has sex with men who regularly has skin to skin physical or sexual contact with other men, especially met through online dating apps or in social venues
    • Recently in endemic areas of Africa and report contact with wild animals, especially rodents.
  • Test clinically compatible patients regardless of specific monkeypox risk factors, and regardless of gender and sexual orientation.
  • Complete specimen collection, labelling and packaging and shipping guidance for the State Lab is available and can be viewed here.
  • DPH Clinical Advisory monkeypox, Aug 5, 2022
  • Instructions for specimen collection for orthopoxvirus testing 7 26 22 at DPH.docx

Materials for Patients

Clinical Course

  • Please note the current outbreak is clinically atypical compared to materials you may read related to monkeypox in general.  Prodrome may be absent; lesions may be sparse and confined only to one location, or one morphology. Maintain a high index of suspicion
  • The differential diagnosis of monkeypox includes:
    • Syphilis
    • HSV
    • Chancroid
    • Varicella (chickenpox)
    • Zoster (shingles)
    • Consider these diagnoses and remember that coinfections with STIs are common.
  • September 2022 - Monkeypox update (JAMA)
  • Monkeypox in July 2022 - What Clinician's Need to Know (JAMA)

Vaccines, Prevention, Boosters

  • Patients with known or presumed exposure to monkeypox may receive Jynneos orthopoxvirus vaccine. Vaccination within 4 days has high likelihood of preventing infection; within 14 days may reduce severity.
  • Due to the severely limited supply of the Jynneos vaccine, first doses for eligible people are being prioritized and second doses will be deferred.
  • Vaccine is available only through the Department of Public Health (DPH):