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.
- 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
- 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)
- 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
- 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:
- 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):