Monkeypox Guidance for Healthcare Providers

To report a positive laboratory result for orthopox or monkeypox virus, immediately call the Communicable Disease Program at (209) 558-5678 during business hours: Monday-Friday, 8AM-5PM, or send an email to CDNurse@schsa.org


Testing and Specimen Submission

Healthcare providers should be alert and consider monkeypox virus in patients who present with an unexplained rash or lesions consistent with monkeypox:

  1. Instruct patient to isolate and avoid contact with other people while waiting for test results
  2. Submit specimens for monkeypox testing through commercial laboratories if possible. A list of commercial laboratories providing monkeypox testing is available at CDPH's Information for Health Care Providers Page
  3. Treatment with Tecovirimat (TPOXX)

Please check with reference lab regarding their lab-specific submission forms and requirements for specimen collection, labeling, and transport.

There is no need to contact Stanislaus County Public Health for approval to test at commercial laboratories. Providers are required to report all suspected and confirmed cases to Stanislaus County Public Health within 1 working day.

Under certain circumstances, Public Health will directly process specimens using our own labs. This includes if the person suspected to have Monkeypox is pregnant, if they are a health care worker, or if an outbreak is identified in a specific location.

Decision Matrix

Monkeypox Decision Making Matrix

Treatment with Tecovirimat (TPOXX)

Tecovirimat (TPOXX) is an antiviral medication that is approved by the United States Food and Drug Administration (FDA) for the treatment of smallpox in adults and children. Data are not available on the effectiveness of Tecovirimat (TPOXX) in treating monkeypox infection in humans.

Consideration for prescribing Tecovirimat requires documentation and patient informed consent.

General Guidance for Tecovirimat Prescribers

Information for Obtaining and Using TPOXX

Required Documents for TPOXX Use:



Vaccination

Stanislaus County receives Jynneos vaccine allotments from CDPH based on a formula using current monkeypox case counts and eligible population size. We continue to request as many doses as allocated in the shortest timeframe available to address the critical shortage of local vaccine needed to stem the outbreak. Information about the amount of Jynneos vaccine allocated to the county can be found at CDPH's Monkeypox Vaccine Page.


Due to the limited supply of vaccines, Public Health and community providers are currently vaccinating these groups of people:

  • Anyone 6 months of age or older who has had close physical contact in the past two weeks with someone with probable or confirmed MPX infection
  • Anyone who identifies as male or is a transgender woman who has sex with anyone who identifies as male and/or transgender women who meet any of the following criteria:
    • Have HIV and are at risk for MPX
    • Take or are recommended to take HIV PrEP medications
    • Have had an STI in the past year
    • Have group sex, transactional sex, and/or sex at bathhouses, clubs, etc.
    • Have had multiple or new partners in the past two weeks or are planning to have multiple or new partners

People in the above groups may be vaccinated in Stanislaus County even if they live outside of Stanislaus County.

Vaccine appointments are now available on myturn.ca.gov.

For more information regarding Monkeypox Vaccination, visit CDC's Vaccine Clinical Considerations Page.

Infection Control: Healthcare Setting & Monkeypox

  • Droplet precautions should be applied in all healthcare settings when a patient presents with fever and vesicular/pustular rash
  • PPE should be donned before entering the patient's room and disposed of prior to leaving the isolation room. PPE includes
    • Dispoable Gown
    • Gloves
    • Eye Protection (i.e. goggles or a face shield that covers the front and sides of the face
    • NIOSH-Approved particulate respirator equipped with N95 filters or higher
  • Patient should be placed in an isolation room (negative air-pressure if available)
  • If the patient is transported outside of their room, they should use well-fitting source control (e.g. medical mask) and have any exposed skin lesions covered with a sheet or gown

For more information please visit: Infection Prevention and Control of Monkeypox in Healthcare Settings.

Epidemiology of Monkeypox

Risk Factors for Monkeypox:


While anyone can get monkeypox, certain individuals are at higher risk of contracting Monkeypox. This includes people who have:

  • Had close, intimate contact with someone with a suspected or confirmed diagnosis of monkeypox.
  • Touched unwashed materials that were exposed to the fluid present in the lesions including bedding, towels, or clothing.
  • Had contact with bodily fluids of an infected person.

Certain individuals may also be at higher risk of severe disease, including:

  • Immunocompromised individuals
  • Pediatric populations
  • Pregnant or breastfeeding women
  • People with a history or presence of atopic dermatitis and people with other active skin conditions such as eczema, burns, impetigo, and varicella zoster virus infection.

How Monkeypox is Presenting in Current Outbreak:

  • The current data show transmission is higher among people in close social networks.
  • In current outbreaks people with monkeypox generally report having close, sustained physical contact with other people who have monkeypox.
  • Painful herpetiform lesions on the skin and mucous membrane at sites of intimate contact.

Symptoms:

The Key Symptom is Rash or Pimple- or Blister-Like sores that may have these features:

  • Sores are painful or itchy
  • Sores go through multiple stages before healing. Individual sores may be in different stages
  • Commonly found on or near genitals, anus, hands, feet, chest, and face
  • May be found on multiple parts of the body or only one part

Other symptoms include:

  • Fever
  • Chills
  • Tiredness or low energy
  • swollen lymph nodes
  • General body aches

By far, the most common symptom of Monkeypox is rash and sores. Some individuals will experience all these symptoms, while others may only experience a few.


How long do monkeypox symptoms last?

  • Symptoms usually start within 3 weeks of exposure to the virus.
  • Rash 1-4 days after flu-like symptoms.
  • Monkeypox can be spread from the time symptoms start until the rash has healed (typically in 2-4 weeks).
  • A rash is considered healed when all scabs have fallen off, and a fresh layer of skin has formed.

Additional Resources

CDC's Clinician FAQs


CDC's Information for Healthcare Professionals


CDC's Information for Laboratory Personnel


CDC's Information for Veterinarians


2022 U.S. Monkeypox Outbreak


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