Health Information Portal (HIP)

Mpox

Topic	Priority Priority Alert Conveys the highest level of importance; warrants immediate action or attention. Advisory Provides important information for a specific incident or situation; may not require immediate action. Notification Provides information regarding an incident or situation; unlikely to require immediate action. Update Provides updated information regarding an incident or situation; unlikely to require immediate action.	Date of Alert
Increase in Mpox Cases in Philadelphia	Advisory	Mar 12, 2024
Mpox Caused by Human-to-Human Transmission of Monkeypox Virus with Geographic Spread in the Democratic Republic of the Congo	Advisory	Dec 8, 2023
Update Regarding Potential Risk for New Mpox Cases	Advisory	May 17, 2023
Update on Managing Monkeypox in Patients Receiving Therapeutics	Update	Nov 21, 2022
Monkeypox Updates: Testing, Treatment, and Vaccine Updates	Update	Nov 4, 2022

Surveillance

Clinical presentation in the current outbreak has been atypical and often there is no prodrome. All patients have been found to have a skin rash upon physical examination, however the rash is often not scattered and is instead limited to one body site. Lymphadenopathy has not been universal during the current outbreak.

Key epidemiologic risk factors have included (1) contact with a person or people with a similar appearing rash or a diagnosis of mpox and (2) close or intimate contact with people in a social network experiencing mpox activity (e.g., men who have sex with men and transgender persons who have sex with men who meet partners through an online website, digital app, or social event).

Worldwide Surveillance Data from the CDC

Vaccine Information

Any patient who feels that they are at risk for coming into contact with mpox can now be vaccinated. No additional eligibility criteria need to be met.

Outreach should continue to those who are most at risk, including gay, bisexual, transgender, or other men who have sex with men and/or transgender, gender non-conforming, or non-binary persons who meet the following criteria:

• Have had multiple or anonymous sex partners in the last 14 days
• Have had a newly diagnosed STI in the past 12 months, including gonorrhea, chlamydia, early syphilis, or HIV
• Have recently attended or plan to attend any venue where anonymous sex or sex with multiple partners will occur (e.g. saunas, bathhouses, sex clubs, sex parties)
• Have met recent partners or plan to meet new partners through social media platforms (such as Grindr, Tinder, or Scruff), or at clubs, raves, sex parties, or saunas

Additionally, anyone with known close contact (skin-to-skin) with someone with mpox in the past 14 days should be vaccinated immediately.

More information on Philadelphia's mpox response can be found on the City of Philadelphia's webpage.

Diagnosis & Management

The following should be considered for management of suspected cases:

• Place the patient in a private examination room as soon as possible and make sure to keep the door closed.
• Provide the patient with a surgical mask to wear and a sheet or gown to cover lesions on exposed skin.
• Personnel collecting specimens should use PPE, including gowns, gloves, an N95 respiratory or equivalent, and eye protection. Maintain documentation of staff who have contact with the patient.

Healthcare workers using appropriate personal protective equipment (gown, gloves, N95 or surgical mask, and eye protection) should collect lesion specimens with sterile non-cotton swabs. Swabs sent to commercial labs should be sent in viral transport media. It is not necessary or recommended to unroof, open or aspirate mpox lesions with sharps to increase sample yield. Healthcare workers have acquired mpox after needle sticks from sharps used in specimen collection. For additional information on specimen collection and testing, see: Mpox Virus Testing Procedures For Labs

Regarding treatment of suspected and confirmed cases:

• Tecovirimat should be considered for pregnant and people who are breastfeeding or chestfeeding people as well as those with or at risk of severe disease, with involvement of anatomic areas that might result in serious sequalae, pediatric populations younger than 8 years of age and people with a condition affecting skin integrity. Black and African American individuals who have contracted monkeypox are less likely to receive TPOXX compared with patients who are White (33% vs. 46%). Be sure to evaluate all patients to determine eligibility for TPOXX.
• Providers should inform patients about the Study of Tecovirimat for Human mpox Virus (STOMP) for their voluntary participation. University of Pennsylvania is a site locally. Reach out to Bill Short, MD at 267-971-3275 for more information about referring a patient. If enrollment in STOMP is not feasible for a patient, tecovirimat can be used under CDC’s expanded access protocol (EA-IND).
• According to the recently updated EA-IND “Tecovirimat treatment beyond the standard 14-day course may be considered at short increments of extension (e.g., 7 to 10-day or 14-day course) at a time while monitoring for clinical improvement or lack of response and adverse events to reassess continuing or stopping tecovirimat treatment accordingly.” In severe cases or in those who are highly immunocompromised consider prolonged courses of treatment. CDC consults are available for clinical teams treating patients with severe disease. Call the Division of Disease Control (DDC) at 215-685-6741 (business hours) or 215-686-4514 (after hours, ask for DDC on-call staff).

Resources

For Healthcare Providers:

PDPH Resources

• Walk-Up Vaccine Flyer
• Fact Sheet: English | Spanish | Chinese | French | Russian | Vietnamese
• Harm Reduction: English | Spanish | Chinese | French | Russian | Vietnamese
• Palm Card: English | Spanish | Chinese | French | Russian | Vietnamese
• Infographic: English | Spanish | Chinese | French | Russian | Vietnamese

CDC Resources

• The Centers for Disease Control and Prevention (CDC) recently conducted a Clinical Outreach and Communication Activity (COCA) call that provided updated information on the clinical diagnosis and treatment of mpox. Clinicians are highly encouraged to watch the recording for further information regarding recognition and testing of mpox including clinical case studies and photos from the current outbreak.
• The CDC will be hosting another COCA call on Tuesday, July 26 to provide additional updates on the epidemiology of the mpox outbreak, commercial testing capacity, how to obtain and use TPOXX (tecovirimat) to treat mpox, and vaccine strategy,

For Patients and Community Members:

Posters:

There are no posters for Mpox.