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 monkeypox and (2) close or intimate contact with people in a social network experiencing monkeypox 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
Any patient who feels that they are at risk for coming into contact with Monkeypox 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 monkeypox in the past 14 days should be vaccinated immediately.
More information on Philadelphia's monkeypox 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 monkeypox lesions with sharps to increase sample yield. Healthcare workers have acquired monkeypox after needle sticks from sharps used in specimen collection. For additional information on specimen collection and testing, see: Monkeypox 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 Monkeypox 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).
For Healthcare Providers:
- 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 monkeypox. Clinicians are highly encouraged to watch the recording for further information regarding recognition and testing of monkeypox 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 monkeypox outbreak, commercial testing capacity, how to obtain and use TPOXX (tecovirimat) to treat monkeypox, and vaccine strategy,
For Patients and Community Members:
There are no patient or community resources for Monkeypox.
There are no posters for Monkeypox.