Search
0 results

No results, please enter a search term above

Monkeypox

Topic Priority Date of Alert
Monkeypox Vaccination Strategy and Prioritization of First Doses Advisory Aug 4, 2022
Pain Management Recommendations for Monkeypox Update Aug 2, 2022
Tecovirimat Treatment for Monkeypox Update Jul 27, 2022
Update on Clinical Presentation and Epidemiology on Monkeypox in Philadelphia Update Jul 8, 2022
Exposure Risk Assessment and Clinical Manifestation of Monkeypox Advisory Jun 8, 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 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

Vaccine Information

The Health Department has begun vaccinating Philadelphians who are at high-risk. Currently, clinics are being offered on a rolling, invitation-only basis. Individuals who believe that they are at a high risk of being exposed to monkeypox can call the Call Center at 215-685-5488 to see if they are eligible to be vaccinated.

To be eligible, people must meet all of the following conditions:

  • Gay, bisexual, transgender, non-binary, and other men who have sex with men, transgender, or non-binary persons; AND
  • Age 18 or older; AND
  • Meet ONE of the following criteria:
    • Have had multiple or anonymous sex partners in the last 14 days and/or believe they have been exposed to an STI or monkeypox in the past 14 days; OR
    • Have had a newly diagnosed STI in the past 3 months, including gonorrhea, chlamydia, early syphilis, or HIV

The eligibility criteria has been established based on who may be at the highest-risk of exposure to monkeypox. As more vaccine is delivered, more people will be invited to these vaccine clinics.

While the vaccine is normally a 2-dose series, the Department of Public Health is currently only administering one dose to patients due to the limited supply of the vaccine. One dose still provides some protection against monkeypox and provides the opportunity to provide vaccine to more individuals who may be at high-risk of contracting monkeypox.

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.
  • Commercial laboratories have begun to offer testing.
    • Testing is now available directly through LabCorp, Quest and Mayo Clinic and will soon become available through several other labs. Please note that LabCorp will accept swabs but not scabs for testing, and that specimen collection must take place in the provider's clinical space and cannot be done at LabCorp locations. Additional information about LabCorp's testing process can be found here.
    • Select 2-4 different lesions to swab for PCR testing. Early lesions may have higher viral loads than older lesions. Discuss collection of scabs with PDPH if no newer lesions are present.
  • For LRN testing: Specimens can also be sent through the Laboratory Research Network (LRN). If testing through the LRN is preferred, immediately notify the Philadelphia Department of Health for additional consultation at 215-685-6741 (business hours) or 216-686-4514 (after hours).
    • Collect two synthetic swabs from each lesion and send each swab in separate dry transport tubes. If testing of the initial swab is orthopoxvirus PCR at the Pennsylvania Department of Health's Bureau of Laboratories (PADOH BOL), the second swab will be sent to the CDC for monkeypox-specific PCR testing.
    • Swab the lesion vigorously with each swab. Note that lesion fluid or material may not be visible even though the specimen is adequate.
    • Clearly label each tube with the lesion location and swab number (1 or 2) along with the patient's name, date of birth, specimen collection date, and specimen type. If lesions are localized to one area of the body, please also number the lesion area (e.g., genital lesion 1 - swab 1, genital lesion 1 - swab 2).
    • Specimens should be refrigerated before transport and transported to PADOH BOL on ice.
    • Include a completed PADOH BOL Specimen Collection Form with the specimens.
  • Consider testing for alternate etiologies, including STIs as well as viral and bacterial infections.
  • Advise patients under investigation for monkeypox who are not hospitalized and are awaiting results to isolate at home until PDPH provides further guidance.

Resources

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.

Posters:

There are no posters for Monkeypox.