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Monkeypox

Latest Updates

Information for the General Public

Information for Healthcare Providers

 

Latest Updates

For the most current information on 2022 monkeypox cases including counts of cases by state see the CDC U.S. Monkeypox 2022: Situation Summary.

 

Information for the General Public

What is monkeypox?

  • Monkeypox is a rare disease that is caused by the monkeypox virus.
  • Monkeypox virus belongs to a group of viruses called Orthopoxvirus, which includes the variola (smallpox) virus, and the vaccinia virus, which is used in the smallpox vaccine.  
  • Monkeypox is of public health concern because the illness is like smallpox and can be spread from infected people, animals, and items contaminated with the virus (ex: bedding sheets). 
  • Monkeypox was first identified in 1958 and occurs primarily in Central and West African countries.
  • Monkeypox cases have occurred in the U.S. in the past (mostly related to international travel or importation of animals) but have been very rare.
  • Recently people with monkeypox infection, not related to travel to Central and West Africa, have been reported in multiple countries, including the US.
CDC Fact Sheets
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Video courtesy of UC Davis Health

How can monkeypox spread?

  • Monkeypox can spread to anyone through close, personal, often skin-to-skin contact including:
    • Direct contact with monkeypox rash, sores or scabs
    • Contact with objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox
    • Through respiratory droplets or oral fluids from a person with monkeypox
  • This contact can happen during intimate sexual contact including:
    • Oral, anal, and vaginal sex
    • Hugging, massage, or mutual masturbation
    • Kissing and talking closely
    • Touching fabrics and objects during sex that were used by a person with monkeypox, such as bedding, towels and sex toys
  • We know the virus can be spread in fluid or pus from monkeypox sores, and are trying to better understand if virus could be present in semen or vaginal fluids.

 

What are the symptoms of monkeypox?

  • Early flu-like symptoms of monkeypox can include:
    • Fever
    • Headache
    • Muscle aches and backache
    • Swollen lymph nodes
    • Chills
    • Exhaustion
  • A rash or sore, sometimes located on or near the genitals or anus, but sometimes in other areas like the hands, feet, chest or face.
    • Sores will go through several stages before healing.
  • Sores may be inside the body, including the mouth, vagina, or anus.
  • Some people experience a rash or sores first, followed by other symptoms and some only experience a rash or sores.
  • Monkeypox can be spread from the time symptoms start until all sores have healed and a fresh layer of skin has formed – this can take several weeks.

 

What if I am concerned I may have monkeypox?

If you have a new or unexplained rash, sores, or other symptoms suggestive of monkeypox:

  • See your healthcare provider – if you don’t have a provider or health insurance, call the Orange County Health Care Agency Health Referral Line:
    • Toll Free — 1 (800) 564-8448
    • TDD (Phone for the Hearing Impaired) — 1 (800) 801-7100
  • When you see a healthcare provider for possible monkeypox, remind them that this virus is circulating in the community.
  • Avoid sex or being intimate with anyone until you have been checked out.

 

What if I or my partner have monkeypox?

  • Follow the treatment and prevention recommendations of your healthcare provider.
  • Avoid sex or being intimate with anyone until all your sores have healed and you have a fresh layer of skin formed.
  • If you have monkeypox or are waiting for test results please see CDC's guidance on home isolation and infection control for measures to keep yourself and others safe.

 

Information for Healthcare Providers

Clinical signs and symptoms

The CDC has put together a Monkeypox Clinical Recognition page, that provides information on incubation period, prodromal symptoms, provides pictures of characteristic rash, and the time-course of the rash.

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Photo source: Centers for Disease Control and Prevention

 

Infection Control

For the most current recommendations see the CDC’s Monkeypox Infection Control: Healthcare Settings.

Personal protective equipment used by healthcare personnel who enter the patient’s room should include:

  • Gown
  • Gloves
  • Eye protection (i.e., goggles or a face shield that covers the front and sides of the face)
  • NIOSH-approved N95 filtering facepiece or equivalent, or higher-level respirator

 

Reporting

If you suspect that you have a patient with monkeypox contact the OCHCA Communicable Disease Control Division immediately at 714-834-8180.  There is no commercially available testing at this time and requests for testing MUST be made via the local health jurisdiction. 

 

Testing

Requests for testing must be preapproved by calling the local health jurisdiction (OCHCA Communicable Disease Control Division immediately at 714-834-8180).  PCR testing for orthopox virus neucleic acid at the CDPH Orthopox Virus Laboratory, Positive test results will be reported and may be managed as presumptive monkeypox.  Confirmatory testing for monkeypox will subsequently be conducted at the CDC.

 

Specimen collection requirements

  • The following human specimens may be submitted for testing at CDPH VRDL: Dry swabs of lesions, using sterile nylon, polyester, or Dacron swabs with plastic or aluminum shaft.
  • More than one lesion should be sampled, preferably from different body sites, for preliminary and confirmatory testing.
    1. Vigorously swab or brush lesion with two separate sterile dry swabs;
    2.  Break off swabs into separate 1.5- or 2-mL screw-capped tubes with O-ring or place each entire swab in a separate sterile container.
  • Label sample and store each lesion separately.
  • Acceptable specimen types include lesion swabs (dry or in viral transport medium and lesion crusts. Swabs are preferred over lesion crusts. At this time universal transport media is not acceptable for specimen submission.
  • Store all specimens at 4°C if shipping within 24-72 hours; store at -80C if shipping will be delayed.

 

Vaccines for pre- & post-exposure prophylaxis

When used properly vaccination can be effective at preventing or mitigating monkeypox virus infection.  Resources on the use of vaccines are linked below as well as links to ACIP guidance on the use of the two licensed vaccines (ACAM200 and JYNNEOSTM ) to prevent smallpox as well as links to the package inserts for these products.  At this time, requests for vaccine should be coordinated through the local health jurisdiction.    

CDC Monkeypox Vaccine Guidance

Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022 MMWR / June 3, 2022 / Vol. 71 / No. 22

Use of Vaccinia Virus Smallpox Vaccine in Laboratory and Health Care Personnel at Risk for Occupational Exposure to Orthopoxviruses – Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015 Source: MMWR 2016, 65(10);257–262

ACAM2000, (Smallpox (Vaccinia) Vaccine, Live) package insert

JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) suspension for subcutaneous injection package insert

 

Treatment

Most cases of monkeypox experience mild or self-limited diseases.  There is currently no licensed treatment for monkeypox.  There are three agents (Tecovirimat, Cidofovir, and Vaccinia Immune Globulin) available from the CDC under Expanded Access Investigational New Drug Protocol (EA-IND).  See the CDC’s Interim Clinical Guidance for the Treatment of Monkeypox for the latest guidance.

 

Last Updated: June 30, 2022