Mpox Resources for Providers

If you encounter a patient with symptoms consistent with Mpox or have had exposure to Mpox, standard precautions should be implemented for all patient care. All health care personnel including administrative staff should be masked as Infection Prevention and Control for COVID-19.

• If possible, patients to notify clinic ahead of time regarding any rash evaluation.
• Ideally health centers should utilize initial virtual evaluation for such cases if possible.
  
• Do not place suspect patient in general waiting area.
  
• Patient should be placed in a single-person room. Door kept closed if able to do so safely. Again, do not put the patient in the general waiting area.
  
• Patient should have a dedicated restroom.
  
• Limit movement of patient throughout facility. If patient must leave private room, patient should be wearing source control including mask, and a sheet or gown to cover any exposed skin lesions.
  
• Any procedures that are likely to spread oral secretions should be performed in an AIIR.
  

Any health care personnel that encounter a patient suspected of mpox infection should have the following personal protective equipment (PPE):

• Gown
• Gloves
  
• Eye Protection
  
• NIOSH – approved N95 filtering facepiece of equivalent, or higher – level respirator
  

Pregnant or immune-compromised staff should avoid interacting with suspect patients.

• Had contact, including sexual, with anyone with a rash or confirmed/probable mpox
• Traveled outside the US or to a state with mpox cases
  
• Had contact with a dead or live wild animal or exotic pet endemic to Africa
  
• Examine patient for deep-seated and well-circumscribed lesions, often with central umbilication (Photo credit: UK Health Security Agency as displayed on CDC’s website)
  
• Take a picture of the rash if possible
  

Immediately contact your LHD to discuss the best ways to:

• Collect lab specimens
• Isolation guidance for the patients
  
• Process for obtaining post exposure prophylaxis and treatment if needed
  

If the rash is characteristic or the patient meets any of the exposure criteria above and has symptoms of mpox, contact your local health department prior to collecting diagnostic specimens.

In addition to isolating infectious patients and use of PPE when caring for patients, other standard precautions can limit the transmission of mpox virus.

• Proper hand hygiene after all contact with an infected patient and/or their environment during care.
• Correct containment and disposal of contaminated waste (e.g., dressings) in accordance with facility-specific guidelines for infectious waste or local regulations pertaining to household waste.
  
• Care when handling soiled laundry (e.g., bedding, towels, personal clothing) to avoid contact with lesion material. Soiled laundry should never be shaken or handled in manner that may disperse infectious particles.
  
• Care when handling used patient-care equipment in a manner that prevents contamination of skin and clothing. Ensure that used equipment has been cleaned and reprocessed appropriately.
  
• Ensure procedures are in place for cleaning and disinfecting environmental surfaces in the patient care environment. Any EPA-registered hospital disinfectant currently used by health care facilities for environmental sanitation may be used. Follow the manufacturer’s recommendations for concentration, contact time, and care in handling.
  

Mpox is spread between people mainly through direct skin to skin contact with infectious sores, scabs, or body fluids. It can also spread by respiratory secretions during prolonged face-to-face contact. It can spread during intimate contact between people, including during sex, kissing, cuddling, or touching parts of the body with mpox lesions.

• Fever
• Chills
• Headache
• Muscle Aches
• Fatigue
• Lymphadenopathy: swollen lymph nodes

In one to three days, a rash with raised bumps develops. The rash will start out as flat, red bumps and then turn in to blisters which fill with pus. After several days, the blisters will crust and fall off.

The rash associated with mpox involves vesicles or pustules that are deep-seated, firm or hard, and well-circumscribed; the lesions may umbilicate or become confluent and progress over time to scabs.

As a health care provider, relaying prevention and control messages will help your patient to reduce their risk to further spread of mpox infection, be exposed and infected, and prevent re-infection.

The messages are:

• Anyone can get mpox. This is not a “gay disease”. Anybody who has sex or in direct physical contact with an infected individual may be exposed and become infected!
  • In Illinois, there are mpox cases among cis-gendered and transgender females.
    
• A lot of close contact with other people – skin-to-skin or face-to-face – can increase your risk. You can lower your risk by limiting your direct physical contact between yourself and others in crowded situations.
  
• Rash, bumps, or blisters may appear anywhere on the body, including the genitals, however, patients may not see or know of symptoms and can still spread the virus.
  
  • Inquire your patient on unexpected rash, sores, or lesions.
    
• If patients and their partners feel sick (flu-like symptoms, enlarged lymph nodes), and especially if they have a new or unexpected rash or sores, or have been exposed, tell them to not have sex and refrain from being in close physical contact with others or pets immediately. Have them stay home. Avoid clubs, parties or gatherings until they have talked to a health care provider.
  
• If they choose to have sex while sick, they should avoid kissing and other face-to-face contact. Cover all sores and lesions with clothing or sealed bandages and wear a mask. This may help reduce – but not eliminate – their risk of transmission.
  
• Have your patients wash their hands, sex toys and bedding before and after sex or other intimate activities.
  
• Have them call (do not visit) to make an appointment to see you as a health care provider.
  

Consultation with the local and state health departments and Centers for Disease Control and Prevention (CDC) should be performed prior to collecting specimens. Real-time PCR may be used on lesion material to diagnose a potential infection with mpox virus.

There is a growing list of laboratories that offer mpox/orthopoxvirus testing. Exact sample collection guidelines and supplies will vary based on your selected laboratory provider.

Personnel who collect specimens should use personal protective equipment (PPE) in accordance with recommendations for health care personnel. Specimens should be collected in the manner outlined below. When possible, use plastic rather than glass materials for specimen collection.

More than one lesion should be sampled, preferably from different locations on the body and/or from lesions with differing appearances. Refer to the Poxvirus Molecular Detection and Poxvirus Serology tests on the CDC Test Directory for specimen storage, packaging, and shipping instructions.

For more information, visit: https://www.cdc.gov/laboratory/specimen-submission/

Health care providers should report by telephone to their local health departments immediately. 

Standard cleaning and disinfection procedures should be performed using and EPA-registered hospital-grade disinfectant with and emerging viral pathogen claim. Products with Emerging Viral Pathogens Claim can be found on EPA’s list Q. Be sure to follow manufacturer’s directions for concentration, contact time (dwell time, kill time), care and handling of product.

Wet cleaning methods are preferred. Avoid dusting, sweeping, or vacuuming.

Soiled laundry including but not limited to bedding, towels, clothing, should be handled in accordance with standard practices. Avoid contact with lesion material that may be present on the soiled laundry. Soiled laundry should be appropriately bagged and never shaken or handled that may disperse infectious material.

Health care workers who have cared for an mpox patient should be alert to the development of symptoms that could suggest mpox infection, especially within the 21-day period after the last date of care, and should notify infection control, occupational health, and the health department to be guided about a medical evaluation.

Health care workers who have unprotected exposures (i.e., not wearing PPE) to patients with mpox do not need to be excluded from work duty, but should undergo active surveillance for symptoms, which includes measurement of temperature at least twice daily for 21 days following the exposure. Prior to reporting for work each day, the health care worker should be interviewed regarding evidence of fever or rash.

Health care workers who have cared for or otherwise been in direct or indirect contact with mpox patients while adhering to recommended infection control precautions may undergo self-monitoring or active monitoring as determined by the health department.

Transmission of mpox requires prolonged close contact with a symptomatic individual. Brief interactions and those conducted using appropriate PPE in accordance with Standard Precautions are not high risk and generally do not warrant PEP. See the link below and/or contact your local or state health department for information.

Local health departments should request the mpox vaccine from the Strategic National Stockpile (SNS) through their emergency preparedness and response procedures.

In the United States, the supply of JYNNEOS is limited but is expected to grow in the coming weeks and months. So providers will need to determine which patients need JYNNEOS based on the following criteria, as ACAM2000 has limitations on who can receive that vaccine.

• Individuals with certain health conditions, such as weakened immune systems like HIV, skin conditions like eczema or other exfoliative skin conditions, or pregnancy should be given JYNNEOS.

The immune response for JYNNEOS take 14 days after the second dose (of two doses) and 4 weeks after the ACAM2000 dose for maximal development. Please remind patients receiving these vaccines that they should continue to take steps to protect themselves from infection.

JYNNEOS is a two dose vaccine, with the second injection 28 days after the first. JYNNEOS is currently licensed by the FDA for use in people ages 18 and older. Use in younger populations currently requires requesting and obtaining a single patient emergency use authorization from FDA for each person under 18 years.

Adverse reactions after JYNNEOS include injection site reactions such as pain, swelling, and redness. Fatigue, headache, and muscle pain were the most common systemic reactions observed after JYNNEOS in a clinical trial.

While there are no data in people who are pregnant or breastfeeding, animal data to no show evidence of reproductive harm. Pregnancy and breastfeeding are not contraindications to receiving JYNNEOS.

When vaccinating with ACAM2000, a successful inoculation will lead to a lesion (known as a “take”) will develop at the site of the vaccination. This lesion may take up to 6 weeks or more to heal.

Adverse reactions after ACAM2000 include injection site pain, swelling, and redness; fever; rash; lymph node swelling; and complications from inadvertent inoculation. ACAM2000 may cause myocarditis and pericarditis. People with severe allergy to any component of the vaccine should not receive it. In addition, people with severely weakened immune systems should not receive this vaccine.

ACAM2000 should not be given to infants less than 12 months of age or to people with the following conditions:

• Congenital or acquired immune deficiency disorders, including those taking immunosuppressive medications and people living with HIV (regardless of immune status)
• Eczema or other exfoliative skin conditions, and people with a history of eczema or other exfoliative skin conditions
  
• Pregnancy
  
• Cardiac disease
  
• Eye disease treated with topical steroids
  

Many people infected with mpox virus have a mild, self-limiting disease course in the absence of specific therapy. However, the prognosis for mpox depends on multiple factors, such as previous vaccination status, initial health status, concurrent illnesses, and comorbidities among others. Patients who should be considered for treatment following consultation with IDPH and the CDC might include:

• People with severe disease (e.g., hemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalization)
• People who may be at risk of severe disease:
  
  • People with immunocompromise
    
  • Pediatric populations, particularly patients younger than 8 years of age
    
  • People with a history or presence of atopic dermatitis, persons with other active exfoliative skin conditions
    
  • Pregnant or breastfeeding people
    
  • People with one or more complications
    
• People with mpox virus aberrant infections that include accidental implantation in eyes, mouth, or other anatomical areas where mpox virus might constitute a special hazard
  

For additional information on patients best qualifying for treatment and treatment options, visit the CDC page with Treatment Information for Health Care Professionals.

• Exposure risk assessment and public health recommendations for individuals exposed to a patient with mpox (CDC)
• Information For Health Care Professionals (CDC)
• Mpox Commercial Testing and State Lab Testing Criteria

• Mpox Considerations for Oral Health Providers