Mpox Healthcare Provider Resources

Patient Evaluation

• If a patient is seeking care to evaluate for rash or lesions, please consider checking for common causes of sexually transmitted diseases in a patient with risk factors.
  • Helpful tips: Rash often starts in the genital/perianal area and then progresses to face, arms, palms, and soles.  Sometimes rash will only involve the genital areas. The typical progression of each stage of rash is about 1-2 days. Lesions will scab usually within 7 to 14 days. 

• An updated health advisory from the CDC informs providers that individuals who are immunocompromised due to HIV or other conditions are at a higher risk for severe manifestations of Mpox than people who are immunocompetent. 
• Healthcare providers should recognize underlying risk factors for severe disease and consider treating immunocompromised people by initiating medical countermeasures (such as tecovirimat) early to prevent or mitigate severe manifestations of Mpox.

When evaluating a potential suspect, please test all sexually active adults and adolescents for HIV, syphilis, gonorrhea, chlamydia, and herpes.

CDC encourages providers are encouraged to discuss Pre-Exposure Prophylaxis (PrEP) and the Mpox vaccine for the following eligible groups:

•  Gay, bisexual, or other man who has sex with men or a transgender, nonbinary, or gender-diverse person who in the past 6 months has had any of the following:
  • You have a sex partner with any of the above risks
  • People who anticipate experiencing the above risks, including individuals with multiple sex partners
  • People who anticipate experiencing any of the above scenarios
• Health Care workers in settings where you may be exposed to Mpox:
  • You work with orthopoxviruses in a laboratory
• People who anticipate experiencing the above risks, including individuals with multiple sex partners
• More than one sex partner
• Sex at a commercial sex venue
• Sex-related to a large commercial event or in a geographic area (city or county for example) where Mpox transmission is occurring
• Sex in exchange for money or other items

For more information on severe manifestations of Mpox among people who are immunocompromised due to HIV or other conditions, please visit emergency.cdc.gov/han/2022/han00475.asp. 

Specimen Collection and Testing Criteria

• The current presentation of Mpox mimics symptoms commonly seen in sexually transmitted diseases. Please continue to screen and test those affected according to the latest CDPH Health Advisory (12/11/23) and SBCDPH Orthopox Testing Guidance.

Specimen Collection

• Please refer to the CDC guidance for the preparation and collection of specimens for details: Preparation and Collection of Specimens | Mpox | Poxvirus | CDC. 

Laboratories

• Aegis Science
• Labcorp
• Mayo Clinic Laboratories
• Quest Diagnostics
• Sonic Healthcare

Public Health Laboratory

See SBCDPH Orthopox Testing Guidance. 

The use of the Public Health laboratory is reserved for high-priority specimens as commercially available testing is now available. High-priority specimens include clusters of cases and severe illnesses requiring hospitalizations. Contact your local laboratory for commercially available testing options. If one is not available to you, you may send your specimen to the San Bernardino County Public Health lab.

CDPH Healthcare Provider Health Advisory

Click here to view Updates on Laboratory Testing and Treatment for Mpox Virus Infection in California.

Treatment

Tecovirimat (also known as TPOXX or ST-246) is an antiviral drug approved by the FDA in 2018 to treat smallpox in adults and children. It should be considered in patients with severe Mpox disease or those who are at high-risk for severe disease, such as immunocompromised (HIV/AIDS, cancer, on current medication that suppresses immune function).

TPOXX is available in a capsule form (each capsule containing 200 mg of tecovirimat) or as an intravenous (IV) solution. It should only be administered to those who provide consent to receive treatment. CDPH has provided information for providers on supportive care suggestions for patients with Mpox, which can be found here.

_______

This antiviral therapy is limited to facilities that can carry out the requirements of the investigational new drug (IND) and may be considered after consultation with your LHD. Further details regarding Tecovirimat, visit CDPH website.

The CDC has made it easier for healthcare providers to obtain Tecovirimat (TPOXX) for Treatment of Mpox. Per the CDC Website, Oral tecovirimat for treatment of mpox is available through enrollment in the Study of Tecovirimat for Human Mpox Virus (STOMP). Providers with patients with mpox who are ineligible for STOMP or decline study enrollment, or who require intravenous tecovirimat treatment, and meet treatment eligibility under the EA-IND protocol (e.g., have severe disease or involvement of anatomic areas that might result in serious sequelae, are at high risk for severe disease), should contact us at CDS@dph.sbcounty.gov to inquire about prepositioned oral tecovirimat supply that may be available within SBC jurisdiction. 

For more information on the Tecovirimat (TPOXX) Treatment for your patients and where to obtain consent forms, please visit the CDC’s website. 

Required Tecovirimat (TPOXX) Facility Form

FDA Form 1572: Facilities must complete the FDA Form 1572 before receiving the treatments. Once completed, the facility will be eligible to enroll in stomp or request treatments from San Bernardino County, Department County, Department of Public Health. Tecovirimat IND Online Registry.

Patient Consent Forms

1. Obtain consent form from the patient before treatment: Informed Consent Form_ENG / Informed Consent Form_SPN
2. Alternative short consent forms are available, however, the provider must present two parts, the written and oral summary. Short Consent Form ENG and Written Summary ENG or Short Consent Form SPN and Written Summary SPN

Additional Mpox Forms:

1. Patient Intake Form: To perform a baseline assessment, follow instructions in the Tecovirimat IND Online Registry.
2. Clinical Outcome Form: Progress and outcome information post-treatment can be accessed through the electronic form: Tecovirimat IND Online Registry.
3. Serious Adverse Events: Per FDA requirement, report life-threatening or serious adverse events associated with tecovirimat by completing a MedWatch Form and returning it to CDC via email (regaffairs@cdc.gov) within 72 hours of awareness. The PDF MedWatch Form can also be downloaded from the FDA website.