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Mpox Healthcare Provider Resources

Reporting Guidelines 

CDPH requests that health care providers report cases of persons meeting the definition of a Suspect Case (Case Definitions for Use in the 2022 Mpox Response | Mpox | Poxvirus | CDC) to their LHD to determine eligibility for testing.

  • Please review clinical guidance for the screening of suspected mpox.
  • If mpox is suspected in a patient, immediately contact the San Bernardino County Department of Public Health Communicable Disease Section (CDS) at (800) 722-4794 and report prior to testing. Once a case had been reported, Public Health will begin contact tracing and offer PEP.

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 that are immunocompromised due to HIV or other conditions are at a higher risk for severe manifestations of monkeypox 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 manifestation of monkeypox. 

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

If HIV negative, please offer HIV PrEP. San Bernardino County Department of Public Health’s Federally Qualified Health Centers offer PrEP services. More information on HIV PrEP can be found by visiting dph.sbcounty.gov/programs/hiv-aids/hiv-prevention-2. Resources can also be accessed for PrEP providers by go to www.pleaseprepme.org.

Addition of groups eligible for mpox PrEP (pre-exposure prophylaxis) include:

  • Any man or trans person who has sex with men or trans persons
  • Any man or trans person who is taking or is eligible for HIV PrEP
  • Anyone living with HIV, particularly those with a CD4 count <350/mm3, an unsuppressed HIV viral load, or an opportunistic infection
  • People who have had any of the following in the past 6 months:
  • Sex at a commercial sex venue
  • Sex in association with a large public event in a geographic area where mpox transmission is occurring
  • Sexual partners of people with the above risks
  • People who anticipate experiencing the above risks, including individuals with multiple sex partners
  • Health Care Workers who are likely to collect laboratory specimens from persons with mpox (e.g., persons working in sexual health clinics or clinical settings that serve at risk populations)

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

Evaluating a post-exposure case for healthcare

Any healthcare worker who has cared for a mpox patient should be alert to the development of symptoms that could suggest a mpox infection.

Visit the CDC website to review the exposure risk assessment in determining post-exposure severity in a healthcare worker. 

For additional assistance, please contact our San Bernardino County Department of Public Health Communicable Disease Section at 1(800) 722-4794 to discuss PEP scheduling with our CDS team. 

Specimen Collection and Testing Criteria

  • 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 (6/23/2022) and SBCDPH Orthopox Testing Guidance.

Specimen Collection

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.

Other Laboratories

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

CDPH Healthcare Provider Health Advisory

Click here to view Updates on Laboratory Testing and Treatment for Monkeypox (mpox) Virus Infection in California.

Vaccination

Vaccine Eligibility

San Bernardino County Department of Public Health (SBCDPH) is working closely with California Department of Public Health (CDPH) in its consideration for expanded mpox Post-Exposure Prophylaxis (PEP)/Pre-Exposure Prophylaxis (PrEP). The ultimate goal is to expand vaccine eligibility to populations at highest risk for recent or future exposure in order to increase population-level immunity and disrupt chains of transmission. In addition, outreach and education will be needed to reach all populations at risk and to reduce disparities in vaccine uptake.

SBCDPH will follow the phase/priority guidance set forth by CDPH given the limited supply of the mpox vaccine. At this time, the initial supply of mpox vaccine (JYNNEOS) will be distributed as PEP for named contacts and PrEP for individuals at high occupational risk according to Advisory Committee on Immunization Practices guidance (e.g. laboratory workers performing Orthopoxvirus tests, selected clinicians, response team members). SBCDPH will continue to assess the provision of the vaccine to the community as more vaccine becomes available.

JYNNEOS Vaccine

JYNNEOS is a live, attenuated, non-replicating Orthopoxvirus vaccine that is FDA licensed for prevention of smallpox and MPX in people >18 years. JYNNEOS can be considered for PEP in people who have had a high- or intermediate-risk exposure to MPX (see CDC guidance), as a method to prevent or reduce severity of disease. PEP should be given, if possible, within 4 days of exposure to prevent disease but may still reduce severity of disease if given up to 14 days after exposure.  

Public health authorities also have the discretion to offer PEP to people who do not meet the high or intermediate criteria based on unique characteristics of the situation.

Some laboratory personnel and health care providers who may have close contact with mpox patients can also be considered for pre-exposure prophylaxis (PrEP). See PrEP MMWR for more information.

Full prescribing information for JYNNEOS vaccine:  www.fda.gov/media/131078/download

If you are a healthcare provider interested in obtaining vaccines for clients who are at-risk for mpox, please complete the
San Bernardino County Vaccine Request and Eligibility form.

For questions or concerns related to mpox, please email monkeypox@dph.sbcounty.gov.

Treatment

Most patients have mild disease and recover without medical intervention.

CDPH has provided information for providers on supportive care suggestions for patients with monkeypox (mpox), which can be found here.

An investigational antiviral medication, tecovirimat (also known as TPOXX or ST-246) was licensed by FDA in 2018 to treat smallpox and can be considered to treat mpox disease. This antiviral therapy is available only at limited to facilities that are able to carry out the requirements of the IND, and may be considered after consultation with your LHD. Further details regarding tecovirimat are available on the CDC website.

The CDC has made it easier for healthcare providers to provide tecovirimat (TPOXX) treatment to patients with mpox. For more information on how to request tecovirimat (TPOXX) for your patients and where to obtain request forms, visit the CDC’s website. The request forms have also been provided below.

Required tecovirimat request forms:
Informed Consent Form (English)
Informed Consent Form (Spanish)
Patient Intake Form
FDA Form 1572
Tecovirimat Clinical Outcome Form *Optional*

A limited supply of TPOXX is available at San Bernardino County’s Department of Public Health.
Inquiries can be made at monkeypox@dph.sbcounty.gov or by calling the San Bernardino County Department of Public Health Communicable Disease Section at (800) 722-4794 during normal business hours.

Infection Control in the Healthcare Setting

  • Please work with your facility’s infection preventionists (IP) regarding proper personal protective equipment (PPE), patient placement (single person room without special air handling), and environmental infection control measures according to the latest CDPH Health Advisory (6/23/2022) and current Centers for Disease Control and Prevention (CDC) MPX infection control measures in consultation with your facility’s IP.
  • All staff entering patients’ rooms should wear the following PPE: gloves, gown, eye protection, and NIOSH-approved particulate respirator equipped with N95 respirator filters or higher.