Monkeypox Resources: What Healthcare Professionals Should Know
Resources compiled by: R.W. “Chip” Watkins, MD, MPH, FAAFP – Special Government Employee, CDC, and member of CDC’s CLIAC (Clinical Laboratory Improvement Advisory Committee)
On Thursday, August 4, 2022, the Biden administration declared the monkeypox outbreak a public health emergency in an effort to galvanize awareness and unlock additional flexibility and funding to fight the virus’ spread. Below lies a few of the fundamentals:
- Monkeypox Case Definition – i.e., suspect case, probable case, confirmed case and criteria
- If clinicians identify patients with a rash that could be consistent with monkeypox, especially those with a recent travel history to central or west African countries, parts of Europe where monkeypox has been reported, or other areas reporting monkeypox cases, monkeypox should be considered as a possible diagnosis.
- The rash associated with monkeypox 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.
- Presenting symptoms typically include fever, chills, the distinctive rash, or new lymphadenopathy; however, onset of perianal or genital lesions in the absence of subjective fever has been reported.
- The rash associated with monkeypox can be confused with other diseases that are encountered in clinical practice (e.g., secondary syphilis, herpes, chancroid, and varicella zoster). However, a high index of suspicion for monkeypox is warranted when evaluating people with a characteristic rash, particularly for men who report sexual contact with other men and who present with lesions in the genital/perianal area or for individuals reporting a significant travel history in the month before illness onset or contact with a suspected or confirmed case of monkeypox.
- Information on infection prevention and control in healthcare settings is provided on the CDC website Infection Control: Healthcare Settings.
- Clinicians should first consult their state health department (State Contacts) or CDC through the CDC Emergency Operations Center (770-488-7100) as soon as monkeypox is suspected.
- Orthopoxvirus Vaccine Guidance for Persons at Risk of Occupational Exposure
All specimens should be sent through the state/territorial public health department, unless authorized to send them directly to CDC.
Monkeypox in North Carolina
North Carolina’s first case was identified on June 23, 2022. As of September 1, 2022, there are 312 individuals that have been infected in the state.
Monkeypox virus can be spread person-to-person through infected body fluids (including saliva and lesion fluid), items that have been in contact with infected fluids or lesion crusts, and respiratory droplets. The incubation period is usually 7−14 days but can range from 5−21 days. People with monkeypox are infectious from the start of symptoms (before the rash forms) until the lesions heal and new skin forms underneath scabs and the scabs have all fallen off.
Testing is widely available and encouraged if you had close contact with someone who has been diagnosed with monkeypox, or have symptoms of monkey pox including unexplained bumps, sores, blisters, or pimples that look like monkeypox. There is no shortage of testing supplies, and people with symptoms of monkeypox should go to their health care provider or a or local health department to get tested. Samples must be collected by a health care professional, and they must follow a specific procedure to collect a good sample for testing. NCDHHS recommends providers test any patient with a suspicious lesion or sore.
Collection, Storage, and Shipment of Specimens for
Procedures and materials used for collecting specimens may vary depending on the phase of the rash (i.e., swab of lesion surface or crust from healing lesion).
For initial laboratory testing of monkeypox virus specimens at Laboratory Response Network (LRN) laboratories or authorized commercial laboratories, the recommended specimen type is lesion material. Specifics on the acceptable specimen type accepted within these laboratories may vary. Please contact the appropriate public health department or commercial laboratory to determine acceptable specimens.
For further characterization of the specimen at CDC, dry swabs of lesion material, swabs of lesion material in viral transport media (VTM), or crusts are acceptable. To ensure specimens are stored and shipped within the required timeframe, consultation with the CDC is suggested.
Personnel who collect specimens should use personal protective equipment (PPE) in accordance with recommendations for healthcare settings. Specimens should be collected in the manner outlined below. When possible, use a plastic, sterile, leak-proof container rather than glass materials for specimen collection.
Two swabs from each lesion (in general, 2-3 lesions should be sufficient) should be collected for testing. Using two sterile synthetic swabs (including, but not limited to polyester, nylon, or Dacron) with a plastic, wood, or thin aluminum shaft, swab the lesion vigorously to collect adequate DNA. Do not use cotton swabs. It is not necessary to de-roof the lesion before swabbing. Break off the end of each swab’s applicator into a 1.5-or 2-mL screw-capped tube with O-ring or place the entire swab in a sterile container that has a gasket seal and is able to be shipped under the required conditions. Two swabs from each lesion should be collected, preferably from different locations on the body or from lesions which differ in appearance. Swabs and other specimens should each be placed in different containers. If using transport media, only viral transport media (VTM) is accepted at CDC at this time; do not use universal or other transport media.
Specimen collection, storage, and shipping of human specimens is subject to CLIA restrictions. CDC 50.34 form must be included for each specimen. When possible, ship specimens on dry ice. Specimens received outside of acceptable temperature ranges will be rejected.
Laboratory testing has indicated that the current monkeypox outbreak is associated with the West African clade of monkeypox virus. The U.S. government does not consider the West African clade of monkeypox virus as meeting the definition of Category A infectious substance under the Hazardous Materials Regulations (HMR). Therefore, specimens and material suspected or confirmed to contain the West African clade of monkeypox virus can be shipped as UN 3373 Biological Substance, Category B. See U.S. Department of Transportation’s (DOT) Transporting Infectious Substances Safely and Managing Solid Waste Contaminated with a Category A Infectious Substance (pg. 94) for further guidance.
Refer to the Poxvirus Serology test on the CDC Test Directory for further specimen storage, packaging, and shipping instructions.
For current information on the Molecular Detection test, please contact the CDC at firstname.lastname@example.org for details on collection, storage, packaging, and shipping of specimens.
For more information, visit: https://www.cdc.gov/laboratory/specimen-submission
Vaccines are available to protect against monkeypox or to reduce disease severity. NC DHHS has expanded the vaccine eligibility criteria to include:
- Anyone who had close contact in the past two weeks with someone who has been diagnosed with monkeypox,
- and Gay or bisexual men or transgender individuals who report any of the following in the last 90 days:
- Having multiple sex partners or anonymous sex
- Being diagnosed with a sexually transmitted infection
- Receiving medications to prevent HIV infection (PrEP)
As of 8/2/2022, 10,148 doses of Jynneos have arrived in NC, with an additional 8,300 doses of Jynneos allocated to NC to order over the next several weeks. Click here for a list of vaccine locations.
For Providers, Community Partners, and Local Health Departments (LHDs)
- Interim Guidance for NC Healthcare Providers Tecovirimat in Treatment of Monkeypox
- Monkeypox Communications Toolkit
- Provider Memo
- Webinar (07/28/22) - Monkeypox Update for Providers
- Vaccine Toolkit
- Providers interested in offering monkeypox vaccine start here: Monkeypox Vaccine Enrollment and Capacity Survey
- Requesting Vaccines and Therapeutics
- Communicable Disease Manual for LHDs
- CDC: DCL – Monkeypox Pain Management
For the Public
- Frequently Asked Questions (Spanish)
- Monkeypox: Quick Facts (Spanish)
- Monkeypox: What You Need to Know (Spanish)
- CDC: How to Prevent Monkeypox
- CDC: Monkeypox Resources and Updates (Spanish)
- CDC: Monkeypox facts for people who are sexually active
- CDC: Social Gatherings, Safer Sex, and Monkeypox
- CDC: Travel Notices – Monkeypox in Multiple Countries
- WHO: Key Facts
- Zoonotic Diseases