Monkeypox Information and Resources

Monkeypox Updates
 

Monkeypox Review and Update July 26, 2022

Our region has had a number of cases of monkeypox identified in the past few weeks.

We would anticipate that there are more cases in the community.

In addition, as active community transmission is likely,  we should expect increasing numbers of cases.
 

Clinical presentation
(taken from https://www1.nyc.gov/site/doh/health/health-topics/monkeypox.page)

  • Symptoms may include the following:
  • Flu-like prodrome may be followed by a rash. Prodromal symptoms might not develop or can occur concurrently with or after rash onset, and may include fever, headache, muscle aches, swollen lymph nodes, and fatigue. Patients may not experience the entire constellation of these symptoms.
  • Rash often starts in a mucosal area, including the mouth, anogenital or rectal areas, and may remain in a limited area or become more widespread to the face, torso, or extremities (including palms or soles). The initial rash has also been documented in other non-mucosal locations. Lesions may start as a macule and then progress to papule, vesicle, pustule, and then scab (see photo examples at Centers for Disease Control and Prevention (CDC) Monkeypox Clinical Recognition webpage).
  • Pictures of the rash can be found here .
  • Pain and pruritus may be prominent and disproportionate to rash appearance. Severe proctitis has been a presenting symptom and can be associated with tenesmus and rectal bleeding.
  • Co-infections with sexually transmitted infections, group A strep pharyngitis, and other viruses (e.g., varicella zoster virus or VZV) have been reported. It is important to evaluate for and treat other potential infections as appropriate.

 

Transmission Routes
(from https://www.cdc.gov/poxvirus/monkeypox/transmission.html)

  • Monkeypox spreads in at least 4 different ways.
    The virus can spread from person-to-person through:
    • Direct contact with the infectious rash, scabs, or body fluids
    • Respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex
    • Touching items (such as clothing or linens) that previously touched the infectious rash or body fluids
    • Pregnant women can spread the virus to their fetus through the placenta
       
  • Transmission Timeline- Monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks. People who do not have monkeypox symptoms cannot spread the virus to others. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.

 

PPE and Environmental Controls for Suspected Cases
(from https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html)

  • Patients must wear surgical mask while in the clinic area.
  • Providers should wear gown, gloves, face shield and N95 masks while caring for suspected and confirmed cases.
  • Negative pressure rooms are not needed unless there will be an aerosol-generating procedure performed. Doors should be kept shut during the visit.
  • Handle soiled laundry (e.g., bedding, towels, personal clothing) in a way that prevents cross contamination and also promptly contain these items in a laundry bag. Never shake or handle in a manner that may disperse infectious material.
  • Wash hands after the patient visit and cleaning of patient rooms.
  • Exam rooms must be cleaned and disinfected prior to use for the next patient. Avoid sweeping or dry mopping floors. Wet cleaning methods are preferred.

 

Diagnostics

  • Currently, testing can be obtained through the Office of Public Health (OPH), Labcorp, and Quest.
    1. Office of Public Health-Call the IDEpi hotline (800-256-2748) to receive detailed guidance regarding specimen submission and transport to the LSPHL (State Public Health Lab). Please follow specific instructions for this testing platform:
      • Vigorously swab or brush the base of the lesion with a sterile dry polyester, rayon or Dacron swab. Collect a second swab from the same lesion. Insert both swabs into the sterile plastic aliquot tube or sleeve and break off the end of the swabs, if required, to tightly close the sample. Do not add any transport media to the sample. ) Two swabs should be submitted to ensure adequate material is sampled.
      • Label samples and place in biohazard bag
      • Arrange for courier pickup and delivery
    2. Labcorp https://www.labcorp.com/infectious-disease/monkeypox
      • Vigorously swab or brush the base of the lesion with a sterile dry polyester, rayon or Dacron swab. Collect a second swab from the same lesion. Insert both swabs into the sterile plastic aliquot tube or sleeve and break off the end of the swabs, if required, to tightly close the sample. Do not add any transport media to the sample. Two swabs should be submitted to ensure adequate material is sampled.
      • Label samples and place in biohazard bag
      • Order code: 140230
      • Arrange for courier pickup and delivery
      • Turnaround time: 2-3 days from specimen pickup.
    3. Quest https://www.questdiagnostics.com/healthcare-professionals/about-our-tests/infectious-diseases/monkeypox
      • Vigorously swab or brush the base of the lesion
      • Lesion swab collected in 3 mL of viral transport media (VTM) or equivalent
      • Label samples and place in biohazard bag
      • Test code: . ()
      • Arrange for courier pickup and delivery
      • Turnaround time: 2-3 days from specimen pickup.

 

Reporting

  • Louisiana healthcare providers should report all suspected cases of monkeypox to the Louisiana Department of Health’s (LDH) Infectious Disease Epidemiology (IDEpi) 24/7 clinician hotline: 800-256-2748. ID EPI must approve all specimens prior to submission to the Louisiana State Public Health Laboratory.
  • Additionally, you should report any suspected cases to your local market infection control department should also be alerted immediately to assure proper isolation and cleaning.

 

Treatment and Supportive Care
(from https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html)

  • Supportive Care (from NYDH.monkeypox-treatment-guidance-interim.pdf)
    1. Supportive care includes maintenance of adequate fluid balance, pain management, treatment of bacterial superinfections of skin lesions and treatment of co-occurring sexually transmitted or superimposed bacterial skin infections. Providers should address these symptoms adequately and early to prevent hospitalizations.
    2. Skin lesions should be kept clean and dry when not showering or bathing to prevent bacterial superinfection. Pruritus can be managed with oral antihistamines and inert, anti-irritant topical agents such as calamine lotion or petroleum jelly.
    3. For oral lesions, compounds such “magic” or “miracle” mouthwashes (prescription solutions used to treat mucositis) can be used to manage pain. Oral antiseptics can be used to keep lesions clean (e.g., chlorhexidine mouthwash). Topical benzocaine/lidocaine gels can be used for temporary relief, especially to facilitate eating and drinking, but should be limited to recommended doses.
    4. For painful genital and anorectal lesions, warm sitz baths lasting at least 10 minutes several times per day may be helpful. Topical benzocaine/lidocaine gels or creams at the recommended doses may also provide temporary relief.
    5. Proctitis can occur with or without internal lesions and, though often manageable with appropriate supportive care, can progress to become severe and debilitating. Stool softeners such as docusate should be initiated early. Sitz baths, as described above, are also useful for proctitis, and may calm inflammation. Similarly, over the counter pain medications such as acetaminophen can be used. Pain from monkeypox proctitis may require prescription medications, use of which should be balanced with the possibility of side effects, like constipation. Proctitis may additionally be accompanied by rectal bleeding. Though rectal bleeding has been observed to be self-limited, patients with rectal bleeding should be evaluated by a healthcare provider.
    6. Nausea and vomiting may be controlled with anti-emetics as appropriate. Diarrhea should be managed with appropriate hydration and electrolyte replacement. The use of anti-motility agents is not generally recommended given the potential for ileus.

 

Medical Treatment Options Available for Monkeypox
(from https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html)

  1. Tecovirimat. A800-256-2748 24/7 phone number)
  2. Cidofovir
  3. Brincidofovir