What providers need to know about monkeypox

Important testing instructions, vaccines and phone numbers

With the rise of monkeypox cases, here is information on how the disease is spread, the testing involved, and potential treatment options.

As of Sept. 13, 2022, there have been 22,630 cases confirmed in the US – with 183 in Oregon. Most cases have been in men but can be spread to anyone through close, personal, often skin-skin contact — including direct contact with the rash or body fluids and contact with respiratory secretions.

The risk to health care workers is rare. However, per CDC guidelines we recommend airborne isolation when caring for a patient with suspected or confirmed monkeypox mainly because of the rare possibility of disseminating viral particles into the air when changing bedding contaminated with body fluids or fluid from the rash.

(Photo courtesy: CDC)

Monkeypox typically starts within three weeks of exposure and can spread to others from the time symptoms start until the rash has healed and new skin has started to form. The illness typically lasts two to four weeks.

The rash is usually preceded by symptoms such as fever, chills, muscle aches, headache, sore throat, and other respiratory symptoms.

Nearly everyone with monkeypox will develop a rash. It goes through several stages, including scabs before healing. The rash can involve any part of the body including the groin. Initially, the rash is not itchy until it starts to scab. It can be painful.

Salem Hospital performs tests; find information in the isolation grid under the red infection prevention tab on the Salem Health intranet. The CDC recommends that multiple lesions get tested and a separate order is required for each specimen. Call the lab at 503-814-3130 to get the proper swabs and collection instructions. The order for monkeypox pcr is under code: LAB4369 or “monkeypox (orthopoxvirus) DNA, PCR". You are not required to unroof the lesion to obtain a sample; simply vigorously swab the top of the lesion.

If providers have a suspected case of monkeypox or someone who has been in contact with it, please call the OHA Acute and Communicable Disease Prevention 24/7 line at 971-673-1111 and they can guide you through testing and potential treatment. Also, Tecovirimat is a medication under the CDC’s investigational new drug protocol (EA-IND) available for patients with severe disease (encephalitis, sepsis, hemorrhagic disease), immunocompromised patients (cancer, HIV, etc.), pregnant or breastfeeding women, and pediatric populations.

If it is determined that Tecovirimat is a therapy option, follow the listed steps for obtainment:

• Obtain informed consent from the patient (in the patient’s primary language) via CDC form:
  • English form  
  • Other languages

• Determine ability of the patient to take IV vs. PO.

• Contact pharmacy to determine what is available and to start the process of obtaining appropriate route of medication if needed. Medication must be requested from OHA via this link.

• Fill out the patient intake form, may request pharmacy’s help if necessary, and submit to CDC (must be done before order can be processed).

• Order the medication in Epic.

The monkeypox vaccine (Jynneos) is also available through all Salem Health primary care clinics. Circumstances that may warrant receiving the vaccine include close contact with someone with monkeypox, sex with multiple partners or group sex, or commercial sex workers. Other circumstances can be found via the CDC website.