Quick Links
- Mpox Online Confidential Morbidity Report (CMR)
- Instructions for patients: Isolation | Exposure
- Provider Hub subpages: Vaccine | Treatment
- CDC Mpox Information for Health Professionals
- CDPH Mpox Information for Healthcare Providers
New and Noteworthy
- CDC Health Advisory:
Mpox Caused by Human-to-Human Transmission of Mpox Virus with Geographic Spread in the Democratic Republic of Congo (12-7-23)
- In LA County, if a provider suspects mpox AND the patient has recent travel to Democratic Republic of Congo (DRC), they should contact the LA County Division of HIV and STD Programs’ Clinical Consultation line immediately for consultation and to coordinate clade-specific testing through the LA County public health laboratory. CDC defines recent travel as within 21 days of illness onset.
- MMWR on vaccine effectiveness:
- LAC DPH News Release: Six New Mpox Cases Reported in Los Angeles County (6-23-23)
- Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study — United States, August 19, 2022–March 31, 2023: In this study, including patients enrolled in Los Angeles County, adjusted vaccine effectiveness was 75% for one dose and 86% for 2 doses of JYNNEOS vaccine, indicating substantial protection against mpox, irrespective of route of administration or immunocompromised status.
- Effectiveness of JYNNEOS Vaccine Against Diagnosed Mpox Infection — New York, 2022: In this study in New York comparing men >18 yo who received a diagnosis of mpox to controls with rectal gonorrhea or primary syphilis, adjusted combined vaccine effectiveness was 75.7%.
- CDC Health Update:
Potential Risk for New Mpox Cases (5-15-23)
- Healthcare providers (HCP) are urged to remain diligent for possible mpox cases and should refamiliarize themselves with mpox presentation, specimen collection, testing procedures, treatment options, and reporting.
- CDPH Advisory:
Updates on Identification, Laboratory Testing, Management and Treatment, and Vaccination for Mpox Virus Infection in California. (4-4-23)
- It is highly important to test for HIV and other sexually transmitted infections (STIs) when testing for mpox and providing HIV and STI treatment as soon as possible for those who test positive.
- MMWR: Interim Clinical Treatment Considerations for Severe Manifestations of Mpox — United States, February 2023. (3-3-23)
- CDC Science Brief: Detection and Transmission of Monkeypox Virus (10-18-22).
- Reporting severe disease. Clinicians must report hospitalizations due to mpox to LAC DPH. In addition, they are asked to call the LAC DPH consultation line if a hospitalized patient is worsening clinically, such as being admitted to the ICU. LAC DPH will provide clinical consultation and access to additional therapeutic options.
- CDC (11-4-22): Completing a Monkeypox-Related Death Certificate
Background
Mpox, a viral zoonotic infection previously known as "monkeypox", is endemic in certain parts of Africa. Human cases outside of Africa had typically been linked to international travel or imported animals. However, since May 2022, there has been a large international outbreak of mpox in nonendemic regions. Most cases have been identified in men who have sex with other men (MSM). Refer to global, national, and local data pages for more information: WHO | CDC | CDPH | LAC.
Mpox is an orthopoxvirus that is in the same genus as variola (causative agent of smallpox) and vaccinia viruses (which is used in the smallpox vaccine). Although the mpox virus is in the same family of viruses as smallpox, it is less transmissible and typically less severe than smallpox.
Healthcare providers are encouraged to visit the CDC Mpox Information for Healthcare Professionals for information on clinical recognition, caring for patients with mpox, infection control, and other guidance.
Clinical Consultation
Providers who need clinical consultation for (including for patients who are clinically worsening or hospitalized), specimen testing at Public Health Lab, and access to treatment:
Los Angeles County DPH Division of HIV and STD Programs
- Weekdays 8:30am-5pm: 213-368-7441
- Weekends and holidays 8:00am-5pm or evenings (urgent situations only): 213-974-1234 and ask for the physician on call.
Reporting
Healthcare providers must report all mpox or orthopoxvirus infections, hospitalizations, and deaths within 1 working day from identification (Title 17, CCR, §2500). See Reportable Disease List
If hospitalized patients are worsening clinically, such as being admitted to the ICU, providers are asked to please contact the LAC DPH healthcare provider line for clinical consultation and to access additional therapeutic options.
Providers should report all cases, hospitalization, and deaths on-line via the LAC DPH secure mpox reporting portal:
Mpox Confidential Morbidity Report
If providers experience technical difficulties with using the on-line report form, reports may be completed using the standard CMR form and submitted via fax to (888) 397-3778 or (213) 482-5508. Note: provider reporting is not necessary for positive tests conducted by the LAC DPH PHL.
Mpox reporting on the death certificate for all decedents where the disease caused or contributed to death is important to ensure deaths related to mpox are captured.
For more information on how to complete a mpox-related death certificate please see here.
Public Health Lab Mpox Testing
Priority Populations for Mpox Testing at the Public Health Lab (PHL)
If a provider suspects mpox AND the patient has recent travel to Democratic Republic of Congo (DRC) contact the Clinical Consultation line immediately for consultation and to coordinate clade-specific testing through the LA County public health laboratory.
Providers with a suspect mpox case in one of the following priority populations are asked to submit specimens to the PHL:
- Persons experiencing homelessness (PEH)
- Pregnant persons
- Children with a history of close, personal contact with someone who has mpox
- History or atopic dermatitis of eczema
- Immunocompromised
- Those with HIV infection and a CD4 count <350mm3
- Recent travel (within 21 days of illness onset) to DRC
In addition, providers that do not have access to commercial orthopoxvirus testing may submit specimens to PHL.
Preparation and Collection of Specimens
Collection
Wear appropriate PPE (including N95, gloves, impermeable gowns, face shield) before collecting specimens.
Depending on the stage of disease, specimen collection involves vigorous, firm swabbing of lesions (vesicular, pustular, or crusted) with synthetic swabs. Swabbing may rupture lesion to release fluid or pus material.
Lesion swabs are required for orthopoxvirus PCR. The swab used may be made of flocked or spun synthetic material but should have a shaft that is sturdy enough to enable the lesion to be rubbed vigorously. Do not use a nasopharyngeal (NP) swab as the shaft is too flexible and the tip too small to collect an adequate sample. At least two swabs from the same lesions must be collected, multiple lesions (up to 3 sites) may be collected. Lesion swabs may be collected in viral transport media (VTM) or universal transport media (UTM) tubes. Lesion swabs can also be placed in an empty sterile screw cap tube or sterile screw cap specimen cup for transport of a dry swab. Unroofing the lesion before swabbing is not necessary for the collection of lesion swabs.
Consultation for collecting and submitting any additional and/or other specimens (e.g., tissue samples) must be made with PHL Director (562-658-1300).
Storage
Lesion swab specimens
should be stored refrigerated (2-8°C) and send to PHL as soon as
possible. Specimens that were collected for more than 3 days must be
frozen (-20°C or lower).
Labeling
Label all specimens with a minimum of two patient identifiers (e.g., full name and date of birth) and completely fill out the
LAC Public Health Laboratory
test requisition form.
For swabs and scabs/crusts, write in "Orthopoxvirus PCR" in the "Other" box at the bottom of the form.
Each specimen needs a separate test requisition form.
Shipment
Use own courier when
available to send specimens to PHL. If a courier is not available, call
PHL’s Central Accession at 562-658-1460 (Monday to Friday 7:00am to
5:00pm).
Resources
For Providers
For Patients/General Public
- LAC DPH: Refer to Mpox Resources for patient resources in multiple languages.
- CDC Information for the Public
- CDC Mpox Communication Resources
- CDPH Mpox