Monkeypox

 

For the most up-to-date number of monkeypox cases in Connecticut and throughout the United States, please visit: 2022 U.S. Map & Case Count | Monkeypox | Poxvirus | CDC

 

ABOUT MONKEYPOX

Beginning in May 2022, cases of monkeypox have been reported in more than 50 countries that don’t normally report monkeypox, including the United States. Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family of viruses as smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder; and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.

Monkeypox 101 from DPH (English)

Monkeypox 101 from DPH (Spanish)

More information about monkeypox is also available from CDC: Frequently Asked Questions | Monkeypox | Poxvirus | CDC

5 Things Sexually Active People Need to Know About Monkeypox

SIGNS & SYMPTOMS

Symptoms of monkeypox can include fever, headache, muscle aches and backache, swollen lymph nodes, chills, exhaustion and a rash. The rash can look like pimples or blisters that appear on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. The rash goes through different stages before healing completely. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash. The illness typically lasts two – four weeks.

with a rash that looks like monkeypox should talk to their healthcare provider, even if they don’t think they had contact with someone who has monkeypox.

 

HOW IT SPREADS

Monkeypox 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 of an infected person
  • Pregnant people can spread the virus to their fetus through the placenta

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 two – four 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.

 

VACCINATION

CDC does not recommend widespread vaccination against monkeypox at this time. However, vaccination may be recommended for some people who:

  • Are close personal contacts of people with monkeypox
  • May have been exposed to the virus
  • May have increased risk of being exposed to the virus, such as people who perform laboratory testing to diagnose monkeypox

More information about considerations for monkeypox vaccination is available from CDC. More information about the national vaccination strategy is available from HHS

  

INFORMATION FOR HEALTH PROVIDERS

To discuss testing or report cases of suspected monkeypox, call CT DPH Epidemiology via phone at 860-509-7994, or 860-509-8000 if after hours. Effective July 1, 2022, monkeypox is a Category 1 reportable disease in Connecticut.

CT DPH epidemiologists are available 24/7 to discuss questions on whether monkeypox should be considered and to facilitate testing at the Connecticut DPH State Laboratory, including to provide information on how to collect specimens, address lack of testing supplies, and where to send collected specimens. Connecticut DPH Epidemiology also can provide guidance in real time if a highly suspicious case is identified.

Recommendations for healthcare providers

  • Appropriate infection prevention measures should be taken when examining patients and when collecting specimens for monkeypox evaluation. Information on infection prevention and control in healthcare settings is provided on the CDC website.
  • Patients with rashes initially considered characteristic of more common infections (e.g., varicella zoster or sexually transmitted infections) should be carefully evaluated for a characteristic monkeypox rash, and submission of specimens of lesions should be considered, especially if the person has epidemiologic risk factors for monkeypox infection.
  • Evaluate any individual presenting with perianal or genital ulcers, diffuse rash, or proctitis syndrome for sexually transmitted infections (STIs) per the 2021 CDC STI Treatment Guidelines. Testing for STIs should be performed. The diagnosis of an STI does not exclude monkeypox as a concurrent infection may be present. The clinical presentation of monkeypox may be similar to some STIs, such as syphilis, herpes, lymphogranuloma venereum (LGV), or other etiologies of proctitis.
  • Perform a thorough skin and mucosal (e.g., anal, vaginal, oral) examination for the characteristic vesiculo-pustular rash of monkeypox; this allows for detection of lesions the patient may not be able to visualize independently or that they may not have been previously aware of.
  • If a patient does not respond to STI treatment as expected, the patient should return for follow-up evaluation and monkeypox testing should be considered.
  • Advise patients with prodromal symptoms (e.g., fever, malaise, headache) and one or more epidemiologic risk factors for monkeypox to self-isolate. If a rash does not appear within 5 days, the illness is unlikely to be monkeypox and alternative etiologies should be sought. Testing can only be performed by sampling lesions at this time, if a rash should develop, the patient should return for testing.

Monkeypox Diagnostic Testing

Diagnostic testing for monkeypox is now available from commercial laboratories, including LabCorp, Mayo Clinic, and Quest. Healthcare providers can order testing from these laboratories as they would order other diagnostic tests.

Testing is also available through the Connecticut State Public Health Laboratory (SPHL); effective July 18 2022, prior approval for testing at SPHL will no longer be required. Testing at SPHL will be available on a first come first served basis Monday through Friday with a daily cut-off time of 8AM. Specimens arriving after 8AM will be tested on the next scheduled testing day; specimens received after 8AM on Friday will be tested on the following Monday. To request urgent testing outside this schedule, call DPH Epidemiology at 860-509-7994, or 860-509-8000 after hours or on weekends.

Instructions for specimen collection are available here. Specimens submitted to SPHL must be accompanied by a completed requisition form. Specimens can be delivered to SPHL 24 hours per day/7 days per week. Facilities with routine courier service should make their own arrangements for specimen transport to SPHL. Courier service is a limited resource which is prioritized for locations that do not have access to a routine courier.

 


Questions and Answers About Monkeypox for Healthcare Professionals 
The Clinicians FAQ answers common questions from healthcare providers and can be used together with CDC’s Information for Healthcare Professionals.

 

Post-exposure prophylaxis

CDC recommends post-exposure prophylaxis be considered for persons with high or intermediate level of exposure to the monkeypox virus. If a patient reports recent close-contact and may benefit from PEP, contact DPH at 860-509-7994, or 860-509-8000 after hours.

More information about considerations for monkeypox vaccination is available from CDC.


Treatment

Antivirals, such as tecovirimat (TPOXX), may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems. Medical countermeasures for monkeypox including tecovirimat (TPOXX), Vaccinia Immune Globulin Intravenous (VIGIV), Cidofovir (Vistide), can be accessed through the Strategic National Stockpile. To request access to these therapeutics, contact DPH Epidemiology at 860-509-7994 or 860-509-8000 after hours.

More information on treatment options for monkeypox can be found here: Treatment Information for Healthcare Professionals | Monkeypox | Poxvirus | CDC


Guidance for Tecovirimat Use Under Expanded Access Investigational New Drug Protocol during 2022 U.S. Monkeypox Cases | Monkeypox | Poxvirus | CDC

TPOXX (tecovirimat) Label (fda.gov)

 

Additional resources for healthcare providers:

Webinar July 8, 2022 – Connecticut Department of Public Health Provider Update for Monkeypox

Connecticut Department of Public Health Provider Update  for Monkeypox. July 8, 2022

Webinar June 29, 2022 – Monkeypox: Updates about Clinical Diagnosis and Treatment (cdc.gov)

Webinar May 24, 2022 – What Clinicians Need to Know about Monkeypox in the United States and Other Countries (cdc.gov)  

Monkeypox in the U.S.: An Update for Clinicians and the LGBTQ+ Community 

ESCMID/IDSA joint web symposium on Monkeypox. ESCMID eLearning. Faculty / Presenters. May 24, 2022; 363235 

link

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