MPX Information for Providers
CDC is urging healthcare providers in the U.S. to be on alert for patients who have rash illnesses consistent with monkeypox, regardless of whether they have travel or specific risk factors for monkeypox and regardless of gender or sexual orientation.
Update on severe manifestations of MPX
The Centers for Disease Control and Prevention (CDC) released a Morbidity and Mortality Weekly Report (MMWR) showing the results of “clinical consultations with hospitalized individuals with severe manifestations of [MPV]. During August–October 2022, CDC provided clinical consultation for 57 hospitalized patients with severe manifestations of [MPV], most of whom were Black men with AIDS. Delays were observed in initiation of monkeypox-directed therapies. Twelve patients died, and [MPV] was a cause of death or contributing factor in five patients to date, with several other deaths still under investigation.” The MMWR highlighted the need for clinicians to “consider early treatment with available therapeutics for those at risk for severe [MPV] disease, particularly patients with AIDS” and the important role and need to prioritize engaging people living with HIV (PLWH) in care.
- Be vigilant to the possibility of monkeypox if a characteristic rash is present
- Some illnesses are presenting atypically
- The rash may be small and difficult to notice at first, and the rash can appear on any part of the body. A full body exam is recommended to evaluate for rash. Some areas may look more typical for monkeypox infection than others.
- The rash associated with monkeypox can be confused with other rashes including herpes, syphilis, varicella, and Molluscum contagiosum.
- Co-infection with these and other infections and MPX has also been reported. Consider if another sexually transmitted infection testing is needed.
- The rash associated with Monkeypox includes vesicles or pustules that are deep-seated, firm, and well-circumscribed. They may umbilicate or become confluent and progress over time to scabs.
- Presenting symptoms typically include fever, chills, rash, or new lymphadenopathy. However, the onset of perianal or genital lesions in the absence of fever has been reported.
Testing and Specimen Collection
- Consider testing in patients with a new rash characteristic of monkeypox or patients meeting one of the epidemiologic criteria for monkeypox and a high clinical suspicion for monkeypox
- Testing is available through Labcorp and Quest. Approval from the Maryland Department of Health/BCHD is not required
- Providers seeking monkeypox virus testing at the MDH laboratory must get health department approval prior to submitting specimens and follow the MDH Laboratories Administration specimen submission guidance.
- Healthcare providers should educate patients on home isolation while results are pending
- Information on how to test your patient can be found here
- If your patient tests positive for MPX, contact the local health department (ideally the local health department in the same county where your patient resides).
- The local health department will give more specific isolation instructions to your patient, and conduct contact tracing to identify close contacts who may qualify for post-exposure prophylaxis.
- The local health department will also discuss any potential exposures among healthcare staff and identify occupational close contacts who may qualify for post-exposure prophylaxis.
Contact information for Baltimore City Health Department
Acute Communicable Disease
8:30am to 4:30pm: 410-396-4436
After hours: 410-396-3100
Fax number: 410-625-0688
Advice to patients
- Patients should be advised to isolate and stay home until all lesions have resolved, scabs have fallen off and a fresh layer of intact skin has formed.
- Patients with suspected or confirmed MPX should be counseled that they can avoid self-inoculation by avoiding touching the rash and then touching other parts of the body. This applies especially to mucosal areas such as the mouth, genitals, and eyes.
- Patients with suspected or confirmed MPX can be counseled to avoid using contact lenses, to avoid self-inoculation of the eyes
- Encourage patients to keep their rashes covered
- Practice strict hand hygiene with soap and water, or use alcohol-based hand sanitizer after touching rashes
- People with monkeypox should follow the following recommendations until cleared by state or local public health officials:
- Do not leave the home except as required for emergencies or follow-up medical care.
- Friends, family, or others without an essential need to be in the home should not visit.
- Avoid close contact with others.
- Avoid close contact with pets in the home and other animals.
- Do not engage in sexual activity that involves direct physical contact.
- Do not share potentially contaminated items, such as bed linens, clothing, towels, washcloths, drinking glasses, or eating utensils.
- Routinely clean and disinfect commonly touched surfaces and items, such as counters or light switches, using an EPA-registered disinfectant (such as List Q) in accordance with the manufacturer’s instructions.
- Wear well-fitting source control (e.g., medical mask) when in close contact with others at home.
- Avoid the use of contact lenses to prevent inadvertent infection of the eye.
- Avoid shaving rash-covered areas of the body as this can lead to the spreading of the virus.
- Bathroom usage:
- If possible, use a separate bathroom if there are others who live in the same household.
- If there is not a separate bathroom in the home, the patient should clean and disinfect surfaces such as counters, toilet seats, and faucets, using an EPA-registered disinfectant (such as List Q) after using a shared space. This may include during activities like showering, using the toilet, or changing bandages that cover the rash. Consider disposable glove use while cleaning if the rash is present on the hands.
- Limit exposure to others:
- Avoid contact with unaffected individuals until the rash has resolved, the scabs have fallen off, and a fresh layer of intact skin has formed.
- Isolate in a room or area separate from other household members and pets when possible.
- Limit the use of spaces, items, and food that are shared with other household members.
- Do not share dishes and other eating utensils. It is not necessary for the infected person to use separate utensils if properly washed. Wash soiled dishes and eating utensils in a dishwasher or by hand with warm water and soap.
- Limit contamination within the household:
- Try to avoid contaminating upholstered furniture and other porous materials that cannot be laundered by placing coversheets, waterproof mattress covers, blankets, or tarps over these surfaces.
- Additional precautions such as steam cleaning can be considered if there is concern about contamination.
- Considerations for isolating with animals in the home:
- People with monkeypox should avoid contact with animals (specifical mammals), including pets.
- If possible, friends or family members should care for healthy animals until the owner has fully recovered.
- Keep any potentially infectious bandages, textiles (such as clothes, bedding), and other items away from pets, other domestic animals, and wildlife.
- In general, any mammal may become infected with monkeypox. It is not thought that other animals such as reptiles, fish, or birds can be infected.
- If you notice an animal that had contact with an infected person appears sick (such as lethargy, lack of appetite, coughing, bloating, nasal or eye secretions or crust, fever, rash) contact the owner’s veterinarian, state public health veterinarian, or state animal health official.
- People with monkeypox should avoid contact with animals (specifical mammals), including pets.
Close contact with positive cases
- Identified close contacts to a positive MPX case should be closely monitored for signs and symptoms of monkeypox for 21 days from their last day of exposure to the case.
- Close contacts do not need to quarantine or stay home while monitoring for symptoms.
Infection Control for Medical Providers and Office Staff
- Information on infection control in healthcare settings is here
- Close contacts of confirmed cases are currently identified as low, intermediate, and high risk
- The Health Department will discuss specific cases with you, to determine the risk stratification of healthcare staff.
Risk Categories for named close contacts of confirmed Monkeypox cases
Low-Risk Close Contact
Intermediate Risk Close Contact
High-Risk Close Contact
Entered the patient room without wearing eye protection on one or more occasions, regardless of the duration of exposure
Being within 6 feet for 3 hours or more of an unmasked patient without wearing, at a minimum, a surgical mask
Unprotected contact between a person’s skin or mucous membranes and the skin, lesions, or bodily fluids from a patient (e.g., any sexual contact, inadvertent splashes of patient saliva to the eyes or oral cavity of a person, ungloved contact with the patient), or contaminated materials (e.g., linens, clothing)
During all entries in the patient care area or room (except for during any procedures listed above in the high-risk category), wore the gown, gloves, eye protection, and at minimum, a surgical mask
Activities resulting in contact between sleeves and other parts of an individual’s clothing and the patient’s skin lesions or bodily fluids, or their soiled linens or dressings (e.g., turning, bathing, or assisting with transfer) while wearing gloves but not wearing a gown
Being inside the patient’s room or within 6 feet of a patient during any procedures that may create aerosols from oral secretions, skin lesions, or resuspension of dried exudates (e.g., shaking of soiled linens), without wearing an N95 or equivalent respirator (or higher) and eye protection
Being within 6 feet of an unmasked patient for less than 3 hours without wearing at minimum, a surgical mask
For example, most administrative/front desk staff will likely have low-risk exposures. This is in part dependent on the location of a patient’s rash and the type of interaction with staff members. Most waiting room interactions will be low risk, especially if masking is still required in waiting rooms. T
- There are two vaccines licensed for preventing monkeypox infection:
- ACAM 2000
- CDC guidance for MPX vaccines
- Baltimore City Health Department has a very limited supply of vaccines. If you have a patient who was exposed to MPX, please call Baltimore City Health Department at 410-396-4436 to see if they meet the eligibility criteria for the Monkeypox vaccine
- When available, limited supplies of vaccines are offered to individuals meeting eligibility criteria, based on high-risk exposures
Treatment for Monkeypox
- TPOXX is available through Maryland Department of Health
- If you are interested in registering to obtain TPOXX for patients : https://forms.gle/ejWqTJTjwgXDZm2R6
- If you are registered and need additional TPOXX : https://forms.gle/cGKUJ9JaDkamMaYNA
- CDC guidance for treatment of monkeypox
- CDC guidance on obtaining Tecovirimat (TPOXX)
Additional information and Resources
Acute Communicable Diseases
Division of Population Health and Disease Prevention
1001 E. Fayette St., Baltimore MD 21202
Phone number 8:30am to 4:30pm 410-396-4436, fax number 410-625-0688
After hours 410-396-3100