Monkeypox Help Sheet

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. Anyone 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.

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.

LabCorp Collection Information See below

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.

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.

Collection Information: Collect one swab from the lesion. The swabs may be made of polyester, rayon or Dacron. When collecting the sample, take care not to touch the swab to any surface other than the point of collection. Once collected, the entire swab should be immediately placed in the universal transport medium (UTM) or viral transport medium (VTM) tube and the screw cap secured tightly. Label specimen with full patient name and DOB, date and time of collection. Place specimen in a Biohazard bag.

If additional viral testing, including HSV and/or VZV, is ordered then a separate UTM/VTM is required.

Specimen collection must be performed by a healthcare worker.

Do NOT submit specimens for viral culture if monkeypox is suspected

Ship refrigerated or frozen at -20C

Room temperature swabs NOT acceptable.