healthcare and public health response team members designated by public health authorities to be vaccinated for preparedness purposes https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html Monkeypox Vaccine Pre-Exposure Prophylaxis ▪ At this time, most clinicians in the United States and laboratorians not performing the orthopoxvirus generic test to diagnose orthopoxviruses, including monkeypox, are not advised to receive orthopoxvirus PrEP • Laboratorians should consult with laboratory biosafety officers and supervisors to identify risks and precautions, depending on the type of work they are doing • Clinicians and laboratorians should use recommended infection control practices https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html Contraindication ACAM2000 Primary Vaccinees ACAM2000 Revaccinees ACAM2000 Household Contacts1 JYNNEOS History or presence of atopic dermatitis X X X Other active exfoliative skin conditions X X X Conditions associated with immunosuppression X X X Pregnancy X X X Aged Situation update* ▪ As of June 21, almost 4,000 confirmed monkeypox + orthopox cases worldwide • Cases have been identified in Europe, North America, South America, the Middle East, Australia, and at least 1 non-endemic country in Africa • Most (but not all) cases among gay, bisexual, or other men who have sex with men ▪ CDC working with partners in U.S. states and several countries ▪ As of June 21: • 142 confirmed monkeypox + orthopox cases • 23 states + DC *For recent monkeypox case numbers see CDC Situation Summary: https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html Confirmed orthopox (OPX) vs. confirmed monkeypox ▪ Currently, testing specimens at states + CDC • 1 st: Laboratory Response Network* can perform OPX generic test; this confirms presence of OPX DNA from rash → Positive = confirmed orthopox case • 2 nd: Confirmatory testing by real time PCR (only available at CDC) → positive = confirmed monkeypox case ▪ Working to expand testing to additional labs ▪ For this event, we are treating all confirmed OPX cases as if they are monkeypox until proven otherwise • A positive OPX test is enough for health departments to take action to care for the patient and help prevent additional spread *https://emergency.cdc.gov/lrn/ index.asp Signs and symptoms ▪ Historically: characteristic rash preceded by prodromal symptoms (e.g., fever, lymphadenopathy, flu-like symptoms) ▪ Current cases: different features • Rash o Still characteristic (firm, pimple-like lesions), but often starting in genital and perianal areas o Sometimes not disseminating to other parts of body o Being recognized at outpatient clinics because easily confused with sexually transmitted infections • Prodromal symptoms: mild or not occurring ▪ Reasons for unusual presentation unknown at this time, possibly route of exposure? ▪ Patients are infectious once symptoms begin, whether prodromal or rash ▪ Remain infectious until lesions form scabs, scabs fall off, and a fresh layer of skin forms Incidence ▪ Monkeypox is endemic in several African countries ▪ From 2018 to mid-May 2022, 9 imported cases of monkeypox to non-endemic countries • United States (2) • United Kingdom (5) • Israel (1) • Singapore (1) ▪ No flight contacts developed infection ▪ One healthcare worker developed monkeypox (UK) and 2 family members acquired monkeypox (UK) Transmission ▪ Direct or indirect contact with body fluids or lesion materials ▪ Contact with fomites ▪ Exposure to respiratory secretions during prolonged, face-to-face contact ▪ Examples of high and intermediate risk exposures • Shared towels and bedding (infectious body fluids and scabs may be present) • Skin-to-skin contact with a patient who has monkeypox • 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, without wearing an N95 or equivalent respirator (or higher) and eye protection ▪ Good news: Not easily transmitted • Transmission via respiratory secretions appears uncommon • Patients generally describe close, sustained physical contact with other people with monkeypox What clinicians need to know: Diagnosis ▪ CDC issued health advisory on May 20, 2022 ▪ Advice for clinicians • Be vigilant to possibility of monkeypox if characteristic rash present* • Know that illness is presenting atypically • Clinicians working in outpatient clinics may be first to suspect monkeypox o Many patients have mild symptoms o Could be confused with sexually transmitted infection and varicella zoster virus infection o STI diagnosis does not exclude monkeypox infection; infections may be concurrent • Obtain sexual and travel history; determine if any contacts have/had a similar rash ▪ Obtain specimens † ▪ Notify health department • Consider initiating contact tracing and monitoring § • FaWhat clinicians need to know: Treatment