• ciprofloxacin-resistant strains of N. meningitidis detected

• ciprofloxacin no longer recommended for PEP

• alternative recommendations

  • • rifampin (90–95% efficacy)

• <1 month: 5 mg/kg PO q12h x 2d; consult expert for infants <1 months

• children ≥1 month: 10 mg/kg PO q12h x 2d (max 600 mg)

  • • can interfere with efficacy of OCP & some seizure and anticoagulant medications

    • can stain soft contact lenses

• adult: 600 mg PO q12h x 2d

• • • ceftriaxone (90–95% efficacy)

• children <15 years: 125 mg IM x1

• ≥15 years – adult: 250 mg IM x1

• • • azithromycin (90% efficacy)

• children: 10 mg/kg PO x1 (max 500 mg)

• adult: 500 mg PO x1

• no changes in empiric treatment of IMD recommended

• counties affected: Imperial, Kern, Long Beach, Los Angeles, Orange, Pasadena, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, and Ventura

How do I test for Mpox?

• Use the same swabs as for COVID testing

• Current recommendation: test two different lesions using one swab each

• In EPIC, use “Miscellaneous Test” and specify that it is for Mpox. Code is 12084. Indicate the anatomic location the specimen is obtained in the "Test Info" section.

What is the isolation and screening protocol for suspected cases?

• Place patient in a private room

• Negative pressure not necessary

• Similar protocol as suspected varicella (chickenpox) cases

• Not as contagious or wide spread as COVID-19

What PPE is required of me when I examine the patient?

• Current CDC recommendation for HCW - full protective gear:

  • • gloves

    • eye protection

• Not thought to be aerosolized easily

Do we have vaccines available here at ARMC and who should get vaccinated?

• ARMC has a very limited supply of JYNNEOS

• Supposed to be a 2 dose vaccine given 28 days apart

• Current guideline: divide single dose into 5 smaller doses (and given to 5 individuals)

• May provide sufficient protection to prevent severe illness 

• Indications include recent close contact exposure (within 14 days) to known or highly suspected case, and as pre-exposure prophylaxis to:

  • • men having sex with men

    • pts on PrEP

    • known immunocompromised status

    • recent STI

    • plan to engage in or attend a high risk activity

    • 18 yrs or older

Do we have any treatment available?

• ARMC has a very limited supply of ticovirimat (TPOXX)

• Should only be offered to “high risk” pts only

• Please speak to ID and Pharmacy to dispense this medication

• It requires a lengthy informed consent process before dispensing it

• It is a two week course, given BID either PO or IV

From the CDC

From CDPH

From CAPTC