Monkeypox Information
GENERAL INFORMATION
Here is the CDC’s website about the disease: https://www.cdc.gov/poxvirus/monkeypox/index.html
TESTING AT LLUH
We finally have a LLEAP order to test for Monkeypox: Monkeypox (Orthopoxvirus), DNA, PCR.
Instructions for test collection: https://files.labcorp.com/labcorp-d8/2022-08/196405_DX_IFU_MonkeyPox-Collection_0822_v1.pdf
Try to collect several specimens from different lesions to increase likelihood of a diagnosis. One possibility is to use the RVP swab with viral medium.
TREATMENT AT LLUH
Loma Linda Hospital Pharmacy has doses of TPOXX. Treatment will be for those who meet criteria (CDC Clinical Criteria https://www.cdc.gov/poxvirus/monkeypox/clinicians/Tecovirimat.html)
Attached is some helpful guidance from our local health department about how to prioritize our monkeypox treatment doses (see attached TPOXX Provider Overview and FAQs).
The tricky part is that TPOXX is for experimental use and there are multiple forms—however you only HAVE to do the first two:
Required: Informed Consent Form
Required: Patient Intake Form
Not required individually: FDA Form 1572—Already filled out for our institution. Per Dr. Veltman “Loma Linda now has an institutional IND with the CDC in my name".
Optional: Serious Adverse Events or “Clinical Outcome Form”: Per FDA requirement, report life-threatening or serious adverse events associated with TPOXX by completing a MED WATCH FORM (https://www.cdc.gov/poxvirus/monkeypox/pdf/MedWatchForm-for-Tpoxx.pdf) and returning it to CDC via email (regaffairs@cdc.gov). When you order TPOXX, you have to acknowledge that you know about this form.
Forms can be found here: https://www.cdc.gov/poxvirus/monkeypox/clinicians/obtaining-tecovirimat.html
Of note, all the links to the CDC forms inside the LLEAP TPOXX order are broken at this time. Use above link to find forms.
A SUPER IMPORTANT POINT: The forms (# 1 and 2) need to be placed in the front pocket of the white ED Comm Center “Follow up” binder found in the cabinet in the physician workroom. The Comm Center nurses will pick them up each morning (M-F) and upload them to the patient chart and send them by email to Dr. Veltman jveltman@llu.edu (who will forward to the CDC).
ID APPROVAL REQUIRED? The Tpoxx order has a requirement for ID approval. However, Dr. Veltman has given us approval to use her name for approval without paging ID.
VACCINATION THROUGH SAN BERNARDINO COUNTY
Our local health department has vaccine doses and considers HCWs a priority group for vaccination:
HCWs who are likely to collect laboratory specimens from persons with MPX (e.g., persons working in sexual health clinics or clinical settings that serve at risk populations).
Dr. Veltman recommends asking for the vaccine subQ instead of intra-dermal because the intra-dermal vaccine is causing permanent scarring/discoloration in some patients.
Other information from our State about who is recognized as a priority for vaccination: