[HIV-STD-Prevention] Update on Monkeypox Activity in Oregon #u#

[Pearson Shelley M]

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Colleagues,

Situation

There has been a concerning increase of monkeypox (hMPXV) cases in Oregon, with 12 new cases reported in the last week; this is greater than the number of cases reported in the preceding month. In addition, we are now seeing cases in new geographic areas of the state. We have received several reports of providers declining to test patients with compatible symptoms with patients later testing positive elsewhere. Testing for monkeypox is commercially available at several labs, including Quest Diagnostics<https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.questdiagnostics.com%2Fhealthcare-professionals%2Fabout-our-tests%2Finfectious-diseases%2Fmonkeypox&data=05%7C01%7CJILLIAN.D.GARAI%40dhsoha.state.or.us%7C2ba7898941d142f53eb008dac9b1c967%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638044062706985582%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=%2F05BoPolAGNOcpyWShsfKfCArRRLKCu89%2BI2X8fAKt4%3D&reserved=0> and LabCorp<https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.labcorp.com%2Finfectious-disease%2Fmonkeypox&data=05%7C01%7CJILLIAN.D.GARAI%40dhsoha.state.or.us%7C2ba7898941d142f53eb008dac9b1c967%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638044062706985582%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=h1t0Rin7M14QhR235McKAwh8lKmUs9zLcqZxIa3gNcU%3D&reserved=0>.  The Oregon State Public Health Laboratory (OSPHL) also provides testing for monkeypox<https://www.oregon.gov/oha/PH/LABORATORYSERVICES/Pages/zOrthopox.aspx>.

 While almost 17,000 people in Oregon have received at least one dose of Jynneos, the vaccine that provides protection against monkeypox, we anticipate that there are many more people who could benefit from vaccination who have not yet received a first dose and almost 6000 people who still need a second dose.

 OHA has a good supply of both tecoviromat (TPOXX) for treatment and vaccine (Jynneos) for prevention.

Action

We urge the medical community to keep monkeypox top of mind when evaluating patients with compatible illness (including genital, peri-anal, and/or oral sores; skin rash; proctitis; and/or pharyngitis) regardless of disclosed risk and known community transmission.

 Providers can reference this poster<https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le4344.pdf> for quick tips on when to think monkeypox, how to test for monkeypox, when to treat with tecovirimat (TPOXX), and when to vaccinate patients at greater risk.

 Test your patients for monkeypox if they request testing. See this video<https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DkEYfW9rVmRI&data=05%7C01%7CJILLIAN.D.GARAI%40dhsoha.state.or.us%7C2ba7898941d142f53eb008dac9b1c967%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638044062707141808%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=KLpnIV0eLUNfha9Gxoacam6%2FMbOZFtE2briqkzq6110%3D&reserved=0> on how to collect a sample for testing.

  1.  Test your patients for monkeypox if syphilis, herpes simplex virus, varicella virus, molluscum contagiosum, or other sexually transmitted infections are on your differential. Remember that many patients may experience mucosal symptoms (e.g., proctitis, pharyngitis) prior to the appearance of a skin rash.
  2.  Monkeypox infection can be very painful. Provide your patients with information<https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le4318.pdf> on supportive home care.
  3.  Use a low threshold to initiate tecoviromat (TPOXX), especially for those with severe disease or those who are at risk for severe disease. TPOXX is safe, may speed the resolution of rash, pain, and systemic symptoms, and may decrease the risk of onward transmission. If you need TPOXX to treat patients with monkeypox, please use this order form<https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fapp.smartsheet.com%2Fb%2Fform%2F8145964e7cf94d0bbe5754e83d3abde4&data=05%7C01%7CJILLIAN.D.GARAI%40dhsoha.state.or.us%7C2ba7898941d142f53eb008dac9b1c967%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638044062707141808%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=uGd2SmyI7uA0339ZATTDl6%2FToIbxVnet06ztY%2BKeUKE%3D&reserved=0>. Your local public health authority may also have TPOXX available to treat patients.
  4.  Vaccinate your patients against monkeypox.  Anyone who requests vaccination should receive it. Please see OHA's most recent guidance on vaccination. If you would like to provide vaccine for your patients, you can order vaccine using this order form<https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le4323.pdf>.
  5.  You can find additional resources to help patients find vaccine at: https://www.oregon.gov/oha/PH/Monkeypox/Pages/vaccine.aspx, which includes vaccine events, a national vaccine locator, and a local public health authority directory.
  6.  Get Vaccinated Oregon<https://getvaccinated.oregon.gov/> now includes information on whether a vaccine event has monkeypox vaccine.  Events with Jynneos will state "hMPXV (Monkeypox) vaccine available" in the ADDITIONAL INFORMATION for each vaccine event.
  7.  Stay informed. Additional information on monkeypox in Oregon including data dashboards can be found at: https://www.oregon.gov/oha/ph/monkeypox

 If you have any questions on monkeypox testing, treatment, prevention, or vaccination, please contact Tim W Menza, MD, PhD at timothy.w.menza at dhsoha.state.or.us<mailto:timothy.w.menza at dhsoha.state.or.us>.
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