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<title>Update on Monkeypox Activity in Oregon</title>
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<p><span style="font-family:"Helvetica",sans-serif">Colleagues,<o:p></o:p></span></p>
<p><strong><span style="font-family:"Arial",sans-serif">Situation </span></strong><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></p>
<p><span style="font-family:"Arial",sans-serif">There has been a concerning increase of monkeypox (hMPXV) cases in Oregon, with 12 new cases reported in the last week<span style="color:black">; this is greater than the number of</span><span style="color:red">
</span><span style="color:black">cases </span>reported in the <span style="color:black">
preceding </span>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.
<span style="color:black">Testing for monkeypox is commercially available at several labs,</span><span style="color:red">
</span><span style="color:black">including </span></span><span style="font-family:"Helvetica",sans-serif"><a href="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"><span style="font-family:"Arial",sans-serif">Quest
Diagnostics</span></a></span><span style="font-family:"Arial",sans-serif;color:red">
</span><span style="font-family:"Arial",sans-serif;color:black">and </span><span style="font-family:"Helvetica",sans-serif"><a href="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"><span style="font-family:"Arial",sans-serif">LabCorp</span></a></span><span style="font-family:"Arial",sans-serif;color:red">.
</span><span style="font-family:"Arial",sans-serif;color:black">The Oregon State Public Health Laboratory (OSPHL) also provides testing for</span><span style="font-family:"Arial",sans-serif;color:red">
</span><span style="font-family:"Helvetica",sans-serif"><a href="https://www.oregon.gov/oha/PH/LABORATORYSERVICES/Pages/zOrthopox.aspx"><span style="font-family:"Arial",sans-serif">monkeypox</span></a></span><span style="font-family:"Arial",sans-serif;color:red">.<strong><span style="font-family:"Arial",sans-serif">
</span></strong></span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></p>
<p><strong><span style="font-family:"Arial",sans-serif"> </span></strong><span style="font-family:"Arial",sans-serif">While almost 17,000 people in Oregon have received at least one dose of Jynneos, the vaccine
<span style="color:black">that provides protection</span> 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.</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></p>
<p><span style="font-family:"Arial",sans-serif"> OHA has a good supply of both tecoviromat (TPOXX) for treatment and vaccine (Jynneos) for prevention.</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></p>
<p><strong><span style="font-family:"Arial",sans-serif">Action</span></strong><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></p>
<p><span style="font-family:"Arial",sans-serif">We urge the medical community to keep monkeypox top of mind when evaluating patients with compatible illness (<span style="color:black">including genital, peri-anal, and/or oral sores; skin rash; proctitis; and/or
pharyngitis</span>) regardless of disclosed risk and known community transmission.
</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></p>
<p><span style="font-family:"Arial",sans-serif"> Providers can reference this </span>
<span style="font-family:"Helvetica",sans-serif"><a href="https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le4344.pdf"><span style="font-family:"Arial",sans-serif">poster</span></a></span><span style="font-family:"Arial",sans-serif"> for quick tips
on when to <strong><span style="font-family:"Arial",sans-serif">think</span></strong> monkeypox, how to
<strong><span style="font-family:"Arial",sans-serif">test</span></strong> for monkeypox, when to
<strong><span style="font-family:"Arial",sans-serif">treat</span></strong> with tecovirimat (TPOXX), and when to
<strong><span style="font-family:"Arial",sans-serif">vaccinate</span></strong> patients at greater risk.
</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></p>
<p><span style="font-family:"Arial",sans-serif"> Test your patients for monkeypox if they request testing.
<span style="color:black">See this </span></span><span style="font-family:"Helvetica",sans-serif;color:#3B5DB9"><a href="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"><span style="font-family:"Arial",sans-serif;color:#3B5DB9">video</span></a></span><span style="font-family:"Arial",sans-serif;color:black">
on how to collect a sample for testing.</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></p>
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<li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level1 lfo3">
<span style="font-family:"Arial",sans-serif">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.</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level1 lfo3">
<span style="font-family:"Arial",sans-serif">Monkeypox infection can be very painful. Provide your patients with
</span><span style="font-family:"Helvetica",sans-serif"><a href="https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le4318.pdf"><span style="font-family:"Arial",sans-serif">information</span></a></span><span style="font-family:"Arial",sans-serif"> on
supportive home care.</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level1 lfo3">
<span style="font-family:"Arial",sans-serif">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
</span><span style="font-family:"Helvetica",sans-serif"><a href="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"><span style="font-family:"Arial",sans-serif">order
form</span></a></span><span style="font-family:"Arial",sans-serif">. Your local public health authority may also have TPOXX available to treat patients.
</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level1 lfo3">
<span style="font-family:"Arial",sans-serif">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 </span><span style="font-family:"Helvetica",sans-serif"><a href="https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le4323.pdf"><span style="font-family:"Arial",sans-serif">order form</span></a></span><span style="font-family:"Arial",sans-serif">.
</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level1 lfo3">
<span style="font-family:"Arial",sans-serif">You can find additional resources to help patients find vaccine at:
</span><span style="font-family:"Helvetica",sans-serif"><a href="https://www.oregon.gov/oha/PH/Monkeypox/Pages/vaccine.aspx"><span style="font-family:"Arial",sans-serif">https://www.oregon.gov/oha/PH/Monkeypox/Pages/vaccine.aspx</span></a></span><span style="font-family:"Arial",sans-serif">,
which includes vaccine events, a national vaccine locator, and a local public health authority directory.
</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level1 lfo3">
<span style="font-family:"Helvetica",sans-serif"><a href="https://getvaccinated.oregon.gov/"><span style="font-family:"Arial",sans-serif">Get Vaccinated Oregon</span></a></span><span style="font-family:"Arial",sans-serif"> 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.</span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level1 lfo3">
<span style="font-family:"Arial",sans-serif">Stay informed. Additional information on monkeypox in Oregon including data dashboards can be found at:
</span><span style="font-family:"Helvetica",sans-serif"><a href="https://www.oregon.gov/oha/ph/monkeypox"><span style="font-family:"Arial",sans-serif">https://www.oregon.gov/oha/ph/monkeypox</span></a><o:p></o:p></span></li></ol>
<p><span style="font-family:"Helvetica",sans-serif"> </span><span style="font-family:"Arial",sans-serif">If you have any questions on monkeypox testing, treatment, prevention, or vaccination, please contact Tim W Menza, MD, PhD at
</span><span style="font-family:"Helvetica",sans-serif"><a href="mailto:timothy.w.menza@dhsoha.state.or.us"><span style="font-family:"Arial",sans-serif">timothy.w.menza@dhsoha.state.or.us</span></a></span><span style="font-family:"Arial",sans-serif">. </span><span style="font-family:"Helvetica",sans-serif"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Helvetica",sans-serif">--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------<br>
This message was sent to Tribal and Local Public Health Authorities, as well as other public health and clinical partners of OHA.
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<p class="MsoNormal"><span style="font-family:"Arial",sans-serif;color:#040404">_______________________________________________________________</span><span style="font-family:"Helvetica",sans-serif;color:#040404"><o:p></o:p></span></p>
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<p><strong><span style="font-family:"Arial",sans-serif;color:#040404">Unless otherwise noted, feel free to share this HAN notification with:</span></strong><b><span style="font-family:"Arial",sans-serif;color:#040404"><br>
<strong><span style="font-family:"Arial",sans-serif">- Others within your organization.</span></strong><br>
<strong><span style="font-family:"Arial",sans-serif">- Professionals within your health, preparedness, and response affiliations.</span></strong></span></b><span style="font-family:"Helvetica",sans-serif;color:#777777"><o:p></o:p></span></p>
<p><strong><span style="font-family:"Arial",sans-serif;color:#040404">Oregon 24/7 disease reporting: 971-673-1111</span></strong><span style="font-family:"Helvetica",sans-serif;color:#777777"><o:p></o:p></span></p>
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