Maricopa County Department of Public Health issued a press release this week announcing an increasing number of monkeypox cases.  While there are just a couple dozen cases under investigation (29 cases statewide as of this morning), there are probably many more in the community that are going undiagnosed. When a case is reported to MCDPH they do a case investigation and contact tracing.

Close (sexual) contacts of people who tested positive for monkeypox are offered the JYNNEOS smallpox/monkeypox vaccine (JYNNEOS is approved for both smallpox and monkeypox). Because the vaccine is given after the exposure, it’s called post exposure prophylaxis.

Why is the Monkeypox Vaccine in Short Supply When There Are 100 Million Doses in the Strategic National Stockpile?

Finding cases is harder than you might think. It’s unlikely than primary care and urgent care providers have ever seen a monkeypox case in their career. There’s also a learning curve for them when they do suspect a case because they need to figure out how to collect a specimen for laboratory testing, how to package it and where to send it. Complicating matters, in this outbreak, the rash is presenting in the genital/anal area.

There’s more and more evidence for pre-symptomatic spread- which is always an impediment for implementing effective control measures. In fact- whether there’s pre-symptomatic spread of monkeypox is probably a determining factor whether this outbreak can be stopped or whether this becomes an endemic illness.

Note: We badly need a new MMWR from the CDC to answer some of these key questions so county health departments and clinicians know how to proceed.

County health departments are urging clinicians to consider monkeypox in their differential diagnosis for patients who have a rash consistent with monkeypox and epidemiological risk factors for exposure to monkeypox (CDC link). 

Monkeypox testing is now commercially available.  Quest DiagnosticsLabCorp and Mayo Clinic Laboratories offer commercial testing, but clinicians need to can contact their commercial laboratory provider to determine the logistics for testing. 

Specimen collection involves swabbing a lesion vigorously with two sterile synthetic swabs with a plastic, wood, or thin aluminum shaft (no cotton swabs). Break off the end of each swab’s applicator into a 1.5-or 2-mL screw-capped tube with O-ring or place the entire swab in a sterile container. Store in a refrigerator or freezer within an hour of collection.

Here’s the laboratory specimen collection guidance for LabCorp, Quest Diagnostics, Mayo Clinic or CDC

Most people with monkeypox virus have a self-limiting disease course without treatment, however, a drug called Tecovirimat is approved by the FDA for the treatment of smallpox in adults and children and may be effective for the treatment of severe monkeypox virus.

WHO chief: Monkeypox now a global emergency