Monkeypox Advisory for Healthcare Providers

Monkeypox Update

Posted July 15, 2022. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

The purpose of this advisory is to provide an update on the U.S. monkeypox outbreak and to provide clinical guidance to Spokane County healthcare providers.

Please direct questions about testing any patients for monkeypox to SRHD at cdepi@srhd.org or call (509) 324-1442. (IMPORTANT: Emails containing patient identifying information must be encrypted.)

Washington State Current Status

Update 7/14/2022: 33 people in Washington state have tested positive for orthopoxvirus, including one person who was exposed in another state, but tested positive in Washington. All positive cases of orthopoxvirus are considered likely monkeypox.

Number of monkeypox cases by county:

  • King: 29
  • Pierce: 2
  • Snohomish: 2
NEW Clinical Response Resources

Commercial laboratories are now accepting specimens for monkeypox testing.

  • Laboratories that are currently accepting specimens for orthopoxvirus testing:
  • Samples positive for orthopoxvirus (the genus of viruses that includes monkeypox virus) are sent to CDC for viral characterization testing for monkeypox. Clinicians and public health authorities should act on positive orthopoxvirus results (initiate isolation, contact tracing, treatment, etc.), and should not wait for CDC characterization results, as monkeypox is the only circulating orthopoxvirus.

When packaging and shipping samples for laboratory testing, please follow CDC directions for Preparation and Collection of Specimens | Monkeypox | Poxvirus | CDC. UN 3373 Biological Substance; Category B shipping is required for monkeypox specimens. Instructions for Category B shipping can be found here: Category B Shipping (wa.gov) and Transporting-Infectious-Substances-Safely.pdf (dot.gov).

JYNNEOS vaccine is available in Washington and Spokane
  • Spokane Regional Health District (SRHD) is being allocated 160 courses (320 vials) of JYNNEOS vaccine as part of HHS/ASPR’s Phase 2A state distribution
    • 25% of this allocation is being held for use by a neighboring county and/or tribal partners, as determined by DOH
  • This vaccine is to be prioritized for post-exposure prophylaxis (PEP) of eligible contacts. Vaccine can be used for expanded PEP (PEP++) in limited amounts for outbreak response.
  • At this time, the allocation will be housed at SRHD and distributed to clinics as appropriate for PEP. As larger allocations are made available, clinics will be able to carry JYNNEOS on-hand.

For information about JYNNEOS, read Considerations for Monkeypox Vaccination | Monkeypox | Poxvirus | CDC and review the package insert.

NEW Clinical Guidance

Interim clinical guidance for monkeypox treatment has been published by CDC.

Treatment considerations, including antivirals and vaccinia immune globulin, can be found on the CDC website Treatment Information for Healthcare Professionals | Monkeypox | Poxvirus | CDC.

Many people infected with monkeypox virus have a mild, self-limiting disease course in the absence of specific therapy. However, the prognosis for monkeypox depends on multiple factors, such as previous vaccination status, initial health status, concurrent illnesses, and comorbidities among others. Patients who should be considered for treatment following consultation with CDC might include:

    • People with severe disease (e.g., hemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalization)
    • People who may be at high risk of severe disease:
      • People who are immunocompromised (e.g., human immunodeficiency virus/acquired immune deficiency syndrome infection, leukemia, lymphoma, generalized malignancy, solid organ transplantation, therapy with alkylating agents, antimetabolites, radiation, tumor necrosis factor inhibitors, high-dose corticosteroids, being a recipient with hematopoietic stem cell transplant <24 months post-transplant or ≥24 months but with graft-versus-host disease or disease relapse, or having autoimmune disease with immunodeficiency as a clinical component)
      • Pediatric populations, particularly patients younger than 8 years of age
      • People with a history or presence of atopic dermatitis, persons with other active exfoliative skin conditions (e.g., eczema, burns, impetigo, varicella zoster virus infection, herpes simplex virus infection, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis, or Darier disease [keratosis follicularis])
      • Pregnant or breastfeeding women
      • People with one or more complications (e.g., secondary bacterial skin infection; gastroenteritis with severe nausea/vomiting, diarrhea, or dehydration; bronchopneumonia; concurrent disease or other comorbidities)
    • People with monkeypox virus aberrant infections that include accidental implantation in eyes, mouth, or other anatomical areas where monkeypox virus infection might constitute a special hazard (e.g., the genitals or anus)