Alerts:  Nov. 12, 2024: Pertussis (whooping cough) outbreak confirmed in Spokane County. SRHD urges parents and pregnant people to vaccinate. Read the press release.

Mpox Advisory for Health Care Providers

Increase in Clade II Mpox Transmission in Washington; Updated Screening, Testing, and Vaccine Recommendations

Posted Sept. 30, 2024. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

Current Situation

There are two distinct clades of mpox circulating globally – clade I and clade II.

  • Clade I mpox is endemic to central Africa, and is now connected to an outbreak of more than 27,000 cases in multiple countries where clade I is not endemic. There is evidence that clade I mpox is more transmissible, and potentially more severe, with case fatality ratios reported up to 10%. To date, no cases of clade I mpox have been identified in WA or in the United States.
  • Cases of clade II mpox, associated with the 2022 outbreak in the US, continue to be identified in Washington (WA). Although current rates are much lower when compared to 2022, there has been a recent increase in mpox cases in Washington. The majority of recent cases have been associated with transmission during sexual and intimate contact and among those who identify as gay, bisexual, or other men who have sex with men (MSM).

Due to this increase in local transmission of clade II mpox, plus the risk of clade I mpox, DOH recommends that health care providers continue to screen patients for signs and symptoms of mpox, to be aware of current testing resources, to continue to offer vaccination for those who are currently at high risk for acquiring mpox, and to be on alert for suspected cases of mpox clade I

Actions Requested
  • Be familiar with clinical symptoms of mpox.
  • Be aware of the ongoing outbreak of clade I mpox circulating in central Africa.
  • Consider mpox when seeing patients with genital ulcers, sores, or rashes, even if diagnosis of syphilis and herpes is considered more likely, regardless of the patient’s vaccination status.
  • Ask patients about their travel history, as well as their sexual health history.
  • Suspect clade I mpox in any patient with clinically compatible signs of mpox AND
    • recent travel to central Africa (or other areas with ongoing clade I mpox transmission) and/or,
    • contact with a confirmed clade I mpox case
  • Immediately report all suspected mpox cases or pending mpox tests to Spokane Regional Health District at 509-324-1449 or by fax 509-324-3623. If clade I mpox is suspected, please include this in your notification.
  • Use a polymerase chain reaction (PCR) test – ideally one that can determine mpox clade – to test patients with suspected mpox.
  • The WA DOH Public Health Laboratory (PHL) has developed mpox PCR testing with clade determination that is available for LHJs and providers.
  • Prior approval from the LHJ and DOH is required before submitting specimens.
  • Clade determination testing may also be available through clinical and commercial labs.
  • If clade determination testing is NOT available through your usual clinical laboratory, contact your LHJ to request clade determination testing at PHL.
  • Provide appropriate isolation recommendations to patients while their test results are pending and after a positive test result.
  • Medical care providers who provide care to gay or bisexual men, their partners, or members of the community should talk to their patients about mpox vaccination, as well as PrEP to prevent HIV and doxy PEP to prevent STIs.
  • The Early Intervention Program (WA’s AIDS Drug Assistance Program) and the PrEP Drug Assistance Program both cover JYNNEOS for those with and without health insurance who are eligible.
  • Offer mpox vaccination to travelers visiting a country where clade I mpox is spreading between people regardless of gender identity or sexual orientation if they anticipate experiencing any of the following:
  • Sex with a new partner,
  • Sex at a commercial sex venue, like a sex club or bathhouse,
  • Sex in exchange for money, goods, drugs, or other trade,
  • Sex in association with a large public event, such as a rave party, or festival.
  • The mpox vaccine, JYNNEOS, is available for providers to purchase off of the commercial market.
  • Consider referring patients with mpox to the antiviral Tecovirimat clinical trial, as the TPOXX EA-IND has limited provider’s ability to prescribe outside of the clinical trial.
  • Medical providers can refer patients for evaluation for enrollment in the Study of Tecovirimat for Human Mpox Virus (STOMP) trial by calling 206-773-7129 (text or call) or 1-855-876-9997 or sending an email to uwpositiveresearch.com.
Background

In May 2022, the World Health Organization (WHO) reported multiple cases of mpox (formerly known as monkeypox) in countries where the disease was not regularly occurring. This outbreak, unlike previous mpox outbreaks in the past, was primarily driven by transmission through close sexual and intimate contact, which disproportionately but not exclusively affected men who have sex with men (MSM). Mpox continues to be reported in WA, but at a much lower rate when compared to the outbreak in 2022. Mpox is often associated with a painful rash, along with other symptoms, that progresses through several stages. Mpox is spread through close contact with a person with mpox, direct contact with contaminated materials, or direct contact with infected animals.

Resources