Monkeypox Information For Healthcare Providers
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Organism, Causative agent, Etiologic agent
The infectious agent of mpox disease is the mpox virus, a species in the genus Orthopoxvirus and the family Poxviridae.
Signs and Symptoms
Mpox is a severe acute illness, usually with sudden onset of initial symptoms of fever, headache, muscle aches, backache, swollen lymph nodes (lymphadenopathy), chills, and exhaustion. Clinically, the disease closely resembles smallpox, but lymphadenopathy is a more prominent feature in the early stage of mpox disease.
Shortly afterwards, a rash develops, usually starting on the face and spreading to other body parts. Lesions typically begin to form simultaneously and evolve together on any part of the body as they progress from small red bumps to larger pus-filled bumps to scabs before falling off. Mpox may not always appear the same way and could be clinically confused with a chickenpox or shingles (varicella zoster virus) or a sexually transmitted infection (STI) like syphilis or herpes. The illness typically lasts for 2-4 weeks. If someone has a very weak immune system, then the rash and illness could present differently.
Mpox is a serious illness, which can be painful and require hospitalization. In recent years, the case fatality rate has been 3 to 6%, and the number of deaths from mpox disease has been higher in young children.
The incubation period (time from infection to symptoms) for mpox is usually 7-14 days but can range from 5-21 days. The rash typically begins within 5 days of the first symptoms.
Currently, there is no FDA approved treatment specifically for mpox virus infection. However, the CDC holds a non-research Expanded Access Investigational New Drug (EA-IND, also known as compassionate use) protocol that allows TPOXX (tecovirimat) to be used for treatment of mpox virus, in adults and pediatric patients. CDC’s guidance on eligibility and treatment considerations can be found at www.cdc.gov/poxvirus/monkeypox/clinicians/Tecovirimat.html.
TPOXX is available as oral capsules and vials for injection. Prescribing information can be found at https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/214518s000lbl.pdf
To request TPOXX, healthcare providers should make requests for Tecovirimat to their local health department.
Once the health care provider has received TPOXX, they need to complete and report the required forms to the CDC. These forms can be found on the CDC website:
- Informed Consent Form,
- Patient Intake Form,
- FDA Form 1572, and
- MedWatch Form (Serious Adverse Event Report).
If you are seeking testing for your patients, please check with your hospital lab and usual commercial labs for options. You may also consult with your local health department (https://idcu/investigation/conditions/contacts/). to request public health testing. More information on public health testing options DSHS Monkeypox Laboratory Testing Guidance for Human Clinical Specimens.
Mpox cases are immediately reportable upon suspicion.
Immediately report persons under investigation, cases of mpox, or laboratory reports to your local health department (https://idcu/investigation/conditions/contacts/).
Several Texas laws (Tex. Health & Safety Code, Chapters 81, 84, and 87) require specific information regarding notifiable conditions to be provided to the Texas Department of State Health Services (DSHS). Health care providers, hospitals, laboratories, schools, and others are required to report patients who are suspected or confirmed of having a notifiable condition (25 Tex. Admin. Code §97.2).