Current Situation

The Centers for Disease Control and Prevention (CDC) issued a Health Advisory on May 20, 2022, regarding a confirmed case of monkeypox virus infection in Massachusetts.  Cases of monkeypox have been identified in several non-endemic countries since early May 2022.  Many of the individuals involved men who have sex with men without a history of travel to an endemic country.  

Monkeypox is a zoonotic illness endemic to several Central and West African countries.  Disease symptoms include a characteristic rash, which is described as firm, well-circumscribed, deep-seated and umbilicated skin lesions.  Historically, the rash has been preceded by a prodrome including fever, lymphadenopathy, and other non-specific symptoms such as malaise, headache, and muscle aches.  In the most recent reported cases, prodromal symptoms may not have always occurred.  Some recent cases have begun with characteristic, monkeypox-like lesions in the genital and perianal region in the absence of subjective fever and other prodromal symptoms.  Average incubation period is 3 to 13 days.  A person is considered infectious from the onset of symptoms through when lesions have thoroughly crusted and a fresh layer of healthy skin has formed underneath.

Recommendations

While no cases have been reported in California yet, the California Department of Public Health (CDPH) and Monterey County Health Department (MCHD) request that medical providers report and test suspected cases of monkeypox virus infection as outlined below:

• Suspect monkeypox virus infection in patients who meet the following working case definition:
  • Presence of unexplained rash that is consistent with monkeypox (firm, well-circumscribed, deep-seated and umbilicated skin lesions; progresses to papules to vesicles to pustules to scabs), and
  • History of close contact with a person suspected to have monkeypox, and/or travel in the past month to an area where confirmed cases have been reported, and/or is a male who has sex with other men.
• Report suspected cases by phone to the Monterey County Health Department’s Communicable Disease Unit:
  • During normal business hours: 831-755-4521.
  • Outside of normal business hours:831-755-5100 and ask for the Hazardous Materials Team; they will connect you with on-call public health staff.
• Collect lesion swabs and submit to the Monterey County Public Health Laboratory:
  • Collect dry swabs of lesions using sterile nylon, polyester, or Dacron swabs with plastic or aluminum shafts:
    • Vigorously swab or brush lesion with two separate sterile dry swabs.
    • Break off swabs into separate 1.5- or 2-mL screw-capped tubes with O-ring or place each entire swab in a separate empty sterile container (do not add or store in viral or universal transport media).
    • More than one lesion should be sampled, preferably from different body sites.
    • Sample, label, and store each lesion separately.
    • Store at 4^◦C if transferring to the Monterey County Public Health Laboratory within 24 to 72 hours; otherwise, store at -80^◦C.
  • Suspected cases must be reported to the Monterey County Health Department’s Communicable Disease Unit before submitting specimens to the Public Health Laboratory.
• Use appropriate infection control procedures with patients presenting with suspected monkeypox:
  • Patient should be placed in a single-person exam room with the door closed or in an airborne isolation room, if available. The patient should remain masked, as tolerated, and any exposed skin lesions should be covered with a sheet or gown.
  • Healthcare personnel (HCP) should wear the following PPE:gloves, gown, eye protection, and an N95 or equivalent.HCP should don PPE before entering the patient’s room and use for all patient contact.HCP should remove and discard gloves, gown and eye protection and perform hand hygiene prior to leaving the patient’s room; the N95 respirator should be removed, discarded, and replaced with a mask for source control (or respirator as required by facility protocols) after leaving the patient’s room and closing the door.
  • Any EPA-registered hospital-grade disinfectant should be used for cleaning and disinfecting environmental surfaces.If a standard examination room was used, the exam room should not be used for at least 2 hours following the patient’s departure from the room.

For Additional Information

• Monterey County Health Department’s Communicable Disease Unit: normal business hours - 831-755-4521; after hours - 831-755-5100 and ask for the Hazardous Materials Team. They will transfer you to the on-call public health professional.
• Monterey County Public Health Laboratory:831-755-4516.
• CDC Monkeypox Website: https://www.cdc.gov/mpox/?CDC_AAref_Val=https://www.cdc.gov/poxvirus/mpox/index.html
• CDC Health Advisory – Monkeypox Virus Infection in the United States and Other Non-endemic Countries-2022 released May 20, 2022: https://emergency.cdc.gov/han/2022/han00466.asp
• Printable Copy of this Alert https://www.co.monterey.ca.us/home/showdocument?id=112110&t=637889888020760577