 We want to keep our partners, contractors, and Washington healthcare providers updated on mpox activities in our region.
It was announced by the Centers for Disease Control and Prevention (CDC) on November 16th, 2024 that a recent case of clade I mpox was reported in California. At this time, CDC considers the overall risk of clade I mpox to the U.S. public to be low at this time.
To date, no cases of clade I mpox have been reported in Washington (WA). There was a low-risk exposure to a WA resident from this reported clade I mpox case in California. The contact was asymptomatic throughout their incubation period, they received post-exposure prophylaxis, and they reported no risk of transmission within Washington. WA DOH and the local health jurisdiction are continuing to monitor the situation.
Due to the potential for clade I mpox to continue being detected within the United States, DOH recommends that health care providers screen individuals who exhibit signs and symptoms of mpox and fit current epidemiologic criteria for mpox, continue to offer vaccination for those who are currently at high risk for acquiring mpox, and be on alert for suspected cases of mpox clade I.
Cases of clade II mpox continue to be identified weekly in WA, although current rates are much lower when compared to 2022. 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).
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.
While both clades of mpox have similar symptoms, there is historical evidence that clade I mpox is more transmissible, and potentially more severe, with case fatality rates reported up to 10%, with higher risk for children. However, initial analysis from the ongoing clade I outbreak in the Democratic Republic of the Congo indicates that people with clade I mpox who are provided high-quality supportive care have a significantly lower mortality than those who were not connected to care.
- Continue to consider the diagnosis of and test for mpox in all patients with compatible signs and symptoms.
- This includes individuals with symptoms who have traveled to Central or Eastern Africa in the 21 days before symptoms onset (including, but not limited to, Burundi, Central African Republic, Democratic Republic of the Congo, Kenya, Republic of the Congo, Rwanda, Uganda, Zambia, or Zimbabwe).
- Management for clade I mpox is the same for clade II mpox and local health jurisdictions and health care providers should follow WA DOH and CDC guidance.
- Health care providers should continue to vaccinate individuals who are eligible to receive mpox vaccination and order vaccine supply off of the commercial market for their own clinics and practices.
- Be aware of the ongoing outbreak of clade I mpox circulating in central and Eastern 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.
- Immediately report all suspected mpox cases or pending mpox tests to your local health jurisdiction (LHJ).
- Ask patients about their travel history, as well as their sexual health history.
- Use a polymerase chain reaction (PCR) test – ideally one specific to monkeypox virus and one that can determine clade – to test patients with suspected mpox.
- WA Public Health Laboratory (PHL) now has a mpox rule out test with clade determination that is available for LHJs and providers.
- Do NOT send specimens to the PHL without prior approval from LHJ/DOH.
- Send specimens to the WA PHL for patients with clinically compatible signs of mpox AND
- Report recent travel to central Africa (or other areas with ongoing clade I mpox transmission) AND/OR
- Contact with a confirmed clade I mpox case.
- 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.
- Travel health providers should conduct a sexual health history with their patients and offer mpox vaccination to travelers visiting a country where clade I mpox is spreading between people regardless of the patient’s 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 or festival.
- 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.
Follow mpox updates and guidance from the CDC and WA DOH mpox reporting and surveillance guidelines , which were updated in October 2024 to incorporate additional guidance for clade I mpox.
Please direct questions to the DOH Sexual Health Coordinator for Vaccine Preventable STIs, Ben Meana via email at mpoxconsult@doh.wa.gov or phone at (206) 418-5500.
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