Wisconsin DHS Health Alert #46: Monkeypox Detected in Wisconsin Resident
Bureau of Communicable Diseases
July 1, 2022
Key Points
- On June 30, 2022, the Wisconsin Department of Health Services (DHS) reported the first case of confirmed orthopoxvirus presumed to be monkeypox in a Wisconsin resident. The individual who is infected is currently isolating and poses little risk to the public.
- Clinicians should suspect monkeypox virus infection in any patient presenting with the characteristic monkeypox rash, regardless of the patient’s travel or social history, gender, or sexual identity. Recommendations for the detection and reporting of monkeypox were issued in HAN #44 on June 1, 2022.
- Testing is available for any patient with signs and symptoms consistent with monkeypox. Clinicians who suspect monkeypox in a patient should immediately contact the DHS Bureau of Communicable Diseases at 608-267-9003 to discuss whether testing or other public health actions are indicated.
Background
DHS is issuing this Health Alert Network (HAN) Health Advisory to update clinicians and public health authorities on the first case of confirmed orthopoxvirus presumed to be monkeypox in a Wisconsin resident. On June 30, 2022, the Wisconsin State Lab of Hygiene (WSLH) identified an orthopoxvirus infection in a Wisconsin resident presenting with skin lesions characteristic of a monkeypox infection. The patient is currently isolating and poses little risk to the public. DHS and local health departments are working to identify and notify known contacts of the positive individual. No additional cases of monkeypox have been identified in Wisconsin at this time. The current case definition, including epidemiologic criteria, is available on the Centers for Disease Control and Prevention (CDC) website.
Clinicians and public health authorities who encounter patients with suspected cases of monkeypox should immediately contact the DHS Bureau of Communicable Diseases at 608-267-9003 to discuss whether testing or other public health actions are indicated.
Information for Clinicians
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Monkeypox is reportable in Wisconsin as a Category I Condition. Providers should immediately consult DHS at 608-267-9003, as soon as monkeypox is suspected, to report the case and obtain approval for testing the patient.
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At this time, testing for orthopoxvirus will be coordinated by DHS at one of Wisconsin’s Laboratory Response Network (LRN) sites which include the Wisconsin State Laboratory of Hygiene (WSLH) and the Milwaukee Health Department Laboratory (MHDL). Additional commercial laboratories are expected to begin conducting testing in the coming weeks.
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Clinicians should suspect monkeypox in any patient who presents with a compatible rash-associated illness regardless of the patient’s travel or social history, sexual orientation, or the presence of risk factors for monkeypox virus infection. However, the CDC reports that most cases of monkeypox in the U.S. have occurred among gay, bisexual, and other men who have sex with men (MSM).
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The rash associated with monkeypox involves vesicles or pustules that are deep-seated, firm or hard, and well-circumscribed; the lesions may umbilicate or become confluent and progress over time to scabs.
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Presenting symptoms typically include fever, chills, the distinctive rash, or new lymphadenopathy; however, onset of perianal or genital lesions in the absence of subjective fever has been reported.
- People who know that a sexual partner in the past 21 days was diagnosed with monkeypox or who had multiple sexual partners in the past 21 days in a jurisdiction with known monkeypox, may be at higher risk of monkeypox infection
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Vaccines are available for pre- and post-exposure prophylaxis through the Strategic National Stockpile, and must be ordered through DHS. Post exposure prophylaxis (PEP) is indicated for individuals with known exposure to a person with confirmed or suspected monkeypox. Pre-exposure prophylaxis (PrEP) is currently indicated for laboratory workers who may be exposed to the virus. Additional supply may be distributed by the U.S. Department of Health and Human Services in the coming weeks.
- Infection prevention and control recommendations for monkeypox in health care settings are available from the CDC.
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Transmission of monkeypox through respiratory droplets requires prolonged close (i.e., face-to-face) interaction with a symptomatic person. The majority of health care interactions, including brief interactions and those conducted using appropriate PPE in accordance with standard precautions are not high risk and would not generally warrant post-exposure prophylaxis (PEP). Vaccines for PEP in the event of a high- or intermediate-risk exposures in health care settings are available from the Strategic National Stockpile and must be authorized for Wisconsin residents by DHS.
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Evaluation for other causes of genital rashes, diffuse rashes, or proctitis such as syphilis, herpes simplex virus (HSV) infection, chancroid, varicella zoster, chlamydia/LGV, gonorrhea and others should occur. Clinical consultations for STDs are available from STDCCN.org. However, if laboratory tests are ordered, notify the laboratory prior to any specimen submission as clinical specimens from patients with suspected monkeypox must be handled using special precautions.
- Patients who do not require hospitalization for medical indications may be isolated at home using protective measures.
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Many individuals infected with monkeypox virus have a mild, self-limiting disease course in the absence of specific therapy. However, antiviral treatments are available for people at risk of severe disease through consolation with DHS and CDC. Similar to vaccines, antivirals must be authorized by DHS and ordered for Wisconsin residents from the Strategic National Stockpile.
Recommendations for Health Departments
- All local health and Tribal health departments (LTHDs) should become familiar with the symptoms of monkeypox and the epidemiologic considerations for the current situation. If monkeypox is suspected in a community member, LTHDs should consult DHS at 608-267-9003.
- LTHD staff should review the current Monkeypox Case Definition on the CDC website.
- LTHDs are encouraged to share this HAN with STI clinics and other relevant health care provider networks in their jurisdictions.
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If monkeypox or orthopoxvirus is confirmed in a patient in their jurisdiction, the LTHD should begin contact tracing for individuals who may have been exposed to the patient. All contacts should be monitored for 21 days after their last known contact with the infected patient. LTHDs should familiarize themselves with CDC’s current guidance for exposure risk assessment, monitoring, and post-exposure prophylaxis.
Recommendations for Testing Laboratories
If your laboratory is notified by a clinician or LTHD of a suspected case of monkeypox:
- Immediately have the clinician consult DHS at 608-267-9003. DHS will conduct screening and consult CDC and will notify WSLH or MHDL if a test is approved.
- Laboratories will conduct PCR testing using CDC Laboratory Response Network (LRN) protocols if testing is approved by DHS. WSLH or MHDL will submit all specimens with non-variola orthopoxvirus positive PCR results to the CDC for monkeypox virus testing.
- Advise clinicians to perform specimen collection per LRN specifications, collecting two swabs (either dry or in VTM) from multiple lesions. Refer to the WSLH laboratory communication dated June 24, 2022 and CDC’s website.
- Take measures to minimize the risk of laboratory transmission when testing routine clinical specimens for confirmed or suspected monkeypox patients. Perform all specimen manipulations within at least a Class II (or higher) biological safety cabinet using enhanced BSL-3 practices.
Resources
From DHS:
From CDC:
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
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