- Case counts of monkeypox continue to increase across the United States and in the National Capitol Region. The highest rate of disease in the US is found in the District of Columbia, suggesting continued transmission in our community.
- Testing for monkeypox is now widely available at commercial laboratories. Healthcare providers who suspect monkeypox infections can submit patient specimens for testing through commercial labs.
- At this time, monkeypox vaccination is only available through public health given limited vaccine supply. Individuals who are at higher risk of transmission (see suggested actions below) can contact their local health department to check vaccine qualifications and availability.
Case Detection and Laboratory Testing
- Maintain an increased index of suspicion for monkeypox when evaluating people with a characteristic rash, particularly for men who report sexual contact with other men and who present with lesions in the genital/perianal area or for individuals reporting a significant travel history in the month before illness onset or contact with a suspected or confirmed case of monkeypox.
- Laboratory testing should be submitted for all individuals who meet the CDC suspect case definition for monkeypox. Testing can be conducted through commercial labs; please consult with testing laboratory on appropriate specimen collection techniques and PPE recommendations. Monkeypox testing through public health is also available in circumstances where more expedited testing is needed (e.g., situations with a large number of exposed individuals needing investigation and post-exposure vaccination).
- Monkeypox is an immediately reportable disease. All suspect cases (any case in which testing was conducted) must be reported to public health via VDH’s disease reporting portal.
- Patients who are being tested and do not require hospitalization should be isolated at home pending test results. Public health will follow-up with individuals who are confirmed by laboratory testing to provide appropriate isolation guidance.
- Contact the Health Department’s Communicable Disease/Epidemiology Program at 703-246-2433 (normal business hours) or 703-409-8449 (evenings and weekends) for consultation and guidance on testing and infection control measures.
Public Health Vaccination
- As monkeypox vaccine becomes more available, public health will continue to expand vaccination efforts to individuals who are at higher risk of exposure and infection.
- At this time, the Virginia Department of Health has initiated expanded post exposure prophylaxis to adults (18 years of age or older) who identify with any of the following groups within the last 14 days:
- Gay, bisexual, and other men who have sex with men and have had multiple (i.e. more than 1) or anonymous sexual partners; OR
- Transgender women and nonbinary persons assigned male at birth who have sex with men and have had multiple (i.e. more than 1) or anonymous sexual partners; OR
- Sex workers (of any sexual orientation or gender); OR
- Staff (of any sexual orientation or gender) at establishments where sexual activity occurs (e.g., bathhouses, sex clubs); OR
- Persons who attend sex-on-premises venues (e.g., bathhouses, sex clubs).
- Patients who meet the criteria above, or who have reported recent contact to a confirmed monkeypox case, should reach out to their local health department to check vaccine qualifications and availability. Fairfax Health District residents can contact 703-267-3511.
- Typically, monkeypox begins with a prodrome that may include fever, chills, malaise, headache, and muscle aches. Lymphadenopathy may affect submandibular, cervical, axillary, or inguinal nodes unilaterally or bilaterally. Within 1 to 3 days after the appearance of fever, the patient develops a rash, often beginning on the face and spreading centrifugally, and commonly involving the palms and soles. Lesions progress from macules to papules, vesicles, pustules, and scabs over 2 to 4 weeks.
- In the current outbreak, some clinical presentations have been atypical, with lesions in the genital and perianal region and without fever or other prodromal symptoms. Infections may be mistaken for varicella zoster or sexually transmitted infections (e.g., syphilis, genital herpes). Co-infections with monkeypox and other infectious agents that can cause a rash (e.g., syphilis, herpes simplex) have also been reported.
- Updated US and worldwide counts of Monkeypox cases associated with the 2022 outbreak can be found on the CDC website.
- People with monkeypox in the current outbreak generally report having close, physical contact with other people who have monkeypox. While many of those affected in the current global outbreaks are gay, bisexual, or other men who have sex with men, anyone who has been in close contact with someone who has monkeypox can get the illness.
- Standard Precautions should be applied for all patient care, including for patients with suspected monkeypox. If a patient seeking care is suspected to have monkeypox, infection prevention and control personnel should be notified immediately. PPE used by healthcare personnel who enter the room of a patient with suspected or confirmed monkeypox should include gown, gloves, eye protection and an N-95 respirator. Additional CDC infection control guidance can be found on the CDC website.