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Mpox resources for health care providers

Last updated August 29, 2023.

The Colorado Department of Public Health and Environment monitors cases of mpox statewide. Anyone who has been in close contact with someone who has mpox can get the illness. At this time, cases are predominantly occurring in gay, bisexual, and other men who have sex with men.

    Before the patient visits, learn how to recognize mpox lesions. Consult CDC’s Clinical Recognition webpage for photographs of what lesions can look like. 

    Patients with mpox may have a new, maculo-papular rash that develops into vesicles and then pustules. Lesions may be deep-seated, firm, well-circumscribed, and umbilicated. 

    The rash may be: 

    • Anywhere on the body, including palms, soles, and anogenital region. 
    • Localized to a specific body site or diffuse. 
    • The only symptom patients experience. 
    • Often painful or itchy. 

    Patients may also have: 

    • Fever, headache, malaise, chills, and lymphadenopathy. 
    • Anorectal pain, rectal bleeding, or tenesmus in association with visible perianal skin lesions and proctitis.

    Infection control precautions can lower the risk of mpox transmission. These include:

    • Isolation of suspected mpox patients in a single room with the door closed (if safe to do so). No special air handling is necessary, including during sample collection. The patient should have a dedicated bathroom.
    • Hand hygiene. Wash hands frequently with soap and water or use hand sanitizer with at least 60% alcohol. 
    • Proper PPE use. Use a gown, gloves, eye protection, and NIOSH-approved respirator with N95 or higher filters when entering the patient’s room.
    • Cleaning and disinfection of the environment following standard procedures, using an EPA-registered hospital-grade disinfectant with an emerging viral pathogen claim. See EPA List Q. 
    • Unroofing or aspiration of lesions (or otherwise using sharp instruments for mpox testing) is not necessary, nor recommended, due to the risk for sharps injury.

    Consult CDPHE’s Mpox Infection Control Guidance for Outpatient Settings and CDC’s Infection Prevention and Control of Mpox in Healthcare Settings for more detailed guidance on how to manage occupational exposures as well as protecting health care workers from transmission in the workplace.

      Use the following tools to determine risk and monitor symptoms after exposure to mpox in health care settings:

      Workers with high or intermediate risk exposures should monitor themselves daily for symptoms and contact a health care provider to discuss prophylactic vaccination with the Jynneos vaccine.

        Although most cases in recent outbreaks have occurred among gay, bisexual, and other men who have sex with men, any patient, regardless of sexual or gender identity, with rash consistent with mpox should be considered for testing. Patients should be considered for mpox testing regardless of vaccination status.

        Ask the patient - In the last 21 days, have you:

        • Had close or intimate contact with someone with a similar rash or confirmed mpox infection? 
        • Had close or intimate contact with someone in a social network experiencing mpox transmission?
          • Most U.S. cases have been among gay, bisexual, and other men who have sex with men, many of whom had anonymous sex with someone they met on dating apps or sex with multiple partners at venues or events where anonymous sex is common.

        Answering “yes” to either of the questions above should increase clinical suspicion for, and the pre-test probability of, mpox.

          No special training or materials are necessary for mpox testing. Most providers should be able to safely collect specimens using appropriate PPE. Specimens can be tested at a commercial laboratory. 

          Commercial testing is strongly encouraged when covered by insurance. Follow specimen collection instructions for the specific commercial laboratory and/or CDC’s Preparation and Collection of Specimens for information on how to collect and ship mpox specimens.

          Testing is also available at CDPHE and requires prior approval. The CDPHE lab can be used to test specimens for people who are uninsured or underinsured. Order testing via Lab Online or call (303) 692-2700. Consult CDPHE’s Guidance for mpox specimen collection. 

            Before a patient with suspected mpox leaves the appointment, share resources on how to prevent transmission at home effectively. Consider printing and/or sharing links to CDPHE’s home isolation guidance and household disinfection guide. CDC’s Isolation and Infection Control At Home page also has information about preventing transmission at home.

            In some highly suspicious cases, empiric mpox treatment may be initiated prior to a positive test result. Consider whether your patient has an indication for treatment with tecovirimat (TPOXX) or other medications including pain management. TPOXX may be available through the Study of Tecovirimat for Mpox (STOMP) trial. If this is not an option, email tpoxx@state.co.us to learn more or to request TPOXX, a CDC clinical consult, or other therapeutics for severe cases. Additional information on treatment is below.

              Inform the patient of their test results. If the test is positive, counsel the patient to expect a call from public health for a confidential interview about recent close contacts. It is important to answer calls from public health with the knowledge that no personally identifying details from these conversations will be released. Patients can learn more about how to notify contacts, including the use of anonymous notification systems, at CDC’s Notifying Close Contacts webpage.

              Consider whether your patient has an indication for treatment with tecovirimat (TPOXX) or other medications including pain management. Adults and children of any age are eligible to enroll in the STOMP trial. STOMP is a National Institute of Allergy and Infectious Diseases-funded clinical trial led by the AIDS Clinical Trials Group to evaluate the efficacy of TPOXX for the treatment of mpox. If this is not an option, email tpoxx@state.co.us to learn more or to request TPOXX, a CDC clinical consult, or other therapeutics for severe cases. Additional information on treatment is below.

                Medical countermeasures are available for use in the treatment of mpox when indicated. The most commonly used treatment is tecovirimat, or TPOXX. Adults and children of any age are eligible to enroll in the STOMP trial for oral TPOXX; adults may be eligible even if they are not at high risk for severe disease. 

                STOMP is a National Institute of Allergy and Infectious Diseases-funded clinical trial led by the AIDS Clinical Trials Group to evaluate the efficacy of TPOXX for the treatment of mpox. Remote enrollment is available. Adults with severe mpox, severe immunodeficiency, or severe inflammatory skin conditions; individuals taking certain medications that could affect tecovirimat levels; and pregnant people, people who are breastfeeding, and children all will be enrolled in an open-label arm in which all participants receive tecovirimat. Other adult participants—530 total—will be randomly assigned in a 2:1 ratio to receive tecovirimat or placebo pills, which participants will take for 14 days.

                Oral and IV TPOXX formulations are also available under an Investigational New Drug (IND) protocol. Patients should first be offered enrollment into the STOMP trial. Those who refuse participation in or do not qualify for the STOMP trial may be considered for treatment under the IND protocol. The IND protocol has been simplified to ease the administrative burden. However, a treating health care provider must still complete some IND paperwork when administering TPOXX to patients via this method.

                In some highly suspicious cases, empiric treatment may be initiated prior to a positive test result.

                Additional information on TPOXX, including indications for treatment, can be found on CDC’s Guidance for Tecovirimat Use. Other therapeutics may also be available through public health for severe cases.

                Role of public health
                CDPHE does not administer or dispense medication directly to patients. Public health officials at CDPHE are available to discuss treatment with providers and consult CDC clinical experts as appropriate. Consultation with CDC is recommended in severe cases, pediatric cases, pregnant cases, cases with ocular involvement, or other complicated cases. Call 303-692-2700 or 303-370-9395 (after hours for urgent and/or time-sensitive needs only), or email tpoxx@state.co.us Monday through Friday to request clinical consultation.

                CDPHE currently has medication on-hand to facilitate timely administration and can courier oral or IV TPOXX as needed. If your facility or health system does not have TPOXX on hand, and it cannot be obtained through the STOMP trial, providers can contact public health to request TPOXX or other therapeutics. Call 303-692-2700 or 303-370-9395 (after hours for urgent and/or time-sensitive needs only), or email tpoxx@state.co.us to request treatment. 

                  Some people who have been recently exposed to mpox, or are at risk for exposure, should receive the Jynneos vaccine.

                  Jynneos vaccines are available at many locations in Colorado, and there are no longer specific eligibility criteria for mpox vaccination — anyone who thinks they may be at risk of exposure to mpox can get vaccinated. Public health specifically recommends vaccination for people who may be at higher risk based on data from recent outbreaks, including:

                  • Anyone who has had close physical contact with someone who has mpox in the last 14 days.
                  • Anyone who: 
                    • Has multiple or anonymous sexual partners, or
                    • Has close physical contact with other people in a venue where anonymous or group sex may occur, or
                    • Was diagnosed with gonorrhea or syphilis in the past six months, or
                    • Is living with HIV, or
                    • Is immunocompromised and anticipates potential mpox exposure, or
                    • Already uses or is eligible for HIV PrEP (medication to prevent HIV, e.g. Truvada or Descovy or Apretude), or
                    • Engages in commercial and/or transactional sex (e.g. sex in exchange for money, shelter, food, and other goods or needs).
                  • Anyone identified by public health as a known high-risk contact of someone who has mpox.
                  • Anyone whose sexual partner identifies with any of the above scenarios.
                  • Anyone who anticipates experiencing any of the above scenarios.

                  The Jynneos vaccine is fully licensed for people 18 years of age and older, and available under Emergency Use Authorization (EUA) for people under 18 years of age who are at high risk for mpox infection. The standard administration route for JYNNEOS vaccine for adults and children is subcutaneous (Subcut) with an injection volume of 0.5mL. An alternative route involving intradermal (ID) administration with an injection volume of 0.1mL may be used for adults under Emergency Use Authorization (EUA).

                  Either the standard (0.5mL SubCut) or the alternative (0.1mL ID) regimen may be used for adult patients. Providers may discuss with patients to determine which route of administration each patient prefers.

                  Some children may benefit from alternative options for post-exposure prophylaxis. Data shows that the Jynneos vaccine may not work well to protect infants aged 6 months and younger from mpox. In these cases, public health will consult with Centers for Disease Control and Prevention and the child’s primary care provider to discuss available options.

                  CDPHE-hosted clinics can vaccinate eligible people aged 15 years and older. Parents and guardians of children younger than 15 years who may need to be vaccinated should contact their health care provider or local public health agency. Parental/guardian consent is required to administer the Jynneos vaccine to anyone under the age of 18 years. In addition to parental/guardian consent, minors aged 15 to 17 must also sign a formal agreement to receive the vaccine. 

                  For a list of vaccine providers in Colorado, consult CDPHE’s Where to get vaccinated for mpox webpage. For additional information, consult CDC’s Interim Clinical Considerations for Use of JYNNEOS and ACAM2000 Vaccines during the 2022 U.S. Mpox Outbreak. 

                    Sign up for Colorado HANs at https://conotification.state.co.us/ to receive continued updates on mpox and other public health issues.