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Monkeypox

Overview

County of Lake Health Services is actively monitoring a multi-country monkeypox outbreak in non-endemic countries, including the United States. In response to a U.S. Centers for Disease Control and Prevention (CDC) Health Alert, County of Lake Health Services is partnering with the California Department of Public Health (CDPH), Rural Association of Northern County Health Officers (RANCHO) and local healthcare providers to enhance surveillance activities, to provide access to post-exposure prophylaxis (PEP), to advance policy conversations about risk-based access to pre-exposure prophylaxis (PrEP), and to increase access to treatment.

The risk to the general public is very low, but you should seek medical care immediately if you develop a new, unexplained skin rash (lesions on any part of the body), with or without fever and chills. Current available evidence suggests that those who are most at risk are those who have had close physical contact with someone with monkeypox, while they are symptomatic. 

Learn more at Centers for Disease Control and Prevention (CDC).

Background

Monkeypox is a rare but potentially serious viral illness that typically begins with flu-like illness and swelling of the lymph nodes and progresses to a rash on the face and body. Most infections last 2-to-4 weeks. The virus does not spread easily between people; transmission can occur through contact with body fluids, sores, items that have been contaminated with fluids or sores (clothing, bedding, etc.), or through respiratory droplets following prolonged face-to-face contact.

Signs and Symptoms

Cases of monkeypox typically begin with flu-like illness.  Symptoms of monkeypox can include:

  • Fever
  • Headache
  • Muscle aches and backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion
  • A rash that can look like pimples or blisters that appears on the face, inside the month, or on other parts of the body, like hands, feet, chest, genitals, or anus.

The rash goes through different stages before healing completely. The illness typically lasts 2-4 weeks. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.

How it Spreads

The Monkeypox virus is spreading mostly through close, intimate contact with someone who has Monkeypox.

Monkeypox can be spread through:

  • Direct skin-to-skin contact with rash lesions, sores, scabs, or body fluids
  • Sexual/intimate contact, including kissing or cuddling  
  • Living in a house and sharing a bed with someone 
  • Sharing towels or unwashed clothing 
  • Respiratory secretions through prolonged face-to-face interactions (the type that mainly happen when living with someone or caring for someone who has monkeypox) 

Monkeypox is NOT spread through: 

  • Casual brief conversations 
  • Walking by someone with monkeypox, like in a grocery store  

Prevention

You can take steps to prevent getting monkeypox and lower your risk during sex.

Vaccine

JYNNEOS is a vaccine that can help prevent monkeypox infection. JYNNEOS is approved for adults 18 & over. It is a two dose injection series in the upper arm at least four weeks apart. CDC advises that people exposed to monkeypox be given the vaccine to prevent them from developing the disease.

There is an extremely limited supply of JYNNEOS in California and across the United States, although more is expected in the coming weeks and months. Due to limits of vaccine supply, although someone may be eligible for the vaccine does not mean a vaccine is readily available to give.

As of July 27, 2022, County of Lake Health Services has received no doses from CDPH, but has applied for an allocation. Most have been distributed in small numbers to health care providers who care for the highest risk patients.  Some are being used to provide Post-Exposure Prophylaxis (PEP) to known close contacts.

Vaccine Eligibility

Because there are so few vaccines, the JYNNEOS vaccine is prioritized for people who are:

  • a close contact of a suspected or confirmed Monkeypox cases with the past 14 days; or
  • notified by a venue or public health authority of a potential exposure to a Monkeypox case at a venue in the past 14 days; or
  • a close contact of others at an event or within a social group within the past 14 days where one or more Monkeypox case(s) were identified; or
  • men who have sex with men (MSM) who have had more than two sexual partners in the past 14 days; or
  • MSM who have tested positive for any sexually transmitted disease in the past month.

CDPH is hosting weekly Monkeypox vaccination clinics in the Bay Area. View calendar and more information.

What to do if you have been exposed

  • Call County of Lake Health Services Communicable Disease Program at (707) 263-1090 ext.9
  • Cover the area of the rash with clean, dry, loose-fitting clothing.
  • Wear a well-fitted mask.
  • Avoid skin-to-skin, or close contact with others, including sexual contact, until a medical evaluation has been completed.
  • Contact a health care provider as soon as possible for an evaluation. Anyone with a rash that looks like monkeypox should talk to their healthcare provider about whether they need to get tested, even if they don’t think they had contact with someone who has monkeypox.
  • Assist public health officials to track others who may have been exposed.
  • Avoid crowds, close contact, including sexual or intimate contact until seeing your healthcare provider.

Provider Information

County of Lake Health Services is urging healthcare providers to be alert for patients who have rash illnesses consistent with monkeypox.

Access CDPH’s Monkeypox toolkit to download and share the following tools:

Case Finding & Management guidance

Clinical Presentation

Lake County healthcare providers should be alert for patients who have rash illnesses consistent with monkeypox, regardless of whether they have travel or specific risk factors for monkeypox and regardless of gender or sexual orientation.

Suspected cases may present with early flu-like symptoms and progress to lesions that may begin on one site on the body and spread to other parts. Illness could be clinically confused with a sexually transmitted infection like syphilis or herpes, or with varicella zoster virus. Thus far in the U.S. outbreak, all patients diagnosed with monkeypox in the United States have experienced a rash or exanthem. Although the characteristic firm, deep-seated, well-circumscribed and sometimes umbilicated rash has been observed, the rash has often begun in mucosal areas (e.g., genital, perianal, oral mucosa) and in some patients, the lesions have been scattered or localized to a specific body site rather than diffuse and have not involved the face or extremities.

People with Monkeypox in the current outbreak report having close, sustained physical contact with other people who have monkeypox. While nearly all affected 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.

See CDC’s Clinical Recognition webpage for more characteristics and photos of monkeypox rashes.

Testing

Commercial labs such as QuestLabCorp and other private labs are now testing for Monkeypox. There is no need to contact County of Lake Health Services for approval to test at commercial laboratories but providers must still report all suspect cases to County of Lake Health Services within 1 working day. To report suspected cases, please complete a Confidential Morbidity Report (CMR) [PDF] and fax to (707) 263-4280.

Treatment

On July 21, 2022, Centers for Disease Control and Prevention (CDC) Institutional Review Board (IRB) approved an amendment and continuation of its research protocol to increase access to monkeypox treatment by providing umbrella regulatory coverage for clinicians and facilities and liability coverage for compensation to patients if injured. County of Lake Health Services will be issuing an advisory for Lake County healthcare providers and facilities that provides information necessary obtain and use TPOXX (Tecovirimat) if clinically indicated.  

Travel Advisories

CDC Travel Advisory - Level 2 [Practice Enhanced Precautions] (June 6, 2022)

Report a suspected case

To report suspected cases, please complete a Confidential Morbidity Report (CMR) [PDF] and fax to (707) 263-4280.