Monkeypox Information for Providers

Monkeypox is a rare viral disease not often seen in the United States. Anyone can get monkeypox. Most people recover in 2–4 weeks, but the disease can be serious, especially for children and people who are immune compromised or pregnant. For more general information, see our monkeypox page.

Immediately report suspected monkeypox cases.

Suspected (labs collected/pending) cases: Complete and fax an intake form to our confidential fax (509) 381-3526 and review exposure guidelines to evaluate close contacts.

Confirmed (by lab) cases: Call the reporting line at 800-535-5016 ext. 541 If you have not already done so complete an intake form and send to our confidential fax (509) 381-3526 and review exposure guidelines to evaluate close contacts.

Call the reporting line with any questions.

Flyer for Providers on When to Test for Monkeypox

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Sign up for email alerts and choose “Health Advisories and Disease Alerts.”

How to identify

It can be easy to miss monkeypox or mistake it for herpes, syphilis, folliculitis or an abscess. 

Early symptoms

  • Fever.
  • Malaise.
  • Headache.
  • Weakness.
  • Swollen lymph nodes.

Lesions

  • Are well circumscribed, deep seated and often develop umbilication (dot on the top of the lesion).
  • Can be extremely painful.
  • Appear after fever.
Visual examples of monkeypox rash. Photo credit: NHS England High Consequence Infectious Diseases Network.

Lesions tend to appear and develop at the same time on an affected area of the body—like pustules on face or vesicles on legs. They progress through 4 stages—macular, papular, vesicular and pustular—before they scab and heal in 1–2 weeks.

Transmission

Monkeypox mostly spreads through close, physical contact, and is far less likely to be spread in the air.

The virus spreads through contact with:

  • Monkeypox rash, sores or scabs.
  • Objects, fabrics or surfaces a person with monkeypox used.
  • Respiratory droplets or oral fluids from a person with monkeypox.

Monkeypox can spread as soon as symptoms start until all sores heal and a fresh layer of skin forms. This can be several weeks.

Personal protective equipment (PPE)

When you interact with a patient, wear:

  • Gown.
  • Eye protection (i.e., goggles or a face shield that covers the front and sides of the face).
  • Gloves.
  • NIOSH-approved particulate respirator equipped with N95 filters or higher.

How to test

Use a PCR test to collect a sample.

  1. Collect 2 swabs from each lesion on 2 separate sites. Use synthetic swabs (i.e., Dacron, polyester, nylon). Do not use cotton swabs. Vigorously swab lesions. You don’t need to de-roof the lesion before swabbing.
  2. Break off the end of each swab’s applicator into separate screw-capped tube or place swabs in separate sterile containers or viral transport medium (VTM). Do not use universal or other transport media.
  3. Store samples at 2–8° C within an hour of collection. If the testing lab won’t receive the sample within 24 hours, freeze it. Coordinate a plan with your lab manager.

Submit to a lab.

Ask your lab if they test for monkeypox. Follow the lab’s sample collection procedure. Labs that currently test for monkeypox:

Washington has no shortage of monkeypox tests.

How to treat

Use tecovirimat (TPOXX) antiviral medication to treat people who are at high risk of severe disease. Learn more in Centers for Disease Control and Prevention’s (CDC’s) interim clinical guidance.

The patient must meet the criteria for TPOXX treatment. If the provider thinks the patient meets the criteria for TPOXX, they can request TPOXX by:

  • Ensuring the patient meets the criteria:
    • People with severe disease (e.g., hemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalization)
    • People who may be at high risk of severe disease:
      • People with immunocompromise (e.g., human immunodeficiency virus/acquired immune deficiency syndrome infection, leukemia, lymphoma, generalized malignancy, solid organ transplantation, therapy with alkylating agents, antimetabolites, radiation, tumor necrosis factor inhibitors, high-dose corticosteroids, being a recipient with hematopoietic stem cell transplant <24 months post-transplant or ≥24 months but with graft-versus-host disease or disease relapse, or having autoimmune disease with immunodeficiency as a clinical component)
      • Pediatric populations, particularly patients younger than 8 years of age
      • People with a history or presence of atopic dermatitis, persons with other active exfoliative skin conditions (e.g., eczema, burns, impetigo, varicella zoster virus infection, herpes simplex virus infection, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis, or Darier disease [keratosis follicularis])
      • Pregnant or breastfeeding women
      • People with one or more complications (e.g., secondary bacterial skin infection; gastroenteritis with severe nausea/vomiting, diarrhea, or dehydration; bronchopneumonia; concurrent disease or other comorbidities)
    • People with monkeypox virus aberrant infections that include accidental implantation in eyes, mouth, or other anatomical areas where monkeypox virus infection might constitute a special hazard (e.g., the throat, genitals or anus)
  • Call the Yakima Health District after hours emergency line (509) 575-4040 option 2

Vaccine

Vaccine is currently prioritized for close contacts. As more vaccine becomes available, we expect CDC will expand eligibility to at-risk populations.

Sexually Transmitted Infections

Individuals are also recommended to get tested for sexually transmitted infections (STIs), such as syphilis, gonorrhea, chlamydia, herpes, and HIV. Symptoms may be similar and, on some occasions, individuals may be infected with both monkeypox and an STI.

Questions?

Questions? Contact Yakima Health District at (509) 575-4040 or (800) 535-5016.

Resources

For clinicians

For patients