Mpox Guidance

Health Advisories and Updates

12/11/2023: Clade I Mpox Virus (MPXV) with Geographic Spread in the Democratic Republic of the Congo: Recommendations for California Health Care Providers – This advisory provides information on clade I mpox and specimen submission for clade-specific mpox testing if clade I mpox is suspected due to travel history to endemic areas.
10/30/2023: Increase in Mpox Cases in California: Updates on Identification, Laboratory Testing, Management and Treatment, and Vaccination for Mpox - This advisory provides an update on rising mpox cases and encourages providers to consider mpox in their differential diagnoses, test persons with suspected mpox, treat mpox, and offer vaccine to populations at increased risk to prevent severe mpox disease and reduce the number of new infections. 
5/30/2023: Preventing a Resurgence of Mpox Cases in California (PDF) – CDPH Dear Colleague letter to California providers to remain vigilant in mpox prevention, recognition, and testing, especially during the 2023 spring and summer season as people gather for festivals and events. Information on how to diagnose, test for, and vaccinate against mpox is included.
4/4/2023: Updates on Identification, Lab Testing, Management and Treatment, and Vaccination for Mpox Virus in California - This advisory provides an update on mpox case recognition, lab testing, vaccination, and management.

Health Care Providers

Topics: Clinical Recognition and Considerations | Provider Vaccine Information | Mpox Treatment | Provider Reporting | Infection Prevention and Waste Management in Healthcare Settings

Clinical Recognition and Considerations

Evaluation:

*NEW May 2024*Mpox Clinical Recognition and Testing Overview and Quicksheet: A CAPTC-developed mpox evaluation tool for providers, including differential diagnoses for mpox, testing indications, and instructions on specimen collection. The printable supplement includes a table with pictures of mpox rash presentations vs common mimickers.

Clinical Assist Tool for Mpox Evaluation – A CDPH developed clinical tool to aid clinicians in determining mpox diagnosis.
Clinical Recognition – CDC guidance on key mpox characteristics, clinical prodrome, and rash development.
CDC Clinical Guidance  – CDC guidance for healthcare providers for managing patients with mpox.

Testing:

Preparation and Collection of Specimens – CDC best practices for specimen collection. Please note, lesions do not need to be unroofed or aspirated; vigorous swabbing of the lesion is sufficient. 
Testing for Suspected Clade I Mpox (updated May 2024)—If Clade I mpox is suspected—including for individuals that report personal, partner, or household travel to the Democratic Republic of the Congo (DRC) within the past 21 days—providers should notify their local health department immediately to arrange for specimens to be sent to the public health lab for appropriate clade-specific testing.

Home isolation guidance for patients:

Isolation and Infection Control at Home – CDC isolation guidance for persons with suspected or confirmed mpox infection.

Clinical considerations for special populations:

People Who are Pregnant or Breastfeeding - CDC guidance for mpox infection in people who are pregnant or breastfeeding. 
People Who are Immunocompromised (including HIV) - CDC guidance for mpox treatment and prophylaxis in patients who are immunocompromised. 
Ocular Infection – CDC interim guidance for mpox infection involving the eyes, including symptomatic management.
Children and Adolescents – CDC guidance for management of children and adolescents with exposure to mpox, suspected mpox, or confirmed mpox.
Consent to Medical Services for the Treatment of Mpox in Minors - CDPH guidance on obtaining minor consent for health care providers and local health departments.

Provider Vaccine Information

*Update June 2024* - JYNNEOS vaccine is now commercially available for ordering, similar to other FDA-approved vaccines. Providers can purchase vaccine via certain wholesalers and distributors—see CDPH EZIZ Mpox Vaccination Resources for more information. JYNNEOS is included on routine adult immunization schedules and remains recommended for anyone who has been exposed to mpox or who may be at risk for mpox exposure. JYNNEOS is available to anyone who requests it. If providers do not have JYNNEOS on site, they can refer patients for JYNNEOS vaccination to providers who do have JYNNEOS: see CDPH Vaccination Site or consult their local health department for assistance.

CDPH EZIZ: Mpox Vaccination Resources—CDPH Immunization Branch website for clinics and LHJs with up-to-date information about JYNNEOS including administration, vaccine ordering, and other resources.
Mpox Vaccine Recommendations—CDC recommendations for mpox vaccination, including who is recommended to be vaccinated against mpox.
Interim Clinical Considerations for Use of JYNNEOS – CDC interim guidance on vaccination to prevent mpox.
CDPH Mpox Vaccination Site—CDPH site for patients, including how to find vaccinating providers by zip code.
CDC and CDPH Adult Immunization Schedules, which now include mpox vaccine:

Mpox Treatment

Pain management and supportive care:

Supportive Care Guidance - CDPH guidance on supportive care measures for patients. 
Clinical Considerations for Pain Management of Mpox - CDC guidance on pain management.

Mpox management guidance:

Treatment Information for Healthcare Professionals – CDC interim clinical guidance and medical counter measures (including TPOXX) available for treatment of mpox
Interim Clinical Treatment Considerations for Severe Manifestations of Mpox – Interim clinical considerations to facilitate decision-making about the use of therapeutics to manage severe manifestations of mpox

Information on accessing Tecovirimat:

The preferred preferred route for accessing oral tecovirimat is through the STOMP (Study of Tecovirimat for Mpox) NIAID-funded clinical trial to evaluate effectiveness of tecovirimat. If patients are ineligible or decline participation in STOMP and meet eligibility criteria for the Expanded Access Investigational New Drug (EA-IND) Protocol, tecovirimat may be obtained through state or CDC supplies under the EA-IND Protocol. For more information see:

Mpox Tecovirimat Treatment Information for Providers – CDPH clinical guidance on treatment of mpox with Tecovirimat (TPOXX).
Obtaining and Using TPOXX (Tecovirimat) – CDC guidance on how providers can request TPOXX through the Strategic National Stockpile if prescribing to patients who meet clinical eligibility criteria under Expanded-Access Investigational New Drug protocol.
STOMP Flyers for patients and providers (PDF) – Printable flyer resources from CAPTC for patients (self-referral / self-enrollment) and clinics.
STOMP: Study of Tecovirimat for Mpox – NIAID Clinical Trials website, includes information about the study and remote enrollment.

Provider Reporting

Title 17 Reportable Disease and Conditions (PDF) – Mpox and orthopoxvirus infections are explicitly reportable by providers and laboratories to the local health department within 1 working day of identification. Cases of suspected clade I mpox should be reported immediately to facilitate appropriate testing with the public health lab.
Completing an Mpox-Related Death Certificate – CDC guidance on death reporting for providers.

Infection Prevention and Waste Management in Healthcare Setting

Infection Prevention and Control of Mpox in Healthcare Settings – CDC guidance that includes transmission prevention, patient placement and PPE.

Workplaces covered by the Cal/OSHA Aerosol Transmissible Diseases (ATD) standard (PDF) should consult those regulations for additional applicable requirements. See  Cal/OSHA: Protecting Workers from Mpox for Employers and Workers Covered by the Aerosol Transmissible Disease Standard (Title 8 Section 5199)  (PDF).

California Prevention Training Center's " Preventing Occupational Mpox Transmission in Outpatient Clinics" - CAPTC presents real-world strategies that allow clinics to care for patients with mpox as safely and effectively as possible.
Mpox Medical Waste Management – CDPH interim guidance for medical waste management. Note: As of March 2024, clade I MPXV specimens are now classified as a Category B infectious substance similar to clade II MPXV (except for clade I MPXV viral cultures, which remain Category A). See Safety Advisory Notice: Classification of MPXV Diagnostic Samples and Waste.

Laboratories

Information for Laboratory Personnel – CDC information on laboratory reporting, procedures, and biosafety guidelines.
Clade-Specific Testing for Suspected Clade I Mpox— At this time, all specimens collected from a case with suspected clade I mpox virus (MPXV) should be sent to your local public health lab and forwarded to CDPH VRDL (Viral and Rickettsial Disease Laboratory) if the local public health lab does not have clade-specific testing capacity.

Guidelines for Collecting and Handling Specimens for Mpox Testing – CDC best practices for specimen collection, storage, and shipment of specimens for mpox diagnosis.
CDPH Viral and Rickettsial Disease Laboratory (VRDL) Monkeypox Virus PCR test—Information for specimen submission to VRDL for MPXV PCR, including for clade-specific testing and contact information. 
Title 17 Reportable Disease and Conditions (PDF) – Mpox and orthopoxvirus infections are explicitly reportable by providers and laboratories to the local health department within 1 working day of identification.
Mpox Medical Waste Management – CDPH interim guidance for medical waste management. Note: As of March 2024, clade I MPXV specimens are now classified as a Category B infectious substance similar to clade II MPXV (except for clade I MPXV viral cultures, which remain Category A). See Safety Advisory Notice: Classification of MPXV Diagnostic Samples and Waste. Specimens identified as clade I MPXV are regulated as a select agent—see Select Agent Regulations | CDC Biosafety Laboratory Guidance for Handling and Processing Mpox Specimens for more information.

As a reminder, mpox testing is available at many commercial laboratories and providers should consult their laboratory for submission criteria. Providers may otherwise contact their local health department to inquire about testing through the public health lab if needed.

Local Health Departments

Topics: Case Reporting | Case Investigation and Other Setting-Specific Guidance | LHJ Vaccine Information | Messaging and Communications Toolkit

Case Reporting

Case Definitions for Use in the 2022 Mpox Response – CDC guidance for surveillance case definitions and criteria, including for reinfections.

Interim reinfection reporting to CDPH:

Create new incident ID for suspected reinfection cases and attach ELR.
Assess for case criteria per CDC definition (i.e., symptom resolution between episodes) and note “reinfection” within notes tab along with primary infection incident ID.
If possible, forward any specimens that may meet reinfection criteria to VRDL for WGS.
Send secure email to stdcb@cdph.ca.gov

Death reporting – See CDC MMWR on mpox-associated deaths. For public health surveillance in CalREDIE, use the death certificate (i.e., if mpox is listed on the death certificate as a primary or significant contributing factor) for determining mpox associated death.

See CalREDIE document repository or LHJ SharePoint for further reporting information—email mpoxadmin@cdph.ca.gov to request SharePoint access.

Suspected Clade I Mpox case: Notify CDPH immediately of any cases with suspected clade I mpox (based on associated travel history to endemic area or preliminary lab results). At this time, all specimens collected from a case with suspected clade I mpox should be sent to your local public health lab and forwarded to CDPH VRDL if the local public health lab does not have clade I testing capabilities.

Case Investigation and Other Setting-Specific Guidance

*NEW May 2024*Mpox Quicksheet (PDF)—Updated CDPH general guidance quicksheet for local health departments including an overview of mpox clinical characteristics, epidemiology, testing, isolation, and infection prevention guidance for different settings.
*NEW May 2024*Mpox Training for Disease Investigators—CAPTC educational video series for DIS with updated content.
Isolation and Infection Control at Home – CDC isolation guidance for persons with suspected or confirmed mpox infection.
Monitoring and Risk Assessment for Persons Exposed in the Community – CDC guidance for post-exposure risk assessment and monitoring.
Mpox Guidance for Congregate Settings - CDPH guidance for congregate settings, including homeless shelters and correctional facilities.
Considerations for Reducing Mpox Transmission in Congregate Living Settings – CDC guidance for prevention of mpox in congregate settings.
Mpox Considerations for Childcare and School Settings – CDPH guidance for administrators and staff of schools and childcare settings. 
Mpox Case and Cluster Investigation Protocol for LHDs – requires local health department SharePoint access, email mpoxadmin@cdph.ca.gov if you work for an local health department to request access.
Consent to Medical Services for the Treatment of Mpox in Minors—CDPH guidance on obtaining minor consent for health care providers and local health departments.

LHJ Vaccine Information

EZIZ: Mpox Vaccination Resources– CDPH Immunization Branch website with up-to-date information for clinics and local health departments regarding JYNNEOS administration, vaccine ordering, and other resources.
Mpox Vaccine Recommendations—CDC JYNNEOS vaccine recommendations.
CDPH Mpox Vaccines – CDPH landing page for outreach with links to find vaccinating providers by zip code (includes both MyTurn and CDC Vaccine Locator).

Messaging and Communications Toolkits

*NEW May 2024*CDPH LGBTQ+ Health: 2024 Pride Toolkit—CDPH webpage with educational materials (posters, flyers, and sticker files) about mpox and sexual health available in English and Spanish.
Mpox General Public Communications Toolkit – CDPH webpage fact sheets, videos, and graphics on mpox.
Mpox Campaign Toolkit - CDPH communication webpage for community-based organizations and local health departments.

Community Guidance

Topics: How to Prevent Mpox | If You Have Mpox | Prevention in Non-Clinical Settings | Mpox Q&A

How to Prevent Mpox

How to Protect Yourself – CDC guidance on steps to protect yourself from getting mpox.
If You’re a Close Contact to Mpox – CDC guidance on what to do if you are exposed to mpox.
CDPH Mpox Vaccination – Find providers near you that offer the mpox vaccine.
Mpox Vaccine Recommendations—CDC guidance about who should receive the mpox vaccine.
Mpox Q&A – CDPH information for commonly asked questions and answers.
Travelers Health: Mpox – CDC guidance for international travelers and mpox outbreaks outside the U.S.

If You Have Mpox

Isolation and Infection Control at Home – CDC information to prevent spread to others.
Cleaning and Disinfecting – CDC information about cleaning and disinfecting at home and other non-healthcare settings.
Tell Your Partner – Visit tellyourpartner.org to anonymously notify persons of exposure.
Patient's Guide to Mpox Treatment with Tecovirimat (TPOXX) — CDC information about mpox antiviral treatment (TPOXX) and the STOMP study.
STOMP Study for TPOXX (PDF) – Information about the clinical trial evaluating the antiviral treatment TPOXX (Tecovirimat) for mpox infections; patients may talk with their provider or call the study hotline to self-enroll.
Mpox Q&A—CDPH information including what to expect if you have mpox infection.

Prevention in Non-Clinical Settings

Mpox Considerations for Childcare and School Settings – CDPH guidance for administrators and staff of schools and childcare settings. 
Mpox Infection Control in Congregate Settings – CDPH guidance for congregate settings including homeless shelters and correctional facilities. 
Considerations for Reducing Mpox Transmission in Congregate Living Settings – CDC guidance for prevention of mpox in congregate settings.

How Can We Help You?

Connect with CDPH for additional mpox resources.

Contact CDPH STD Control Branch Mpox Team

If you need further clarification or have questions, comments, and concerns regarding CDPH Mpox, submit an inquiry.

Contact Your Local Public Health Department

Reach out to your local health department with any questions.

Mpox-Guidance

Division of Communicable Disease Control

Mpox Guidance

Health Advisories and Updates

Health Care Providers

Clinical Recognition and Considerations

Provider Vaccine Information

Mpox Treatment

Provider Reporting

Infection Prevention and Waste Management in Healthcare Setting

Laboratories

Local Health Departments

Case Reporting

Case Investigation and Other Setting-Specific Guidance

LHJ Vaccine Information

Messaging and Communications Toolkits

Community Guidance

How to Prevent Mpox

If You Have Mpox

Prevention in Non-Clinical Settings

How Can We Help You?

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Diseases and Conditions

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Personal Health and Prevention

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