Monkeypox (MPX) Information For Health Professionals - Minnesota Dept. of Health

Monkeypox (MPX) Information For Health Professionals

On this page:
Reporting monkeypox
Clinical presentation
Testing and specimen submission
Infection control
Vaccine
Treatment
Health advisories and resources

Reporting monkeypox

  • Reporting Orthopox Virus
    Monkeypox is caused by an Orthopoxvirus. All suspected cases of orthopox virus must be reported to MDH immediately 24 hours a day, seven days a week.
    • Call 651-201-5414 or 877-676-5414 immediately if monkeypox is suspected or to report Orthopoxvirus.
      Infectious Disease Epidemiology, Prevention and Control staff are available for disease consultation 24 hours a day, seven days a week.

Clinical presentation

Clinical disease may start with a prodrome lasting 1-4 days prior to any rash. Prodrome often includes lymphadenopathy, malaise, headache, myalgia, fever, and fatigue. The rash can be deep-seated, vesicular or pustular with lesions that are well circumscribed and umbilicate. The evolution of the rash usually progresses through four stages—macular, papular, vesicular, to pustular—before scabbing over and resolving. Generally the rash progress through the four stages synchronously across the body. Lesions are often described as painful until the healing phase when they become itchy (crusts).

Recent monkeypox cases suggest a less classic symptom presentation, which includes:

  • Absence of the typical prodrome period of fever, tiredness, or swollen lymph nodes.
  • Atypical rash presentation:
    • Few lesions, sometimes small, and present very similar to herpes viruses, syphilis, chickenpox, and other rash differentials.
    • Starts around the anus or genitals and does not always result in a disseminated rash across the body.
    • Stages of rash do not always progress in a synchronous fashion.
  • Symptoms such as anorectal pain, tenesmus, and rectal bleeding caused by ulcerative skin lesions and proctitis have been reported.
  • Dual infection with syphilis, HSV or VZV has been reported in individuals with monkeypox. Testing lesions consistent with monkeypox should be performed even if lesions from other infections are observed or identified.

More information: CDC: Monkeypox: Clinical Recognition

Monkeypox should be suspected in:
  • An individual with a new unexplained acute rash,
    OR
  • An individual who within 21 days of symptoms has had:
    • Contact with a person or people with a similar appearing rash or who received a diagnosis of confirmed or probable monkeypox
      OR
    • Close or intimate in-person contact with individuals in a social network experiencing monkeypox activity, this includes men who have sex with men (MSM) who meet partners through an online website, digital application (“app”), or social event (e.g., a bar or party)
      OR
    • Traveled outside the US to a country with confirmed cases of monkeypox or where Monkeypox virus is endemic
      OR
    • Contact with a dead or live wild animal or exotic pet that is an African endemic species or used a product derived from such animals (e.g., game meat, creams, lotions, powders, etc.)

MDH also encourages evaluating and testing for other common rash illnesses including syphilis, herpes simplex, and chickenpox if indicated.

Testing and specimen submission

Please call MDH at 651-201-5414 or 1-877-676-5414 before sending any specimens to MDH-PHL.
Preliminary screening for Orthopoxvirus will be performed at MDH-PHL using real time PCR.

Turnaround time for testing at MDH-PHL is 1-2 business days. Specimens that test positive will be forwarded to CDC for confirmatory testing for monkeypox.

Dry swabs of lesion fluid, lesion surface and/or lesion crust are acceptable specimen types. Dry swabs are required (do not put swab in viral transport media). Lesion crusts may be submitted with a dry swab specimen.

  • Use only dry nylon, polyester, or Dacron swabs.
  • Vigorously swab the lesion with a sterile dry swab.
  • Submit two swabs per lesion: one for screening at MDH-PHL and one for confirmatory testing. If more than one lesion, sample at least two different sites.
  • Place the paired swabs into a dry sterile vial (not urine) for each site swabbed.
  • Keep specimens cold:
    • Refrigerate within one hour of collection.
    • Ship at refrigeration temperature. Ice packs may be used to maintain refrigeration temperature during shipment.
  • Label each vial with:
    • Two unique patient identifiers (e.g., patient name, date of birth) that match the patient information provided on the specimen submission form.
  • For each specimen (i.e. each vial containing 2 swabs), fill out:
  • If any of the above criteria are not met, the sample(s) will be rejected.
  • Send specimens to arrive Monday-Friday between 8:00 a.m. and 4:30 p.m. to:
    MDH Public Health Laboratory
    Attn: Biological Accessioning
    601 Robert St. N
    St. Paul, MN 55155-2531
  • For help with packaging and shipping, call MDH-PHL Biological Accessioning at 651-201-4953
  • Note: Patient should be sent home and told to isolate until monkeypox is ruled out.

For more information on collecting and submitting specimens: Clinical Laboratory Guide to Services - Monkeypox.

Consider testing for other rash illnesses, such as syphilis, herpes simplex, and varicella, using your standard reference laboratory if indicated.

Infection Control

Health care providers evaluating individuals for suspected monkeypox should use a combination of standard, droplet and contact precautions when patients present with fever and/or vesicular/pustular rash.

Providers should wear gloves, gown, eye protection and an N95 respirator. The patient should be placed in a negative pressure room if any aerosol-generating procedures occur.

Vaccine

There are two vaccines available in the U.S. to prevent monkeypox. The Advisory Committee on Immunization Practices (ACIP) recommends pre-exposure prophylaxis (PrEP) for certain individuals with a high risk of occupational exposure. However, most clinicians and laboratorians are not advised to receive PrEP at this time. In some circumstances, vaccination may be recommended after exposure to monkeypox virus for post-exposure prophylaxis (PEP). Ideally vaccination should be received within 4 days of the exposure to prevent disease.

More information:

Treatment

There is no specific treatment approved for monkeypox infection and most individuals have mild, self-limiting disease. However, antivirals developed for use in the treatment of smallpox may prove beneficial for some individuals.

Monkeypox Health Advisories and Resources

Updated Wednesday, 03-Aug-2022 16:23:48 CDT