The SCCPHD encourages all providers to take the following steps:

1. Be alert to the possibility of monkeypox infection in all individuals who present with a characteristic rash illness, regardless of travel history, gender or sexual orientation.

The risk to the general public remains low, but clinicians are requested to maintain a high suspicion for monkeypox in individuals presenting with a characteristic rash, particularly in those with history of recent international travel or in trans persons or cismen or who have sex with men. Familiarize yourself with the clinical presentation and typical appearance of monkeypox lesions. If genital lesions or body rash are observed, complete evaluation for other sexually transmitted infections (STIs) as per CDC recommendations (e.g. herpes zoster or syphilis) and other more common infections (e.g. varicella). Note that a minority of monkeypox cases have been co-infected, therefore a positive monkeypox test does not rule out the presence of other infections in those at high risk for STIs and vice versa. If monkeypox is suspected, call your infectious disease specialist or infection control practitioner (if available) to assist in determining whether monkeypox testing is warranted. The SCCPHD remains available for clinical consultation for providers seeking additional guidance on testing of individual cases (408-885-4214).

2. Implement immediate infection control for all suspected monkeypox cases

Patients presenting with suspected monkeypox should be placed promptly in a single-person exam room with door closed or an airborne isolation room, if available. The patient should remain masked and any exposed skin lesions covered with a sheet or gown. If discharged home, patients should be provided with home isolation guidanceand be instructed to remain isolated until test results return.

Healthcare workers evaluating patients with suspected monkeypox should wear the following: gloves, gown, eye protection (goggles or face shield), and a N95 or equivalent or higher-level respirator. PPE should be donned before entering patient’s room. Remove gloves, gown, and eye protection and perform hand hygiene prior to leaving the room. Remove and discard the N95 after leaving the room and closing the door. Replace with a mask.

Environmental surfaces should be cleaned and disinfected with an EPA-registered disinfectant.

3. Collect specimens for testing

Testing is available through the SCC Public Health Laboratory (SCC PHL). Testing may also be available through one of the five commercial laboratory companies recently approved by the federal government (Aegis Science, Labcorp, Mayo Clinic Laboratories, Quest Diagnostics and Sonic Healthcare) or by a hospital or academic center locally or regionally who offers a laboratory developed test (LDT).

For samples being sent to SCC PHL, please submit a laboratory specimen submission form and a printed copy of the Monkeypox Suspect Case Form.  Please complete all fields on both forms, including the necessary demographic and epidemiologic data. Incomplete forms may result in specimen rejection. Specimen collection instructions are as follows: 1) vigorously swab or brush lesion with two separate sterile dry polyester or Dacron swabs; 2) place both swabs into a single 15 ml dry sterile tube. We recommend swabbing two to three lesions from different anatomic locations to increase yield. Do not add or store in viral or universal transport media. 

For samples being tested outside of the SCC PHL, follow laboratory-specific guidance on specimen collection and submission. In addition, please complete and submit the Monkeypox Suspect Case Form online within four hours of test submission. Case report submission is essential to ensure rapid case investigation and contact tracing should the sample result positive. Please note that all health care providers are required to report suspect cases under Title 17, California Code of Regulations, Section 2500, as an “occurrence of an unusual disease.”

4. Report all confirmed monkeypox cases to SCCPHD Communicable Disease Prevention and Control

Report all confirmed monkeypox cases to the PHD immediately by phone by calling 408-885-4214 during regular business hours (or 408-998-3438 during evenings and weekends to reach the Health Officer on call). Prompt notification is essential to initiate contact tracing and offer Post Exposure Prophylaxis (PEP) to prevent the spread of disease.

While initially extremely limited, the supply of this vaccine is gradually increasing and SCCPHD is presently able to administer PEP to eligible close contacts as part of a ring vaccination approach. As vaccine supply becomes more robust, and based on state and federal guidance, SCCPHD will seek to reduce barriers to receiving PEP and to institute pre-exposure vaccination aimed at preventing Monkeypox in members of the public determined to be at highest risk for exposure to Monkeypox.

5. Sign up to receive time-sensitive alerts from Public Health

We encourage all providers to sign up for health alerts from SCCPHD and CDC to keep updated on this fast-evolving situation, and to refer to the CDPH and CDC monkeypox websites for updated information.