For Providers

Information for Medical Providers

Clinical Signs

Symptoms in this outbreak also seem to be slightly different than previous outbreaks. The incubation period is most commonly 7 to 14 days but can range from 5 to 21 days and people are not contagious during this period. General symptoms include fever, headache, muscle and backache, swollen lymph nodes, chills, exhaustion, and rash.

Monkeypox is most like a clinical course of discrete smallpox, but with the addition of swollen lymph nodes. Lesions go through four stages- macular, papular, vesicular, to pustular- over 2 to 3 weeks. These lesions are well circumscribed, deep seated, and likely develop umbilication. In this outbreak, lesions have been noted to be in different stages of development, which is new. There have been cases of co-infections of similarly presenting infections such as chickenpox, syphilis, and herpes.

 

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Testing

Testing is vital in identifying cases. Providers should utilize appropriate precautions when collecting samples.

 

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Treatment

Antivirals used for smallpox treatment, such as tecovirimat (TPOXX), may be recommended for those with a weakened immune system.

 

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Vaccines

For clinicians, laboratory staff, or anyone whose job may expose them to orthopoxviruses, such as monkeypox, The Advisory Committee on Immunization Practices (ACIP), recommends getting vaccinated with ACAM2000 or JYNNEOS. This is essentially a pre-exposure prophylaxis. Not all clinicians need to receive this vaccine, only those with high risks for exposure. CDC also recommends a vaccine 4 days after exposure to monkeypox or if a smallpox vaccine is more than 3 years old.

 

JYNNEOS

JYNNEOS is a two-dose vaccine given 28 days apart and takes 2 weeks from the second dose for peak immunity to develop. The standard JYNNEOS regimen is a series of two subcutaneous injections of 0.5mL given 28 days apart. The alternative JYNNEOS regimen is a series of two intradermal injections of 0.1mL given 28 days apart. This alternative regimen seeks to expand the number of doses available. Further information can be found here.

Schedule and Dosing Regimens for JYNNEOS Vaccine

  • Alternative regimen for people age ≥18 years
    • Route of administration: ID
    • Injection volume: 0.1 mL
    • Recommended number of doses: 2
    • Recommended interval between first and second dose: 28 days
  • Standard regimen for (1) People age <18 years, and (2) people of any age who have a history of developing keloid scars
    • Route of administration: Subcut
    • Injection volume: 0.5 mL
    • Recommended number of doses: 2
    • Recommended interval between first and second dose: 28 days

 

ACAM2000

ACAM2000 is a single dose vaccine that takes 1 month after vaccination for peak immunity to develop and is an alternative to JYNNEOS. This vaccine is not administered like typical vaccines and it is a live virus so care must be taken to prevent it from spreading to other parts of the body or other people. There is a large supply within the United States; however, there are more side effects and contraindications than JYNNEOS.

 

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Medical Countermeasures (MCM) Ordering Process for Federally Recognized Tribal Nations

 

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