Last updated: 9/30/22. Short URL for this page: www.sfcdcp.org/mpxhcp (mpxhcp short for “mpx for healthcare providers”)
On This Page
- Case Reporting
- Testing and Specimen Submission
- Treatment with Tecovirimat
- Additional Sources
- Health Advisories
Report All Suspect MPX Cases to SFDPH
All suspect MPX cases must be reported within 1 working day to SFDPH Communicable Disease Control, preferably by email or fax. Please submit a Confidential Morbidity Report form (CMR) by email to firstname.lastname@example.org or by fax to (415) 554-2848 and write “suspect MPX” in the disease field at the top of the form. 24/7 reporting of suspect MPX by telephone is no longer required and is not the preferred method.
Testing and Specimen Submission
Commercial Reference Labs. MPX testing is now available through LabCorp, Quest, ARUP, and other reference labs.
- For most SF healthcare providers outside of SFDPH, a commercial reference laboratory will be the best option for streamlined MPX testing and resulting.
- Please check with the reference lab regarding their lab-specific submission forms and requirements for specimen collection, labeling, and transport.
- There is no need to contact SFDPH for approval to test at commercial laboratories but providers must still report all suspect cases to SFDPH within 1 working day.
San Francisco Public Health Lab is still accepting specimens for MPX testing and has improved turn-around-time with the addition of on-site MPX PCR assay.
All providers are requested to review and follow this SF-specific guidance for MPX evaluation, including infection control, specimen collection, and patient isolation.
Jynneos MPX vaccine supply is improving. SF receives vaccine allotments from the state health department based on a formula using current MPX case counts and eligible population size. SFDPH continues to request as many doses as possible in the shortest timeframe available, and vaccine doses have begun to arrive more regularly.
Eligibility. Please review and adhere to current eligibility guidance. SF has expanded eligibility to include 2nd doses for those who are at least 4 weeks from their first dose, and no longer requires recipients to be within 14 days of a potential exposure. Eligibility is usually limited to persons who live or work in SF, but during the period from 9/18 through 10/2/22, visitors to SF are also eligible if they otherwise qualify. See memo for details. SF Updated MPX Vaccine Eligibility (Updated 10/12/2022)
Storage, Handling, and Expiration. See CDC resources for Jynneos vaccine for info on storage and handling under the new EUA for intradermal dosing.
Jynneos prescribing information for the 0.5 mL subcutaneous route has been superseded in part by additional regulatory updates. See Jynneos may be stored refrigerated for up to 8 weeks – do not refreeze and this Jynneos storage and expiration Q&A.
Administration. As of 8/9/22 an Emergency Use Authorization (EUA) by FDA allows for administration of Jynneos via the intradermal route to persons ages 18 years and older. See CDC Monkeypox vaccination Considerations. The dose is 0.1 mL administered intradermally (ID), and this is a dose-sparing approach under which each 0.5-mL Jynneos vial can support vaccination of up to 5 adults. See SFDPH guidance to support the use and availability of ID dosing.
On 9/28/22 CDC updated its Jynneos administration guidance to state the following: “Intradermal administration involves injecting the vaccine superficially between the epidermis and the hypodermis layers of the skin, typically of the volar aspect (inner side) of the forearm. If the volar aspect of the forearm is not an option (e.g., strong patient preference), intradermal administration of vaccine may be performed at the upper back below the scapula or at the deltoid.”
Resources for training on how to properly administer ID doses are available through CDC. SFDPH is providing consultation and hands-on support to healthcare facilities seeking assistance in developing their on-site training plans for the intradermal administration of JYNNEOS. Requests can be registered HERE.
Pediatric Vaccination. As of 8/9/22 an Emergency Use Authorization (EUA) by FDA allows for administration of Jynneos to persons younger than age 18 years. There is no lower limit to the age of children who can receive Jynneos under the EUA. See CDC MPX vaccination Considerations. The pediatric dose is 0.5 mL given subcutaneously.
Process for Minor Consent to Receive MPX Vaccine. See SFDPH minor consent guidance for the process by which minors ages 12 years and older may consent to receive Jynneos vaccine.
Are you a provider interested in vaccinating your patients? Please fill out this survey as a first step to request being considered. For any questions, email email@example.com
Treatment with Tecovirimat
Tecovirimat (TPOXX) has an FDA indication for treating smallpox and is available to treat cases of MPX via an Expanded Access Investigational New Drug (EA-IND) protocol. Tecovirimat efficacy for treatment of MPX disease in humans is unknown and undergoing evaluation.
In most cases, supportive care and symptomatic treatment is sufficient. This includes pain relievers, topical cortisone, and benzocaine/lidocaine gels for painful proctitis. In rare cases a patient may need pain management beyond over the counter pain relivers. Criteria used in SF as indications for tecovirimat are aligned with CDC and can be found here.
Though rare, TPOXX resistance has been observed with prolonged treatment courses (>14 days). See the November 17, 2022 CDC Health Update for more details, as well as for information on other treatments that can be administered concurrently with tecovirimat for certain patients with severe monkeypox.
STOMP Clinical Study Information
Please inform your patients about an ongoing clinical trial, the Study of Tecovirimat for Human Monkeypox Virus (STOMP). This trial is actively enrolling participants, and the goal of the trial is to learn more about TPOXX safety and effectiveness. If your patient is interested, please call 415-535-9495 or email ID-Research.ZSFG@ucsf.edu.
San Francisco providers can obtain and prescribe tecovirimat. SFDPH encourages all providers and clinics who are testing for and diagnosing MPX to have access to tecovirimat and can assist with obtaining the medication for your site. Instructions to become a tecovirimat prescriber can be found here. Clinicians can also contact us for assistance by emailing firstname.lastname@example.org.
If your site does not currently have access to tecovirimat, you can refer patients with an urgent need for MPX treatment to a tecovirimat prescribing site. A list of TPOXX prescribing sites in San Francisco can be found here. After referring a patient, please contact SFDPH to become a tecovirimat prescriber.
- Tip sheet: MPX for healthcare providers (SFDPH, 8/19/2022)
- Webinar: SFDPH MPX Update for SF Clinicians-July, 28, 2022
- CDC MPX pages for healthcare providers
- CDPH MPX pages and CDPH MPX resources site
- Intradermal JYNNEOS Vaccine for Monkeypox – Patient Facing Resources/Links
Most recent Monkeypox Health Advisories
- SFDPH Advisory on Intradermal Jynneos, August 18th, 2022
- SFDPH MPX Update August 10, 2022
- SFDPH Advisory-July 15th, 2022
- SFDPH Media Statement-July 13th, 2022
- SFDPH Advisory-June 30th, 2022
- CDPH Advisory June 23rd, 2022
- SFDPH Advisory June 14th, 2022
- CDPH Advisory-May 27th, 2022
- SFDPH Advisory-May 24th, 2022
- CDPH Advisory-May 20th, 2022
- CDC Advisory-May 20th, 2022
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