Disease Prevention and Control, San Francisco Department of Public Health

Mpox Info & Guidance for SF Healthcare Providers

Last updated: 9/30/22. Short URL for this page: www.sfcdcp.org/mpxhcp  (mpxhcp short for “mpox for healthcare providers”)

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Report All Suspect Mpox Cases to SFDPH

All suspect mpox 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 monkeypox@sfdph.org or by fax to (415) 554-2848 and write “suspect mpox” in the disease field at the top of the form.  24/7 reporting of suspect mpox by telephone is no longer required and is not the preferred method.

Testing and Specimen Submission

Commercial Reference Labs.  Mpox 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 mpox 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 mpox testing and has improved turn-around-time with the addition of on-site Mpox PCR assay.

All providers are requested to review and follow this SF-specific guidance for mpox evaluation, including infection control, specimen collection, and patient isolation.

Vaccination

Jynneos mpox vaccine supply is no longer scarce. SF receives vaccine allotments from the state health department based on a formula using current mpox case counts and eligible population size. SFDPH currently has sufficient doses to offer vaccine to the general public.

Eligibility. Eligibility criteria has been removed. Anyone who wants protection from mpox infection may receive mpox vaccine. Vaccine providers can offer mpox vaccine to any patients who may be at risk, and persons who request vaccination should receive it without having to attest to specific risk factors. See Health Update:Expanded Mpox Vaccination Recommendations (Updated Dec 9, 2022)

Storage, Handling, and Expiration.  See CDC resources for Jynneos vaccine for info on storage and handling under the new EUA for intradermal dosing.

See Jynneos may be stored refrigerated for up to 8 weeks – do not refreeze and this Jynneos storage and expiration Q&A.

Administration.  Jynneos dosing is available through BOTH 0.5mL subcutaneous administration OR 0.1mL intradermal administration.

As of 10/19/22, subcutaneous administration is the standard route, but intradermal may be used under an Emergency Use Authorization (EUA).

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 Mpox 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 mpx.vaccine.administration@sfdph.org

Treatment with Tecovirimat

Tecovirimat (TPOXX) has an FDA indication for treating smallpox and is available to treat cases of mpox via an Expanded Access Investigational New Drug (EA-IND) protocol. Tecovirimat efficacy for treatment of mpox 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 mpox.

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 mpox 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 monkeypox@sfdph.org.

If your site does not currently have access to tecovirimat, you can refer patients with an urgent need for mpox 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.

Additional Sources

Most recent Mpox Health Advisories

 

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