Nebraska Infectious Disease Society State on MonkeyPox
Nebraska Infectious Disease Society (NIDS) Statement on Monkeypox
On August 4, the U.S. Department of Health and Human Services Secretary Xavier Becerra declared the ongoing spread of monkeypox virus in the United States a Public Health Emergency. We, the Nebraska Infectious Disease Society or NIDS, are providing this information to you for easier access and to allow sharing with healthcare providers and the public.
Monkeypox virus is an orthopoxvirus, related to variola virus (the cause of smallpox) but causing less severe disease. It manifests as infectious lesions, frequently painful, similar in appearance to smallpox, that may appear all over the body at once or may occur in localized areas of the body (including genital areas) and in different stages. The lesions are often preceded or accompanied by a febrile systemic illness. Monkeypox may mimic other diseases that cause a rash, such as syphilis or hand, foot, and mouth disease.
Monkeypox virus is mainly transmitted by close and intimate contact with infected individuals – it is shed in multiple body fluids and is highly concentrated in skin lesions. The current epidemic is primarily (>90%) affecting men who have sex with men (MSM), but we are seeing increasing incidence of spread to other populations, mostly through intense exposure environments (i.e. healthcare settings, household contact, school or daycare, close-contact sports). Monkeypox virus can also be transmitted through fomites (i.e. shared towels, bedding, etc.) and contact with respiratory droplets.
Public health officials are conducting case investigations and contact tracing to identify exposures and limit spread. Close contacts include those in direct close contact, household contacts, and healthcare workers. More information about initial Douglas County, Nebraska cases is available at: https://www.douglascountyhealth.com/images/Monkeypox_DCHD_8_2_22.pdf
Laboratory testing for monkeypox is available through the Nebraska Public Health Laboratory (NPHL.org) and approval from public health officials is no longer required. NPHL.org has information on specimen collection and transport. Tests can be ordered with a paper form or using the NUlirt public health test ordering system (https://www.nphl.org/phlip.cfm ) Testing is also available at large reference laboratories and may be expanded to other labs. For more assistance with suspected cases or specimen collection, contact local health departments or an infectious diseases specialist.
Post-exposure vaccination is a proven intervention to prevent disease. Ideally, vaccination should occur within 72 hours of exposure, and post-exposure vaccination more than 5 days after exposure likely has limited benefit. An antiviral medication, tecovirimat, is FDA-approved for the treatment of smallpox and has excellent efficacy data in animal models of monkeypox infection. Currently, the CDC and FDA require that tecovirimat for monkeypox is administered under an expanded access investigational new drug (EA-IND) protocol.
Limited amounts of the JYNNEOS vaccine for high risk groups or contacts (including kids under 8) and/or TPOXX (tecovirimat) treatments will be utilized based on exposure and risk for severe disease and are being distributed through state and local public health departments. It is expected that supplies will continue to flow in this way before it becomes more widely available. Please call the local health department in your area to discuss situations or for assistance in accessing these products (link below in resources).
The Nebraska ID Society recommends the following sources of information to help you in caring for your patients and to inform the public so they know where to seek care.
Resources:
Map of Nebraska Local Health Departments with Contact Information: https://dhhs.ne.gov/CHPM%20Maps/LHD-EPISurvelliance.pdf
Douglas County Health Department Health Alerts and Information on signing up for updates from DCHD, Nebraska DHHS, and CDC: https://www.douglascountyhealth.com/information-for-healthcare/health-alerts-and-messages
Nebraska Health Alert Network: https://dhhs.ne.gov/pages/Health-Alert-Network.aspx
CDC: Monkeypox Information for Healthcare Providers
https://www.cdc.gov/poxvirus/monkeypox/clinicians/index.html
CDC: Information for Healthcare Providers on Obtaining and Using TPOXX (Tecovirimat) for Treatment of Monkeypox
https://www.cdc.gov/poxvirus/monkeypox/clinicians/obtaining-tecovirimat.html and https://www.unmc.edu/healthsecurity/_documents/tpoxx_guidance.pdf (consolidated)
NETEC.org Monkeypox Specimen Collection (with video): https://repository.netecweb.org/exhibits/show/monkeypox/item/1694
NETEC.org Monkeypox: Infection Prevention Controls and Waste Management: https://repository.netecweb.org/exhibits/show/monkeypox/item/1673
NETEC.org other resources (EMS response, PPE, clinical and laboratory resources, etc): https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox