Monkeypox (MPX)

What is Monkeypox (MPX)?

Monkeypox (MPX) is a rare but potentially serious viral illness that typically begins with flu-like illness and swelling of the lymph nodes and progresses to a rash on the face and body. Most infections last 2-to-4 weeks. The virus does not spread easily between people; transmission can occur through contact with body fluids, sores, items that have been contaminated with fluids or sores (clothing, bedding, etc.), or through respiratory droplets following prolonged face-to-face contact.

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MPX in Marin County

Data Source: CDPH and California Immunization Registry (CAIR)

Cases of MPX in Other Parts of the Country

• Cases of MPX globally and in the United States
• Cases of MPX in California

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Signs and Symptoms

MPX typically begin with flu-like illness.  Symptoms of MPX can include:

• Fever
• Headache
• Muscle aches and backache
• Swollen lymph nodes
• Chills
• Exhaustion
• A rash that can look like pimples or blisters that appears on the face, inside the month, or on other parts of the body, like hands, feet, chest, genitals, or anus.

The rash goes through different stages before healing completely. The illness typically lasts 2-4 weeks. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.

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How it Spreads

The MPX virus is spreading mostly through close, intimate contact with someone who has MPX.  MPX can spread from the time symptoms start until the rash has fully healed with a fresh layer of skin has formed (this can take several weeks).

MPX can be spread through:

• Direct skin-to-skin contact with rash lesions, sores, scabs, or body fluids
• Sexual/intimate contact, including kissing or cuddling  
• Living in a house and sharing a bed with someone 
• Sharing towels or unwashed clothing that previously touched the rash or body fluids of someone with MPX
• Respiratory secretions through prolonged face-to-face interactions (the type that mainly happen when living with someone or caring for someone who has MPX) 

MPX is NOT spread through: 

• Casual brief conversations 
• Walking by someone with MPX, like in a grocery store  

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How is it Prevented?

 MPX is not considered a sexually transmitted disease, but it is often transmitted through close, sustained physical contact, which can include sexual contact.

People at highest risk are those who have had close physical contact with someone actively infected with MPX. Based on statewide data, men are at highest risk for MPX infection. However, MPX can be acquired by anyone, regardless of gender identity or sexual orientation.

Vaccination is an important tool in preventing the spread of MPX. But given the current limited supply of vaccine, consider temporarily changing some behaviors that may increase your risk of being exposed. These temporary changes will help slow the spread of MPX until vaccine supply is adequate.

How to protect yourself: 

• Avoid close, skin-to-skin contact with people who have a rash that looks like MPX
  • Do not touch the rash or scabs.
  • Do not kiss, hug, cuddle or have sex with someone with MPX
• Follow guidelines for safer sex
  • Condoms protect from sexually transmitted infections (STIs) but not MPX
• Learn how to lower your risk at CDC's Safer Sex, Social Gatherings, and Monkeypox website 
  • Exchange contact information with any new partner to allow for sexual health follow-up
  • Take a temporary break from activities that increase exposure to MPX until you are two weeks after your second dose of MPX PrEP
  • Limit your number of sex partners to reduce your likelihood of exposure
  • Decrease participation in high-risk events (e.g., bath houses, saunas, sex clubs/parties)
  • Engage in sexual activity only with known partners

If you or your partner has or recently had MPX symptoms, or you have a new or unexplained rash anywhere on your body, do not have sex and see a healthcare provider.

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Vaccine

JYNNEOS is a vaccine that can help prevent MPX infection. JYNNEOS is approved for adults 18 & over. It is a two dose injection series at least four weeks apart.  CDC advises that people exposed to MPX be given the vaccine to prevent them from developing the disease.

Anyone who wants protection from MPX infection may receive MPX vaccine.

There is no shortage of MPX vaccine now, and so Marin County Public Health and many other health departments in California have removed all the eligibility criteria.  Anyone who may be at risk of getting MPX can now receive the JYNNEOS vaccine to prevent MPX. There is no need to prove eligibility for the vaccine.  

Some people are still at higher risk of getting MPX than others, and those persons are now considered priority groups that are recommended to get the JYNNEOS vaccine.

Eligible Persons:

• Must be a Marin County resident
• Persons who have had a known exposure to MPX and need post-exposure prophylaxis (PEP)
• People with occupational (job-related) risk, including
  • Healthcare workers likely to collect laboratory specimens from patients with MPX
  • Persons working in sexual health clinics
  • Persons working in clinical settings that serve at-risk populations
  • Any occupational group recommended by Advisory Committee on Immunization Practices (ACIP) to get the vaccine
• Any person living with HIV, especially those with risk of complications of MPX, such as persons with a CD4 count <350/mm3, an unsuppressed viral load, or who have had an opportunistic infection
• Any man, trans person, or nonbinary person who has sex with men, trans persons, or nonbinary persons
• Persons who are taking or are eligible to take HIV PrEP
• Sex workers
• Sexual contacts of any persons included above
• Persons who have had close contact, within the past 6 months, with someone with suspected or confirmed MPX
• Persons who had sex or close contact, within the past 6 months, at a venue or event, or within a social group, with a suspected or confirmed MPX case. This includes persons who received notice from a venue or event of a potential exposure.
• Persons diagnosed, in the past 3 months, with a bacterial sexually transmitted disease (for example: chlamydia, gonorrhea, syphilis)
• Persons who expect to experience any of the above
• Individuals are eligible for their 2nd doses 28 days after their 1st dose

Providers Offering Vaccines

Please contact clinics and health care providers directly to verify information, availability, and to make an appointment.  Don't forget to bring your immunization record with you each visit.

• Coastal Health Alliance / Petaluma Health Center - Pt Reyes Station:  Call 415-663-8666 for an appointment.
• Kaiser (must be a Kaiser member):  Call 415-444-2000 for an appointment.
• Marin Community Clinic STD Clinic (Mondays & Thursdays 1-4 pm):  Call 415-448-1500 for an appointment, walk-ins accepted. 
• Ritter Center:  Call 415-457-8182 for an appointment.

Upcoming Vaccine Clinics

No clinics currently scheduled.

What to do if you have been exposed

If you have been exposed and/or are symptomatic, contact your primary care provider for potential testing and treatment.  Anyone with a rash that looks like MPX should talk to their healthcare provider about whether they need to get tested, even if they don’t think they had contact with someone who has MPX.

If you are a Kaiser Permanente (KP) member and have been exposed and/or are symptomatic, contact KP at (415) 444-3100 (8:30 am to 5:00 pm Monday through Friday) or send a secure message through KP.org for more information. Do not go to the emergency room for testing.

Avoid crowds, close contact, including sexual or intimate contact until seeing your healthcare provider.

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Provider Information

MCPH is urging healthcare providers to be alert for patients who have rash illnesses consistent with monkeypox.

Updated Clinical Assist Tool [PDF] (CDPH; July 25, 2022)

Case Finding & Management guidance

• Monkeypox Virus Activity in Marin and Guidance for Clinicians [PDF] (MCPH; July 22, 2022)
• Evaluation and Management of Suspected Monkeypox Cases [PDF] (CDPH; June 23, 2022)
• Case Finding Guidance for Clinicians (CDC; June 14, 2022)
• National Monkeypox Vaccine Strategy (The White House; June 28, 2022)

Clinical Presentation

Marin healthcare providers should be alert for patients who have rash illnesses consistent with monkeypox, regardless of whether they have travel or specific risk factors for MPX and regardless of gender or sexual orientation.

Suspected cases may present with early flu-like symptoms and progress to lesions that may begin on one site on the body and spread to other parts. Illness could be clinically confused with a sexually transmitted infection like syphilis or herpes, or with varicella zoster virus. Thus far in the U.S. outbreak, all patients diagnosed with MPX in the United States have experienced a rash or exanthem. Although the characteristic firm, deep-seated, well-circumscribed and sometimes umbilicated rash has been observed, the rash has often begun in mucosal areas (e.g., genital, perianal, oral mucosa) and in some patients, the lesions have been scattered or localized to a specific body site rather than diffuse and have not involved the face or extremities.

People with MPX in the current outbreak report having close, sustained physical contact with other people who have MPX. While nearly all affected are gay, bisexual, or other men who have sex with men, anyone who has been in close contact with someone who has MPX can get the illness.

See CDC’s Clinical Recognition webpage for more characteristics and photos of MPX rashes.

Testing

Commercial labs such as Quest, LabCorp and other private labs are now testing for MPX Virus. There is no need to contact Marin County Public Health for approval to test at commercial laboratories but providers must still report all suspect cases to MCPH within 1 working day. To report suspected cases, please complete a Confidential Morbidity Report (CMR) [PDF] and fax to (415) 473-6002.

Treatment

On July 21, 2022, Centers for Disease Control and Prevention (CDC) Institutional Review Board (IRB) approved an amendment and continuation of its research protocol to increase access to mpox treatment by providing umbrella regulatory coverage for clinicians and facilities and liability coverage for compensation to patients if injured.

Marin County Public Health encourages health care providers to obtain and use TPOXX (Tecovirimat) for the treatment of MPX when clinically indicated and with informed consent. Provider should review the TPOXX Provider Packet and determine readiness to obtain and use TPOXX for the treatment of active MPX.  

If a healthcare provider has a non-pediatric patient in urgent need of treatment, the provider may proceed with TPOXX treatment once informed consent has been obtained. To secure TPOXX for an immediate need, please contact the Marin County Public Health.  During business hours (Mon - Fri, 9 am - 5 pm), call (415) 473-4163.  After hours, call the On Call Health Officer (415) 499-7237.

Travel Advisories

CDC Travel Advisory - Level 2 [Practice Enhanced Precautions] (June 6, 2022)

Report a suspected case

To report suspected cases, please complete a Confidential Morbidity Report (CMR) [PDF] and fax to (415) 473-6002.

References

• CDC Vaccine Information Statement
• CDPH. Monkeypox
• CDC. Monkeypox
• World Health Organization (WHO). Vaccines and immunization for monkeypox: Interim guidance (June 14, 2022)
• Equality California.  Monkeypox Resource Center
• WHO.  Public health advice for gay, bisexual and other men who have sex with men on the recent outbreak of monkeypox
• WHO. Multi-country monkeypox outbreak in non-endemic countries (May 21, 2022)
• CDC.  Health Alert - Monkeypox Virus Infection in the United States and Other Non-endemic Countries—2022 (May 20, 2022)

Page last reviewed: October 5, 2022