Mpox for Healthcare Providers
Overview
NYSDOH continues to provide the guidance, resources, and infrastructure needed for healthcare providers in New York to have the information on case reporting, testing, treatment, and vaccination to care for New Yorkers with suspected or confirmed mpox. The latest guidance for healthcare providers is here.
Reporting
Healthcare providers must immediately report suspected cases of mpox to the local county health department (LHD) in the county in which the patient resides:
- New York City residents suspected of mpox infection should be reported to the New York City Department of Health and Mental Hygiene (NYCDOHMH) Provider Access Line (PAL) at 866-692-3641.
- Contact information for reporting New York State residents who reside in counties outside of New York City is available here.
If you are unable to reach the LHD where the patient resides, please contact the NYSDOH Office of Sexual Health and Epidemiology at: 518-474-3598 during business hours (Monday—Friday, 9AM – 5PM) or 866-881-2809 evenings (after 5PM), weekends, and holidays.
Testing
Patients with rashes initially considered characteristic of more common infections (e.g., varicella zoster or sexually transmitted infections) should be carefully evaluated for a characteristic mpox rash (see main page for images). Submissions of specimens of lesions should be considered, especially if the person has epidemiologic risk factors for mpox infection.
Testing for mpox is currently available at numerous laboratories, including but not limited to commercial and public health laboratories (Erie County Public Health Laboratory, NYSDOH Wadsworth Center Laboratory, the New York City Public Health Laboratory, and the Westchester County Department of Laboratories and Research). The process for testing is in accordance with CDC guidance and based on the testing process that CDC has laid out nationwide. Additional directions for ensuring adequate collection of a lesion specimen are available from CDC here.
Laboratories
Testing for mpox is available at numerous laboratories. Contact your routine reference laboratory for specific specimen submission procedures for mpox testing or contact your local health department for further guidance. Contact the Wadsworth Center for questions related to mpox testing (wcid@health.ny.gov).
Public Health Laboratories
Testing for orthopoxvirus, the family of viruses to which mpox belongs to, is available at Erie County Public Health Laboratory, NYSDOH Wadsworth Center Laboratory, the New York City Public Health Laboratory and the Westchester County Department of Laboratories and Research. Specimen collection and submission in NYS (outside of NYC) must be coordinated with the LHD and/or NYSDOH.
Instructions and details regarding specimen collection and submission in New York City (NYC) can be found here.
NYSDOH Wadsworth Center will accept specimens collected and transported in viral transport media (VTM) OR collected and transported dry. Specimens in VTM can be tested for orthopoxvirus, varicella zoster virus, and herpes simplex viruses I and II. Specimens collected dry can only be tested for orthopoxviruses. Testing for other viruses should be done locally. Additional instructions and details regarding specimen collection and submission to the NYSDOH Wadsworth Center can be found here
Vaccination
JYNNEOS (aka: IMVANEX, IMAVUNE)
New York State is currently offering the JYNNEOS vaccine as a 2-dose series for the prevention of mpox among adults ages 18 years and older. As vaccine supply becomes available from the federal government, NYSDOH continues to roll-out the JYNNEOS vaccine using a phased approach, in accordance with CDC guidance. Vaccine resources for providers are listed here:
- Provider Agreement for Vaccine During Emergencies
- Vaccine guidance for healthcare providers and vaccine administrators on JYNNEOS (Also available in Spanish)
- Storage and Transport Guidance for Jynneos Vaccine
- Information for health care professionals about screening individuals for the JYNNEOS vaccine. (Also available in Spanish)
- JYNNEOS screening and consent form. (Also available in Spanish)
- JYNNEOS patient handouts. (Also available in Spanish)
- Standing orders for administering JYNNEOS vaccine intradermally
- JYNNEOS subcutaneous and intradermal training for vaccinators
NYCDOHMH receives vaccine directly from the federal government, which they distribute directly within their jurisdiction. For more information on NYCDOHMH's program in New York City, please visit the page here or contact NYCDOHMH directly.
Treatment
Mpox Provider Treatment Network
If you have diagnosed a patient with mpox, you may refer them to one of these mpox provider treatment network sites (outside of NYC) to be evaluated for potential treatment.
Mild to Moderate Disease
For those with mild to moderate disease, at low risk for severe disease, treatment includes:
- Supportive care including fluids and wound hygiene/care
- Analgesics as needed
- Topical or aerosolized diphenhydramine (Benadryl) or lidocaine for lesion associated pruritus and pain respectively
Supportive Care
This first level of care includes the maintenance of fluids, pain management, treatment of bacterial superinfections of skin lesions, and treatment of any possible co-occurring sexually transmitted or superimposed bacterial skin infections.
Skin lesions should be kept clean and dry to prevent further secondary infection. Pruritus can be treated with an oral antihistamines and topical agents such as calamine lotion, cortisone 10, or petroleum jelly. For oral lesions, prescription medicated mouthwashes can be used to manage pain. Oral antiseptics are helpful in keeping lesions clean. Topical gels such as benzocaine/lidocaine can be used for temporary relief, while eating and drinking.
Proctitis can occur with or without lesions and is often manageable with supportive care, stool softeners may be beneficial. Topical gels such as benzocaine/lidocaine can be used for temporary relief as well. Sitz baths can also be used for proctitis. Pain management may be beneficial utilizing over-the-counter medication such as acetaminophen or prescription medications (narcotics risk constipation). Additionally, proctitis may cause rectal bleeding, which should be evaluated by a healthcare provider. Nausea and vomiting can be controlled with the use of anti-emetic as deemed appropriate. Diarrhea should be managed through proper hydration and electrolyte replacement.
Moderate to Severe Disease
- Currently no treatments are approved specifically for mpox. However, multiple agents have been developed for smallpox, which may be beneficial in treating mpox.
- Four agents are available for treatment. More detailed information on these individual agents is available here:
- Tecovirimat (TPOXX)
- Vaccinia Immune Globulin Intravenous (VIGIV)
- Cidofovir (Vistide)
- Brincidofovir (CMX001 or Tembexa)
- More information for healthcare providers on obtaining and using TPOXX for treatment of mpox can be found here.
Infection Control Guidelines
Standard precautions should be applied for all patient care, including for patients with suspected mpox. If a patient seeking care is suspected to have mpox, infection prevention and control personnel should be notified immediately. Activities that could resuspend dried materials from lesions, e.g., use of portable fans, dry dusting, sweeping, or vacuuming should be avoided.
- Detailed guidance regarding infection control guidance and environmental infection control for mpox cases in healthcare delivery settings can be found here and in Spanish here.
- Guidance for mpox cases in non-healthcare congregate settings is available here and in Spanish here.
- More information on infection prevention and control of mpox can be found on the CDC infection prevention and control webpage.
- Information regarding guidance on the handling of regulated medical waste (RMW) from suspected or confirmed cases of mpox is available here. Additional information can be accessed through the U.S. Department of Transportation (USDOT) and CDC.
Additional guidance on environmental infection control can be found at the links below:
- Handling of soiled laundry
- EPA's List Q for products with emerging viral pathogen claims
- CDC Guidelines for Environmental Infection Control in Health-Care Facilities
Provider Webinars
NYSDOH continues to host a series of webinars for healthcare providers to provide a situational update on the evolving mpox outbreak in New York City and New York State. We invite you to join NYSDOH's Dr. Eugene Heslin as we discuss this evolving mpox outbreak affecting New Yorkers as well as the ongoing NYSDOH and NYCDOHMH response.
- NYSDOH & NYCDOHMH June 2023 Virtual Briefing for Elected Officials - Video, Slides (PDF)
- May 9, 2023 Healthcare Provider Update Webinar - Video, Slides (PDF)
- Mpox/MPV Vaccination and Care for Adolescents: Access and Best Practices - Video, Slides (PDF)
- Part IV: August 25, 2022 - Video, Slides (PDF)
- Part III: August 4, 2022 - Video, Slides (PDF)
- Part II: July 21, 2022 - Video
- Part I: July 14, 2022 - Video, Slides (PDF)
Resources
NYSDOH Resources
- Health Advisory - June 13, 2023 (PDF)
- Health Advisory - May 1, 2023 (PDF)
- Dear Colleague Letter - March 23, 2023 (PDF)
- Symptomatic/Asymptomatic Guidance for HC Workers (PDF). Also available in Spanish (PDF)
- Guidance for EMS Professionals on Suspected Cases of Mpox (PDF)
- NYSDOH Health Alert Notice for providers in New York State - July 8, 2022 (PDF)
- NYSDOH Health Alert Notice for providers in New York State - June 17, 2022 (PDF)
- NYSDOH Health Alert Notice for providers in New York State - May 22, 2022 (PDF)
CDC Resources
- Webinar Thursday, August 11, 2022 - CDC and FDA Update: Interim Clinical Considerations for Mpox Vaccination | PowerPoint Presentation (PDF)
- Interim Clinical Considerations for Use of JYNNEOS and ACAM2000 Vaccines during the 2022 U.S. Mpox Outbreak
- JYNNEOS Smallpox and Mpox Vaccine Intradermal Vaccine Preparation and Administration Summary: ALTERNATIVE DOSING REGIMEN (PDF)
- Mpox Health Alert July 30, 2022 (PDF)
- Isolation and Prevention Practices for People with Mpox
- What Clinicians Need to Know about Mpox in the United States and Other Countries - June 29, 2022
- Safer Sex, Social Gatherings, and Mpox
- Case Definitions for Clinicians