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New and Noteworthy

Background

Mpox, a viral zoonotic infection previously known as "monkeypox", is endemic in certain parts of Africa. Human cases outside of Africa had typically been linked to international travel or imported animals. However, since May 2022, there has been a large international outbreak of mpox in nonendemic regions. Most cases have been identified in men who have sex with other men (MSM). Refer to global, national, and local data pages for more information: WHO | CDC | CDPH | LAC.

Mpox is an orthopoxvirus that is in the same genus as variola (causative agent of smallpox) and vaccinia viruses (which is used in the smallpox vaccine). Although the mpox virus is in the same family of viruses as smallpox, it is less transmissible and typically less severe than smallpox.

Healthcare providers are encouraged to visit the CDC Mpox Information for Healthcare Professionals for information on clinical recognition, caring for patients with mpox, infection control, and other guidance.

Clinical Consultation

Providers who need clinical consultation for (including for patients who are clinically worsening or hospitalized), specimen testing at Public Health Lab, and access to treatment:

Los Angeles County DPH Division of HIV and STD Programs

  • Weekdays 8:00am-4:30pm: 213-368-7441
  • Weekends and holidays 8:00am-4:30pm or evenings (urgent situations only): 213-974-1234 and ask for the physician on call.

Mpox Reporting

  • Healthcare providers must report all mpox or orthopoxvirus infections, hospitalizations, and deaths within 1 working day from identification (Title 17, CCR, §2500). See Reportable Disease List
  • If hospitalized patients are worsening clinically, such as being admitted to the ICU, providers are asked to please contact the LAC DPH healthcare provider line for clinical consultation and to access additional therapeutic options.
  • Providers should report all cases, hospitalization, and deaths on-line via the LAC DPH secure mpox reporting portal:

Mpox Confidential Morbidity Report

  • If providers experience technical difficulties with using the on-line report form, reports may be completed using the standard CMR form and submitted via fax to (888) 397-3778 or (213) 482-5508. Note: provider reporting is not necessary for positive tests conducted by the LAC DPH PHL.
  • Mpox reporting on death certificate: Mpox reporting on the death certificate for all decedents where the disease caused or contributed to death is important to ensure deaths related to mpox are captured.

Mpox Testing

General Information and Updates

  • All major commercial laboratories offer testing for Mpox
    • If you do not have access to commercial orthopoxvirus testing, then specimens can be submitted to the Public Health Laboratory (PHL)
  • Public Health Lab (PHL) testing is available for following priority populations
    • Persons experiencing homelessness (PEH)
    • Pregnant persons
    • Children with a history of close, personal contact with someone who has mpox
    • History or atopic dermatitis of eczema
    • Immunocompromised
    • Those with HIV infection and a CD4 count <350mm3
    • Recent travel (within 21 days of illness onset) to Democratic Republic of Congo
  • Consultation for collecting and submitting any additional and/or other specimens (e.g., tissue samples) must be made by calling the STD Provider Consultation Line.
    • During the evening and weekends and holidays, providers should collect, store, and label the specimens as outlined in this section.
  • If a provider suspects mpox AND the patient has recent travel to Democratic Republic of Congo (DRC), then contact the Clinical Consultation line immediately for consultation and to coordinate clade-specific testing through the LA County public health laboratory.

Preparation and Collection of Specimens


Collection
  • Wear appropriate PPE (including N95, gloves, impermeable gowns, face shield) before collecting specimens.
  •  Depending on the stage of disease, specimen collection involves vigorous, firm swabbing of lesions (vesicular, pustular, or crusted) with synthetic swabs. Swabbing may rupture lesion to release fluid or pus material. Lesions do not need to be unroofed or aspirated
  • Lesion swabs are required for orthopoxvirus PCR.
    • Type of Swab: Use a sterile nylon, polyester, or Dacron swab with a plastic, wood, or thin aluminum shaft
      • Do not use a nasopharyngeal (NP) swab as the shaft is too flexible and the tip too small to collect an adequate sample.
      • Do not use cotton swabs
  • Number of Samples: Collect at least 2 dry swabs from the same lesion
  • Specimen Transport: Lesion swabs can also be placed in an empty sterile screw cap tube or sterile screw cap specimen cup (for example, urine cup) for transport of a dry swab.
  • Consultation for collecting and submitting any additional and/or other specimens (e.g., tissue samples) must be made with PHL Director (562-658-1300).
  • Reference: CDC: Testing Patients for Mpox: https://www.cdc.gov/poxvirus/mpox/pdf/MPoxTestingPatients.pdf
Storage
  • Lesion swab specimens should be stored refrigerated (2-8°C) and send to PHL as soon as possible.
  • Specimens that were collected for more than 3 days must be frozen (-20°C or lower).
Labeling
  • Each specimen needs a separate test requisition form.
  • Label all specimens with a minimum of two patient identifiers (e.g., full name and date of birth) and completely fill out the LAC Public Health Laboratory test requisition form.
  • For swabs and scabs/crusts, write in "Orthopoxvirus PCR" in the "Other" box at the bottom of the form.
Shipment
  • Use own courier when available to send specimens to PHL.
  • If a courier is not available, call PHL’s Central Accession at 562-658-1460 (Monday to Friday 7:00am to 5:00pm).

Reference: CDC Mpox Specimen Collection: https://www.cdc.gov/poxvirus/mpox/clinicians/prep-collection-specimens.html  

Resources

For Providers

For Patients/General Public