Potential risk for new mpox cases; JYNNEOS vaccination recommended for patients at risk for exposure

BE AWARE that mpox (monkeypox) cases continue to be reported in Washington state and a cluster of mpox cases was recently identified in Chicago. Public health officials are concerned that spring and summer events could lead to a resurgence in cases. See the Background section below for more information.

OFFER OR RECOMMENDJYNNEOS VACCINATION to prevent infection or serious illness in patients who are at higher risk for potential exposure to mpox. Currently, CDC does not recommend routine immunization against mpox for the general public.

• Providers can now request JYNNEOS vaccine directly and orders can be shipped directly to provider clinics. Fill out this form to request JYNNEOS vaccine.

• Kitsap Public Health offers JYNNEOS vaccination on Wednesdays in downtown Bremerton.

• Extensive risk assessment should not be conducted in people who request vaccination to avoid the barriers created by the stigma experienced by many who could benefit from vaccination.

• People who previously received only one JYNNEOS vaccine dose should receive a second dose as soon as possible.

• JYNNEOS vaccine can also be given as post-exposure prophylaxis (PEP) to people with known or presumed exposure to the mpox virus, and to people with certain risk factors and recent experiences that may make them more likely to have been exposed to mpox. Call Kitsap Public Health for guidance at 360-728-2235.

• To help minimize overstocking, please place orders in increments of 20 vials and for an amount to cover a 2-3 week period. Shipments can take up to 2-3 days to receive from date of order.

• Please note, providers need HPOP accounts to make an order. For assistance with setting up an HPOP account, please reach out to: mcm@doh.wa.gov.

• People in communities at risk (e.g., gay, bisexual, or other MSM; transgender or nonbinary people) asking for vaccination is adequate attestation to individual risk of mpox exposure.

EDUCATE patients on mpox risk factors and prevention.

CONSIDER MPOX when determining the cause of a diffuse or localized rash, including in patients who were previously infected with mpox or vaccinated against mpox.

• Conduct a thorough patient history to assess possible mpox exposures or epidemiologic risk factors.

• Perform a complete physical examination, including a thorough skin and mucosal (e.g., oral, genital, anal) examination to detect lesions of which the patient may be unaware.

• Specimens should be obtained from lesions (including those inside the mouth, anus, or vagina), if accessible, and tested for mpox and other sexually transmitted infections (STI), including HIV, as indicated. The diagnosis of an STI does not exclude mpox, as a concurrent infection may be present.

• It is important to take a detailed sexual history for any patient with suspected mpox, as the virus is usually transmitted through close, sustained physical contact and has been almost exclusively associated with sexual contact in the current global outbreak.

• Differential diagnoses include herpes simplex virus (HSV) infection, syphilis, herpes zoster (shingles), disseminated varicella-zoster virus infection (chickenpox), molluscum contagiosum, scabies, lymphogranuloma venereum, allergic skin rashes, and drug eruptions.

NOTIFY Kitsap Public Health District of any suspected or confirmed mpox cases by calling 360-728-2235. The Health District will conduct case and contact investigations and can provide guidance or access for JYNNEOS vaccination and Tecovirimat (TPOXX) treatment.