Mpox for Healthcare Providers

Overview

The New York State Department of Health provides guidance, resources, and infrastructure on case reporting, testing, vaccination, treatment, and infection control for healthcare providers to care for New Yorkers with suspected or confirmed mpox.

Case Reporting

Healthcare providers must immediately report suspected cases of mpox to the local county health department (LHD) in the county where the patient resides, using established mpox case definitions.

  • Within New York City: Report suspected cases to the New York City Department of Health and Mental Hygiene at 866-692-3641.
  • Outside New York City (Rest of State):Contact the local health department where the patient resides.

If you are unable to reach the local health department where the patient resides, please contact the New York State Department of Health Office of Sexual Health and Epidemiology:

  • Business Hours (Monday – Friday, 9AM – 5PM): 518-474-3598
  • After Hours, Weekends, and Holidays: 866-881-2809

Testing

Providers should be alert for anyone presenting with rashes or lesions consistent with mpox (See mpox rash images). Testing should be considered, especially if the person has known risk factors.

Clade-specific testing (PDF) may be warranted for individuals based upon community circulation patterns and recent patient travel to areas experiencing a clade I outbreak.

New York State lab testing and specimen collection guidance can be found here. For more information on mpox testing procedures including clade-specific testing please see CDC guidelines.

Testing is available at approved clinical laboratories, including:

For technical questions regarding testing at the state laboratory, contact the Wadsworth Center at wcid@health.ny.gov.

Vaccination

Any New Yorker at risk for mpox is eligible for the two-dose JYNNEOS vaccine (also know as IMVANEX or IMAVUNE).

Commercial Availability: JYNNEOS is commercially available for direct ordering by healthcare providers. A list of authorized distributors can be found on the manufacturer's (Bavarian Nordic) website.

Patient Referrals: Providers who do not stock the vaccine can refer eligible patients to participating local pharmacies and health clinics using the manufacturer's vaccine locator map. Providers serving New Yorkers disproportionately affected by mpox are encouraged to maintain an active supply of JYNNEOS vaccine or identifying rapid referral pathways.

Vaccine Resources:

Questions:

Clinical Management and Treatment

Mild to Moderate Disease – Supportive Care

For patients with mild to moderate disease who are at low risk for severe complications, management focuses on supportive care, symptom relief, and wound hygiene:

  • Fluids
  • Wound Care: Keep skin lesions clean and dry to prevent secondary bacterial infections. Autoinoculation can be common. Lesions should not be scratched, blisters should be popped, nor the lesions shaved over.
  • Pruritus Relief: Treat itching with oral antihistamines (Benadryl) and topical agents (e.g., calamine lotion, or petroleum jelly).
  • Pain Management:
    • Use oral analgesics (e.g., acetaminophen or NSAIDs) as first-line therapy. Use prescription opioids with caution due to the risk of constipation.
    • Apply topical or aerosolized agents (e.g., benzocaine, lidocaine) for localized lesion pain.
    • Prescribe medicated mouthwashes for oral lesions.
    • Recommend stool softeners and sitz baths to manage painful proctitis - which can occur with or without lesions.
  • Systemic Symptoms: Manage nausea and vomiting with anti-emetics. Ensure proper oral hydration and electrolyte replacement for patients experiencing diarrhea.

Moderate to Sever Disease – Therapeutics

Currently no specific treatments are approved for mpox. However, multiple agents developed for smallpox, may be beneficial in treating mpox. These include:

  • Tecovirimat (TPOXX)
  • Vaccinia Immune Globulin Intravenous (VIGIV)
  • Cidofovir (Vistide)
  • Brincidofovir (Tembexa)

These medications may be prescribed to patients experiencing or at risk for severe mpox under special permission from the Food and Drug Administration.

Treatment with Tecovirimat (TPOXX)

Certain patients may be eligible to receive tecovirimat through the Centers for Disease Control and Prevention's (CDC's) Expanded Access-Investigational New Drug (EA-IND) Protocol if they are experiencing severe mpox or are at risk for severe mpox. Eligible patients include those with certain immunocompromised conditions, certain skin conditions, children as well as pregnant or lactating persons, and patients with severe manifestations of mpox.

The use of Tecovirimat alone was found to be ineffective at improving mpox pain or time to symptom resolution (nih.gov) for persons with mild to moderate clade II mpox. For those experiencing or at risk for severe mpox, Tecovirimat may be considered in combination with either Cidofovir or Brincidofovir.

Providers with patients with mpox who meet these criteria should work in concert with the county or State Health Department to request a supply of tecovirimat by contacting the CDC's Emergency Operations Center (EOC) at (770) 488-7100 or poxvirus@cdc.gov. Please note that there is no longer pre-positioned supply of tecovirimat (TPOXX) in New York State.

Infection Control

  • If you suspect a patient has mpox, immediately notify infection prevention and control personnel.
  • Apply standard precautions for all patient care, including for patients with suspected mpox.
  • Place patients with suspected or confirmed mpox in a single-person room - special air handling is not required. Keep door closed if safe to do so.
  • Healthcare workers who enter the patient's room should use gowns, gloves, eye protection. (e.g., goggles or a face shield that covers the front and sides of the face), and a respirator (e.g., N95 or higher).
  • Perform procedures likely to spread oral secretions in an airborne infection isolation room.
  • Avoid activities that could resuspend dried materials from lesions (e.g., portable fans, dry dusting, sweeping, or vacuuming).

Standard cleaning and disinfection procedures should be done using an EPA-registered hospital-grade disinfectant with an emerging viral pathogen claim.

Detailed guidance on infection prevention and control:

Detailed guidance on environmental infection control:

Additional Provider Resources:

New York State Provider Resources

CDC Resources