Mpox for Healthcare Providers

Overview

NYSDOH 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. (Mpox Case Definitions) to the local county health department (LHD) in the county in which the patient resides:

  • In New York City, report suspected cases to the New York City Department of Health and Mental Hygiene at 866-692-3641.
  • In New York State outside of New York City, 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 at: 518-474-3598 during business hours (Monday—Friday, 9AM – 5PM) or 866-881-2809 evenings (after 5PM), weekends, and holidays.

Testing

Providers should be alert for patients who present with rashes/lesions consistent with mpox. (See Mpox rash images). Mpox testing should be considered, especially if the person has risk factors for mpox infection.

Clade-specific testing should take place for anyone exhibiting symptoms of mpox who reports recent travel to any of the areas affected by the clade I mpox outbreak or areas which have diagnosed and reported cases. More information can be found in this Health Alert Notice.

Testing for mpox is currently available at numerous approved clinical laboratories, including but not limited to those listed below:

The process for testing is in accordance with guidance from the Centers for Disease Control and Prevention.

Instructions and details regarding specimen collection and submission in New York City (NYC) can be found here.

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 any additional questions related to mpox testing (wcid@health.ny.gov).

Vaccination

Any New Yorker at risk for mpox is eligible for the two-dose JYNNEOS vaccine (aka: IMVANEX, IMAVUNE).

In April 2024, Bavarian Nordic, the manufacturer of JYNNEOS, made the vaccine available for ordering by healthcare providers. Providers seeking to order vaccine can find a list of JYNNEOS distributors on their website. Providers are encouraged to work with partner agencies and locations to facilitate linkage of patients to available doses in their locality.

Providers who would like to refer patients to a nearby pharmacy to receive the vaccine may use the manufacturer's vaccine locator map.

Providers serving New Yorkers disproportionately affected by mpox are encouraged to consider maintaining a supply of JYNNEOS vaccine or identifying speedy available referral pathways for patients eligible for and seeking vaccination.

Vaccine Resources for Healthcare Providers:

Questions About JYNNEOS Vaccine:

Treatment

Mild to Moderate Disease

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.

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 includes:

  • Keeping skin lesions clean and dry to prevent further secondary infection (Oral antiseptics help keep lesions clean; Topical gels such as benzocaine/lidocaine can be used for temporary relief, while eating and drinking).
  • Treating pruritus with oral antihistamines and topical agents (e.g., calamine lotion, cortisone 10, or petroleum jelly).
  • Prescribing medicated mouthwashes for oral lesions to manage pain.
  • Recommending stool softeners and sitz baths to help manage proctitis which can occur with or without lesions.
  • Managing pain with medications such as acetaminophen or prescription medications (narcotics risk constipation).
  • Managing nausea and vomiting with anti-emetics, and diarrhea with proper hydration and electrolyte replacement.

Moderate to Severe Disease

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

  • Tecovirimat (TPOXX)
  • Vaccinia Immune Globulin Intravenous (VIGIV)
  • Cidofovir (Vistide)
  • Brincidofovir (CMX001 or Tembexa)

These medications are not approved for treatment of mpox, however 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 protocol, including specific eligibility criteria, can be found here.

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.

More information on tecovirimat (TPOXX) for the treatment of mpox, from the U.S. Centers for Disease Control and Prevention

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:

Provider Webinars

Additional Provider Resources:

New York State Provider Resources

CDC Resources