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Division of Communicable Disease Control

Mpox

Information for Health Care Providers

Check with your local health department (LHD) for more information on case reporting and treatment options available.

Case Definition, Diagnosis and Reporting:

Help identify, test, and diagnose mpox cases with the following resources.

Information for Laboratories Performing Mpox Testing: 

Information for preparing for and completing laboratory testing for mpox

Prevention and Management in Healthcare Settings:

Know how to prevent the spread of mpox in your healthcare setting.

Management:

People with suspected mpox should isolate while awaiting testing results and if confirmed positive, continue isolation until all lesions are healed or criteria are met per the CDPH Mpox Home Isolation Guidance for the General Public.  

Tecovirimat (also called TPOXX), an antiviral medication available through an expanded access Investigational New Drug (EA-IND) protocol for the treatment of mpox infection, is available at an increasing number of sites in California. Contact your LHD if you need information about sites where you can refer your patient.  

Treatment considerations include the following taken from the CDC healthcare professionals guidance webpage and CDPH guidance

  • Patients with severe disease — including hemorrhagic disease; large number of lesions such that they are confluent; sepsis; encephalitis; ocular or periorbital infections; or other conditions requiring hospitalization 
  • Involvement of anatomic areas which might result in serious sequelae that include scarring or strictures — these include lesions directly involving the pharynx causing dysphagia, inability to control secretions, or need for parenteral feeding; penile foreskin, vulva, vagina, urethra, or rectum with the potential for causing strictures or requiring catheterization; anal lesions interfering with bowel movements (for example, severe pain); and severe infections (including secondary bacterial skin infections), especially those that require surgical intervention such as debridement 

Tecovirimat should also be considered for use in people who are at high risk for severe disease: 

  • People currently experiencing severe immunocompromise due to conditions such as advanced or poorly controlled human immunodeficiency virus (HIV), leukemia, Lymphoma, generalized malignancy, solid organ transplantation, therapy with alkylating agents antimetabolites, radiation, tumor necrosis factor inhibitors, or high-dose corticosteroids, being a recipient of a hematopoietic stem cell transplant <24 months post-transplant or ≥24 months but with graft-versus-host disease or disease relapse, or having autoimmune disease with immunodeficiency as a clinical component1
  • Pediatric populations, particularly patients younger than 8 years of age2 
  • Pregnant or breastfeeding people3
  • People with a condition affecting skin integrity — conditions such as atopic dermatitis, eczema, burns, impetigo, varicella zoster virus infection, herpes simplex virus infection, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis, or Darier disease (keratosis follicularis)

For patients at high risk for progression to severe disease, tecovirimat should be administered early in the course of illness along with supportive care and pain control.   

Please note, the FDA has released a statement highlighting the potential for the development of antiviral resistance. It is also important to highlight that while there are data showing that tecovirimat is effective at treating orthopox infections in animals, at this time, there is a lack of data on tecovirimat effectiveness for human mpox.

Supplies of tecovirimat are maintained by the Strategic National Stockpile (SNS) in the Office of the Assistant Secretary for Preparedness and Response. TPOXX can be ordered through your local MHOAC:

For guidance on treatment options, see our Guidance page.

  1. Ogoina D, Iroezindu M, James HI, Oladokun R, Yinka-Ogunleye A, Wakama P, Otike-Odibi B, Usman LM, Obazee E, Aruna O, Ihekweazu C. Clinical Course and Outcome of Human Monkeypox in Nigeria. Clin Infect Dis. 2020 Nov 5;71(8):e210-e214. doi: 10.1093/cid/ciaa143. PMID: 32052029.
  2. Jezek Z, Szczeniowski M, Paluku KM, Mutombo M. Human monkeypox: clinical features of 282 patients. J Infect Dis. 1987 Aug;156(2):293-8. doi: 10.1093/infdis/156.2.293. PMID: 3036967.
  3. Mbala PK, Huggins JW, Riu-Rovira T, Ahuka SM, Mulembakani P, Rimoin AW, Martin JW, Muyembe JT. Maternal and Fetal Outcomes Among Pregnant Women With Human Monkeypox Infection in the Democratic Republic of Congo. J Infect Dis. 2017 Oct 17;216(7):824-828. doi: 10.1093/infdis/jix260. PMID: 29029147.



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