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DOH Health Advisory: Monkeypox Outbreak, United States

SUMMARY

  • See attached Health Update from the Centers for Disease Control and Prevention (CDC): Monkeypox Virus Infection in the United States and Other Non-endemic Countries 2022, dated June 14, 2022.
  • Monkeypox is a previously uncommon zoonotic viral disease rarely detected in the United States. Previous cases were typically associated with travel or exposure to an infected animal.
  • As of June 16, 2022, there have been 72 confirmed monkeypox/orthopoxvirus cases in the US, and 2,166 reported worldwide since this outbreak started. There have been no reported deaths associated with the current outbreak.
  • Twenty-one of these cases have been in residents of New York, with 19 of those in residents of New York City.
  • Early data suggest that people who identify as gay, bisexual, and other men who have sex with men have made up a high proportion of cases. However, anyone who has been in close contact with someone who has monkeypox is at risk of infection.
  • In the U.S., evidence of person-to-person disease transmission in multiple states and reports of clinical cases with some uncharacteristic features have raised concern that some cases are not being recognized and tested.
  • Although all patients diagnosed with monkeypox in the U.S. to date have experienced a rash or enanthem, some cases have presented with some features uncharacteristic of classic monkeypox disease. These include:
  • Rash beginning in mucosal areas (e.g., genital, perianal, oral mucosa)
  • Lesions scattered or localized to a specific body site, rather than diffuse, and that may not involve the face or extremities
  • Lesions in different stages of progression on a specific anatomic site.
  • Classical prodromal symptoms not always occurring before the rash if they occur at all.
  • Presentation with symptoms such as anorectal pain, tenesmus, and rectal bleeding.
  • Presentation similar to some sexually transmitted infections (STI), such as syphilis, herpes, lymphogranuloma venereum (LGV), or other etiologies of proctitis.
  • The diagnosis of an STI does not exclude monkeypox, as a concurrent infection may be present. Please refer to the CDC HAN for detailed considerations regarding concurrent evaluation for monkeypox and STI.
  • Regardless of gender or sex of sex partner(s), providers should be alert for patients who have rash illnesses consistent with monkeypox, regardless of their travel history or specific risk factors for monkeypox.
  • In people with epidemiologic risk factors, rashes initially considered characteristic of more common infections (e.g., varicella zoster, herpes, syphilis) should be carefully evaluated for concurrent characteristic monkeypox rash and considered for testing.
  • Clinicians suspecting monkeypox infection should strictly adhere to infection prevention and control practices and immediately contact their local health department (LHD) to coordinate testing.
  • Testing for monkeypox can be performed at NYSDOH Wadsworth Center and the NYC Public Health Laboratory. In this update, specimen collection for testing at Wadsworth has changed; specimens should be sent in viral transport media (VTM).

For questions, please send an e-mail to bcdc@health.ny.gov.

NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15