Mpox (Monkeypox) - Notifiable Condition

Cause: Monkeypox virus (MPXV).

Illness and treatment: Some mpox infections begin with a prodrome including fevers, chills, muscle aches, backaches, lymphadenopathy, and exhaustion, as well as cough or sore throat. A few days after prodrome (if present), a rash develops. Typical rash has deep-seated, well-circumscribed, firm, and discrete lesions that turn into scabs over time. Rash typically appears on face, extremities, genitals, perianal area, pubic area, and rectum. Lesions can be painful especially in sensitive areas. Lesions can be varied: asynchronous (multiple stages on an anatomical site), single, diffuse, limited to one body part, disseminated, shallow rather than deep-seated, or under a nail. Rectal inflammation without external rash can also occur. Patients can present with rectal symptoms such as purulent or bloody stools, rectal pain, or rectal bleeding.

There is no direct or specific treatment for mpox. Most patients recover over time with supportive care and pain management. For patients with severe disease, investigational antiviral agents can be considered. Antibiotics may be appropriate if lesions develop secondary bacterial infections. 

Sources: Although first recognized in a research monkey colony, the reservoir for the virus in Central and West African countries is unknown. Several species of primates and rodents are known to be susceptible to infection with the virus. Person-to-person transmission occurs with close or intimate contact, or through fabrics or material with lesion or scab contamination.

Prevention: Vaccination is the best protection against mpox. Vaccine can also be administered as post-exposure prophylaxis (PEP) within 4 days of exposure to prevent infection, and 4-14 days from exposure to prevent severe disease. 

Recent Washington trends: During the global outbreak of mpox in 2022, WA reported 656 cases of mpox. Washington has continued to receive reports of mpox cases each year since the outbreak, but at a much lower rate. The main source of mpox transmission has been through sexual and intimate contact. Mpox has disproportionately impacted gay, bisexual, or other men who have sex with men (MSM), transgender people, and non-binary people.

Purpose of Reporting and Surveillance

  • To understand the epidemiology of mpox in Washington State residents and to inform public health and healthcare organizations about conditions that have been diagnosed in residents.
  • To assist in the diagnosis and treatment of cases.
  • To identify potentially exposed close contacts, health care workers, and laboratory personnel and to provide counseling.
  • To identify sources of transmission and to prevent further transmission.

Legal Reporting Requirements

  • Health care providers and health care facilities: immediately notifiable to local health jurisdiction.
  • Laboratories: immediately notifiable to local health jurisdiction.
  • Local health jurisdictions: immediately notifiable to the Washington State Department of Health (DOH) through WDRS.

Investigation Guidelines

  • Mpox cases should be reported to DOH using the Washington Disease Reporting System (WDRS) as a Rare Disease of Public Health Significance. In the Clinical and Laboratory question package, select “Mpox” as the “Rare disease of public health significance.” All case investigation and partner management data must be entered in the Mpox Wizard in WDRS.
  • Local health jurisdiction staff should initiate investigation of an mpox case within 24 hours.
  • Local health jurisdiction staff should isolate cases, obtain full clinical information, and other test results, especially if clade I mpox infection is suspected.
  • All close contacts from 4 days before the case’s symptom onset until symptoms resolution should be identified, offered post-exposure prophylaxis (if applicable), and referred to testing if they are symptomatic.
  • Contact symptom monitoring if clade I is suspected or confirmed should be conducted for 21 days after last contact.
  • Provide cases with infection control and prevention guidance.

Contact

Email Mpox Surveillance Program

Resources

Notifiable Conditions Directory