Mpox Frequently Asked Questions

About Mpox

How is mpox spread?

Transmission of mpox requires close contact with a symptomatic person. Brief interactions that do not involve physical contact and health care interactions conducted using appropriate protective equipment are not high risk.

The mpox virus can be spread through:

Direct contact with the rash or body fluids of an infected person (including sexual or intimate contact)
Contact with virus-contaminated objects (such as bedding, clothing, fetish gear, or sex toys)
Direct contact with infected animals
Respiratory droplets during direct and prolonged face-to-face contact (such as kissing, licking, and other intimate contact with saliva)
Spread to baby during pregnancy or spread to newborn during or after birth

Some people are contagious before their symptoms appear. People with a confirmed case of mpox are contagious starting four days before they develop symptoms and continue to be contagious until the scabs fall off the rash. A person with mpox should isolate from others until the scabs fall off.

What are the symptoms?

Mpox can cause a range of symptoms including the following:

Fever
Headache
Swollen lymph nodes
Subsequently, a rash that can appear anywhere on the body

Some people may not have any symptoms before the start of the rash. Some people initially have pain in the anal region, with or without other symptoms such as fever and headache. For some people, the rash might only be on the genitals or anal region. For others, the rash might cover a larger area of the body. Over time, the rash will usually turn into raised bumps, which then fill with fluid. The rash eventually scabs over, and the scabs fall off.

Most people recover in 2-4 weeks although the lesions can leave scars. The disease can be serious, especially for immunocompromised people, children, and pregnant people.

People with symptoms of mpox should contact their primary health care provider or clinic. Before the visit, they should tell the provider or clinic that they are concerned about mpox and tell them whether they recently had close contact with a person who had a similar rash or who was diagnosed with mpox. If you don't have one, find a provider.

How long is the incubation period (the time from when you get exposed to potentially developing symptoms)?

The incubation period (time from exposure to the start of symptoms) for mpox is usually 7-14 days but can range from 3-17 days. It is recommended to monitor symptoms for up to 21 days from the day you were exposed to someone with mpox.

Most people recover in 2-4 weeks although the lesions can leave scars. The disease can be serious, especially for immunocompromised people, children, and pregnant people.

Who could get mpox?

Anyone could get mpox, but some people are at a higher risk. Mpox is primarily spread through close (skin to skin) contact. It also can be spread through respiratory droplets during prolonged face-to-face contact but does not spread through the air over longer distances. Brief interactions that do not involve physical contact and health care interactions conducted using appropriate protective equipment are generally considered low risk. Anyone who is sexually active is at risk, and risk increases with more sexual partners.

Other risk factors may include travel to areas where mpox is spreading; close, non-sexual contact with someone who is infected; or contact with sick animals. To protect yourself and others from mpox Washington State Department of Health (DOH) recommends the following measures:

Practicing safe sex and harm reduction methods such as reducing your number of sexual partners
Avoiding sexual contact with anyone who has open wounds, sores, or rashes
Avoiding other skin-to-skin contact with anyone who has open wounds, sores, or rashes, or anyone who is infected with mpox
Getting vaccinated if you meet criteria for receiving JYNNEOS
Washing hands often

What should I do if I have been exposed?

If you have had close contact with a person who has confirmed or probable mpox, getting vaccinated right away may prevent an infection. Close contact can include sexual contact, being together for several hours, hugging, cuddling, kissing, or sharing items (such as bedding, clothing, sex toys etc.).

CDC recommends that the vaccine be given within four days from the date of exposure to prevent onset of the disease. If given between four and 14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the infection. See where you can get a vaccine in your area.

You might also want to consider letting your own close contacts know that they should get vaccinated, especially if they are eligible and if they have not received 2 doses of the vaccine.

Monitor your symptoms for 21 days from the last time you had close contact with a person who has confirmed or probable mpox. If you develop a new or unexplained rash, or have other mpox symptoms, see a healthcare provider to get a test.

Contact your health care provider or your local health department for more information if you think you’ve been exposed. If you don't have a provider, find a provider.

What should I do if I think I have mpox or test positive for mpox?

If you have a new or unexplained rash and think you may have had close contact with someone who could have mpox in the last 21 days, talk to your medical provider or local clinic to find out if you should be tested, get vaccinated, or receive antiviral medication. If you don't have one, find a provider. If you already have symptoms of mpox, the mpox vaccine is not recommended.

You can spread mpox starting 4 days before you have symptoms until the rash has fully healed, which can take two to four weeks. To keep from spreading the infection, the following measures are recommended:

Separate yourself from other people and animals (mammals).
Restrict family, friends, or other visitors to those with an essential need to be in the home.
Wear a well-fitting medical mask when in close contact with others at home.
Do not let others touch your skin, especially any areas with a rash. Consider wearing disposable gloves if you have lesions on your hands and live with others.
Stay home except for getting health care. If you have a medical appointment, call the office before you go in to see if they have any special procedures for you to follow.
Keep lesions covered and remain separate until the rash is gone, all scabs have fallen off, and the skin below is healed.
Do not share bedding, towels, dishes, or utensils.
Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.
Wash your own laundry and dishes.
Routinely clean and disinfect commonly touched surfaces and items.
Have somebody else take care of animals (mammals) like pets and livestock.
Avoid use of contact lenses to prevent unintentional infection of the eye.
Avoid shaving rash-covered areas of your body.
Do not use commercial travel (airplane, bus, train/light rail, taxi, rideshare services).
Do not kiss, hug, cuddle, sleep, or have sex with others.

If you are infected with mpox and are in severe pain, or you are more likely to become severely ill, you may need antiviral treatment. Have your health care provider call your local health department for information. If you have rectal mpox symptoms, the following guidelines can help ease discomfort.

What causes mpox? How did it get to humans?

Mpox was discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. The first human case was recorded in 1970. Despite previously being named "monkeypox," the source of the disease remains unknown. However, African rodents and non-human primates (like monkeys) might harbor the virus and infect people.

We are seeing more cases of mpox now for several reasons:

The main reason is that we no longer vaccinate against smallpox. Smallpox vaccination also protected people against mpox.
Some cases of mpox in the past probably were misdiagnosed as smallpox, so we see more cases now partly due to more accurate testing.
Globally, recent cases of mpox are often linked to international travel and close, intimate/sexual contact.

Can mpox cause death?

Infections of mpox in the United States are fortunately rarely fatal.

People with weakened immune systems, children under eight years of age, people with a history of eczema, and people who are pregnant or breast/chest feeding may be more likely to get seriously ill or die.
While mpox is rarely fatal, symptoms can be extremely painful, and people might have permanent scarring resulting from the rash.

If I have mpox, do I need to stay home or go to the hospital?

If you suspect you have mpox, isolate yourself from others in a single-person room if available and immediately talk to your health care provider. Ask if you need to go to a medical office or the hospital. It is important to call as soon as you think you have symptoms of the disease because antiviral treatments may be available for those at high risk of severe illness. If you have been exposed and do not have symptoms yet, you may be able to be vaccinated. If you don't have one, find a provider.

Here are some strategies for isolating at home.

What are some examples of the mpox rash?

Mpox lesions (rash) often start as pimple-like raised bumps, which then fill with fluid. The rash eventually scabs over, and the scabs then fall off. If you have a new or unexplained rash and think you may have had close contact with someone who could have mpox in the last 21 days talk to your medical provider to find out if you should be tested. If you don't have one, find a provider.

What is a clade and should I be concerned with clade I mpox?

Monkeypox virus (MPXV), the virus that causes mpox, is a DNA virus in the genus Orthopox. There are two clades, or viral families, clade I and clade II. Clade II causes milder illness. There can be various strains within a clade. The outbreak that started in 2022 is due to Clade IIb and was primarily associated with sexual transmission. Starting in 2023, there is an ongoing outbreak of Clade I mpox in the Democratic Republic of the Congo (DRC) and transmission through sexual contact has been documented. Clade I can cause more severe symptoms of mpox. Washington state and the CDC are closely monitoring the situation should clade I transmission occur outside of the DRC and Central Africa. To date, no Clade I cases have occurred in the U.S. The best protection against all clades of mpox is getting vaccinated.

For up-to-date information on clade I mpox see CDC Current Situation.

Are mpox infections still occurring?

Yes, mpox infections are still occurring in Washington and across the United States. We are not seeing cases at the same rate we did back in 2022. The best way to protect yourself against severe mpox disease is to start and complete the 2-dose vaccination series.

No vaccine is 100% effective and some people may get mpox even after being fully vaccinated. The vaccine has been shown to prevent severe mpox disease. Getting vaccinated is still the best protection against mpox.

Testing

How do I get tested?

If you have symptoms of mpox, or have been in close contact with someone diagnosed with mpox in the last 21 days, contact a health care provider to see if you should be tested.

In addition, commercial labs are now able to test for mpox. Find a provider.

What should I expect when I get tested for mpox?

Your health care provider will swab your rash at multiple locations, and sometimes they will use multiple swabs. This can feel uncomfortable, but it is important for your health care provider to get a good sample for the test. They will then send your swabs over to a lab so that they can see if you have mpox. Most labs use PCR testing, and you should expect your results within a couple days.

While you are waiting to get your test results, it is important that you take precautions and isolate away from others. CDC has more information on how you can prevent spreading mpox.

Can physicians and other medical providers order a mpox test in Washington?

Yes. Here’s how testing currently works in our state:

People who have symptoms of mpox (including a rash on one or more parts of the body) should visit a health care provider. If the provider suspects mpox, they will swab the rash for testing. Providers may test for other conditions at the same time and may need to take other kinds of samples. If you don't have one, find a provider.
These swabs (specimens) are sent to a laboratory for testing. Specimens might go to the Washington State Public Health Lab or to other clinical labs in the area.
If a specimen tests positive, the state or local health jurisdiction will contact the patient. Public health will recommend what actions to take, including if the person needs to isolate or if they need to be assessed by a health care professional. They also will ask questions to see if any people the patient has been in close contact with need vaccination, testing, or treatment.

Treatment

What is the treatment for people with mpox?

Most people recover without treatment. Antiviral medications are available to treat mpox in specific circumstances. If symptoms have not started, post-exposure vaccination may be an option. Post-exposure vaccination can reduce symptoms or prevent symptoms.

Read more information on how to take care of yourself when diagnosed with mpox.

If you have rectal mpox symptoms, the following guidelines can help ease discomfort.

Who should be treated?

Anybody with severe pain, having widespread infection, at higher risk of getting severe illness, or experiencing infection in sensitive sites should ask their health care provider about being treated. If you don't have one, find a provider. People who are at risk for severe infection, include:

People with severe symptoms such as:
- Bleeding or infected sores
- Lesions that have merged into larger lesions
- Symptoms that require hospitalization
People with rash or lesions in the eye, mouth, throat, genitals, and anus (butthole)
People with weakened immune systems
Children under 18 years of age
People with an active skin condition/disease such as eczema or psoriasis
People who are pregnant or breast/chest feeding

Treatment can start before testing if mpox is highly suspected and there is severe infection or risk for severe infection. Your local health department may help to locate antiviral medications.

Vaccines

What vaccine is available for protection against developing mpox?

JYNNEOS vaccine is available for both prevention of mpox and post-exposure prophylaxis. JYNNEOS is safe to administer to people with HIV and eczema or other exfoliative skin conditions.

Pregnancy and breastfeeding do not disqualify you from receiving JYNNEOS. While there are no data in people who are pregnant or breastfeeding, animal data do not show evidence of reproductive harm.

Please see the Guidelines for JYNNEOS Vaccine Use (DOH) for additional guidance.

ACAM2000 is another vaccine that has been FDA approved for preventing mpox. Currently, DOH does not recommend the use of ACAM2000 as it has many contraindications.

Who should receive mpox vaccination?

You can receive mpox vaccination if any of the following apply:

You had known or suspected exposure to someone with mpox
You had a sex partner in the past two weeks who was diagnosed with mpox
You are a gay, bisexual, or other man who has sex with men or a transgender, nonbinary, or gender-diverse person who in the past six months has had any of the following:
- A new diagnosis of one or more sexually transmitted infections (STIs; e.g., chlamydia, gonorrhea, or syphilis)
- More than one sex partner
You have had any of the following in the past six months:
- Sex at a commercial sex venue (like a sex club or bathhouse)
- Sex related to a large commercial event or in a geographic area (city or county for example) where mpox virus transmission is occurring
- Sex in exchange for money or other items
You have a sex partner with any of the above risks
You anticipate experiencing any of the above scenarios, especially if you are traveling to an area with heightened mpox clade I activity.
You have HIV or other causes of immune suppression and have had recent or anticipate future risk of mpox exposure from any of the above scenarios
You work in settings where you may be exposed to mpox (e.g., through working with orthopoxviruses in a laboratory)

You are considered fully vaccinated two weeks after the second dose. Even when fully vaccinated, you should continue other safety and prevention practices such as not having skin-to-skin contact with someone who has a rash or has a confirmed or probable case of mpox.

More Information

How many doses of JYNNEOS vaccine should I receive?

JYNNEOS is administered as two doses delivered 28 days (four weeks) apart. People with moderate and severe immunosuppression should get the second dose as close to the 28-day mark as possible.

When should I get mpox vaccination?

If you are eligible to receive the vaccine, you should get vaccinated as soon as possible. You should also get the vaccine if you have been exposed to mpox. CDC recommends that JYNNEOS be given within four days from the date of exposure to prevent onset of the disease. If given between four and 14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the infection. JYNNEOS is a series of two doses given 28 days apart.

Where can I get mpox vaccination?

If you qualify, you can get vaccinated by your medical provider, pharmacy, or local health jurisdiction. If you don't have one, find a provider. JYNNEOS vaccine is a two-dose series with the first dose given as soon as possible after exposure, and the second dose given 28 days later. You should receive your second dose from the same place as your first dose.

Check and see if a Care-a-Van Event near you is offering JYNNEOS.

Should I get the vaccine if I was exposed to mpox and developed symptoms?

No, there is no known benefit for offering vaccination once someone has developed symptoms of mpox. People who have developed symptoms of mpox should see a health care provider to get tested. The health care provider might also recommend antiviral treatment depending on the individual situation.

When am I fully protected after vaccination?

A person is fully protected two weeks after the second dose is administered. People who get vaccinated should continue to take steps to protect themselves from infection by avoiding close, skin-to-skin contact, including intimate contact, with someone who has mpox and get tested if they develop any mpox symptoms.

No vaccine is 100% effective and some people may get mpox even after being fully vaccinated. The vaccine has been shown to prevent severe mpox disease in those who do test positive after being fully vaccinated. Receiving 2 doses of JYNNEOS continues to be the best protection against all known types of mpox.

Is the vaccine safe?

JYNNEOS is fully licensed by the U.S. Food and Drug Administration (FDA) and recommended by the CDC’s Advisory Committee on Immunization Practices for prevention of mpox. Ongoing safety monitoring occurs even after licensing.

Adverse reactions after JYNNEOS include injection site reactions such as pain, swelling, and redness. Fatigue, headache, and muscle pain were the most common systemic reactions observed after receiving JYNNEOS in a clinical trial.

Adverse events that occur in a recipient following mpox or smallpox vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS). Reporting is encouraged for any clinically significant adverse event, even if it is uncertain whether the vaccine caused the event. Vaccine administration errors can be reported whether or not associated with an adverse event. Information on how to submit a report to VAERS is available online or by calling 1-800-822-7967.

Can I get JYNNEOS at the same time as other vaccines?

JYNNEOS may be given at the same time as other vaccines. Certain people at increased risk of a condition called myocarditis (swelling of the heart muscle), including adolescents or young adult males, might consider waiting four weeks after JYNNEOS vaccination before getting an mRNA COVID-19 vaccine.

Does the COVID-19 vaccine work against mpox?

No. Vaccines work differently depending on the virus they are targeting. The COVID-19 vaccine was developed to help prevent serious illness and death from COVID-19. It does not prevent any other disease, like flu or mpox. Only the licensed mpox and smallpox vaccinations work against mpox infection.

Should health care professionals get vaccinated?

Health care professionals who do not perform diagnostic testing for mpox are not recommended to receive vaccination.

Can I travel out of country without the mpox vaccination?

There are no travel restrictions or requirement for the mpox vaccine to travel. However, many countries require other vaccines before you travel, so check with your local health department or your health care provider before traveling internationally to make sure you have all the vaccines you need. If you don't have one, find a provider.

Does the vaccine leave a scar?

JYNNEOS is not given to you through scarification (percutaneous route). JYNNEOS can be given to you through 2 different ways. One way is an injection between the muscle and the skin (subcutaneous route) on your upper arm.

The other way is an injection into your skin which can cause a temporary bubble to form (intradermal route). This can be given to you on the inner part of your forearm, your upper back, or your upper arm. This way was commonly used in 2022 to extend the number of doses that could be administered when there was a lot of demand for vaccine.

Now that there is an adequate supply of JYNNEOS, you can receive the JYNNEOS vaccine through either one of these ways. The choice is yours. Children under the age of 18 can only receive JYNNEOS as an injection between the muscle and the skin (subcutaneous route).

Scarification is used for the smallpox vaccine and not JYNNEOS.

I have already received 2 doses of JYNNEOS. Do I need to get a booster dose?

The CDC currently does not recommend booster doses for the general population. The CDC will continue to monitor JYNNEOS vaccination data.

Is the JYNNEOS vaccine effective against clade I mpox?

Yes, JYNNEOS has been shown to be effective against clade I mpox. Vaccination with 2 doses of JYNNEOS still remains the best protection against all known clades of mpox.

Can I still get mpox after being vaccinated?

No vaccine is 100% effective and some people may get mpox even after being fully vaccinated. The vaccine has been shown to prevent severe mpox disease in those who do test positive after being fully vaccinated. Receiving 2 doses of JYNNEOS continue to be the best protection against all known types of mpox.

Why is the mpox vaccine (JYNNEOS) going commercial?

The maker of the mpox vaccine, Bavarian Nordic (BN), collaborated with the federal government to create JYNNEOS, a vaccine used to prevent smallpox. Smallpox is a significant national security threat. The company also obtained FDA approval for JYNNEOS to be used commercially as a way to prevent mpox. Since the U.S. Government supply is intended for use in a smallpox emergency, having JYNNEOS commercially available is beneficial for both national security and U.S. taxpayers.

Can I still get the mpox vaccine (JYNNEOS) free of charge?

The Washington State Department of Health (DOH) anticipates that most private and public insurance programs will cover JYNNEOS, the mpox vaccine. The Affordable Care Act (ACA) requires insurance companies to cover recommended vaccines, including JYNNEOS. The Inflation Reduction Act (IRA) guarantees coverage of recommended vaccines for adults enrolled in Medicaid (Apple Health) and Medicare Part D. The Childhood Vaccine Program (CVP) has also announced that they will cover JYNNEOS for those who are 18 years of age starting late summer 2024. The Early Intervention Program (EIP) and the PrEP Drug Assistance Program (PrEP DAP) also covers JYNNEOS for those who are eligible for those programs.

DOH is also exploring additional coverage options as we continue to ensure equitable access to the JYNNEOS vaccine.

How much will getting vaccinated cost me?

If you are eligible to receive the JYNNEOS vaccine, our goal is that there will be no cost associated with getting vaccinated. We anticipate that most private and public insurance programs will cover JYNNEOS, the mpox vaccine. Community health clinics also offer immunizations for low to no cost. Here is where you can find an immunization provider. Be sure to call ahead and learn more about associated fees. JYNNEOS is also offered at Care-A-Van immunization clinics free of charge, see here for an mpox vaccine clinic near you. The Early Intervention Program (EIP) and the PrEP Drug Assistance Program (PrEP DAP) also covers JYNNEOS for those who are eligible for those programs. Without insurance one dose of the JYNNEOS vaccine can cost up to $280.

What is available to help me pay for the vaccine if I can't afford it?

The Early Intervention Program (EIP) and the PrEP Drug Assistance Program (PrEP DAP) covers any associated cost for JYNNEOS for those who are eligible for those programs. DOH is exploring additional options to increase equitable, accessibility of the vaccine. We will provide updates if more options for JYNNEOS vaccine coverage become available.

Does the state/DOH still supply the mpox vaccine (JYNNEOS)?

On April 30, 2024, the federal government closed the current process for obtaining JYNNEOS from the strategic national stockpile, and DOH is no longer able to process orders through this mechanism. Providers will need to get JYNNEOS on the commercial market to offer to patients.

Providers are able to access JYNNEOS vaccine for individuals recommended who are 18 years of age through the state Childhood Vaccine Program (CVP). DOH will continue working with federal partners to understand availability of public sector JYNNEOS vaccine.

Is there any change to the formulation or dosage of the vaccine now that it's commercially available?

There are no changes to the JYNNEOS formulation or dosage now that it is commercially available. The CDC has more information about the formulation and dosage of JYNNEOS.

What other vaccines could I get that would support my sexual health?

There are a variety of immunizations that can also be used to support your sexual health. Human papilloma virus (HPV) is the virus that causes genital warts and can be transmitted through skin-to-skin contact which often happens during sex. HPV can also cause cervical, anorectal, and oral/throat cancers. Consider starting or finishing your HPV vaccine series to lower your risk of developing warts and HPV-related cancers.

Hepatitis A virus is a virus that can cause severe liver disease and can be transmitted fecal-orally, which can sometimes occur during sex. Check with your provider to see if you need to start your Hepatitis A series or receive a Hepatitis A booster shot. Hepatitis B virus is another virus that can cause severe liver disease and can be transmitted when bodily fluids (like blood and semen) from one person enters the body of another. This can occur during sex. Check with your provider to see if you need to start your Hepatitis B series or need a Hepatitis B booster shot. There is also an option to get vaccinated and boosted with a vaccine for both Hepatitis A virus and Hepatitis B virus to lower your risk of becoming infected with both Hepatitis A virus and Hepatitis B virus. Ask your provider about your vaccine options.

Meningococcal bacteria are a bacterium that causes meningitis, which is an infection that affects the brain and spinal cord. Meningococcal bacteria are transmitted through lengthy contact of respiratory and throat secretions (like saliva), which occurs when kissing during sex or intimate contact. Consider getting boosted or starting your meningococcal vaccine series to lower your risk of developing meningitis.

For more information on adult immunization schedule and to learn more about adult immunizations please visit the CDC’s website.

For Health Care Providers

What are the clinical features of mpox? What does the rash look like?

See the CDC Clinical Recognition webpage for information on diagnosing mpox disease, including photos of rashes.

Is there a lab test to determine if my patient has mpox?

Yes, an mpox infection is typically diagnosed through a PCR test performed on a swab of a lesion. Testing is available at commercial, academic clinical laboratories and the Washington State Public Health Laboratories (WSPHL). Testing by WSPHL requires approval from the patient’s local health jurisdiction.

If you have a patient who has clinically compatible signs of mpox and who had recent travel to central Africa (or other area with ongoing clade I mpox transmission) and/or contact with a confirmed clade I case, mpox testing with clade determination is recommended. WSPHL has mpox testing with clade determination available as well as academic and some commercial laboratories. Please call your local health jurisdiction if you suspect a clade I mpox in a patient.

If I am testing a patient for mpox, what other testing and treatment should I consider?

Most people who receive mpox testing should also be tested for HIV and other STIs (e.g., syphilis, gonorrhea, chlamydia). Many people who receive mpox testing would also benefit from HIV pre-exposure prophylaxis (PrEP) and the use of doxycycline as post-exposure prophylaxis (doxy PEP).

What PPE should be used for health care personnel who enter the room of a person with suspected or confirmed mpox?

According to the CDC, health care personnel should use a gown, gloves, eye protection, and a NIOSH-approved particulate respirator equipped with N95 filters or higher.

What should I do if I suspect that my patient might have clade I mpox?

If your patient has clinically compatible signs of mpox and has had recent travel to an area with ongoing clade I mpox transmission and/or has had contact with a confirmed case of clade I mpox, you should suspect clade I mpox.

Immediately contact your local health jurisdiction. They can help with connecting you to mpox testing with clade determination.

For up-to-date information on clade I mpox see CDC Current Situation.

I diagnosed my patient with another infection (e.g., syphilis, gonorrhea, chlamydia). Can I assume that they don't have mpox?

Co-infections with mpox and STIs have been reported, so the presence of an STI does not rule out mpox infection. If the patient’s clinical presentation is compatible with mpox disease, you should still consider mpox testing regardless of your patient’s vaccination status. See CDC guidance for further information: See CDC clinical overview for further information.

Where and how can we get the vaccine?

As of April 1, Bavarian Nordic launched the private sector sale of JYNNEOS vaccine. On April 30, 2024, the federal government closed the current process for obtaining JYNNEOS from the strategic national stockpile, and DOH is no longer able to process orders through this mechanism. Providers will need to get JYNNEOS on the commercial market to offer to patients.After April 30th, providers will need to procure JYNNEOS on the commercial market.

Providers are able to access JYNNEOS vaccine for individuals recommended who are 18 years of age through the state Childhood Vaccine Program (CVP). Additional options are being explored as ways to increase equitable accessibility of the vaccine. We will provide updates if more options for JYNNEOS vaccine access become available.

When is someone with mpox contagious?

It is possible that people with an mpox infection might be contagious prior to symptom onset, or even if they have an entirely asymptomatic infection. A person with mpox is considered to be contagious from four days before the first symptom began until all the scabs have fallen off and a fresh layer of intact skin has formed.

Who is at higher risk for severe mpox?

According to the CDC, people who are at risk for severe infection include the following:

People with severe symptoms such as:
- Bleeding or infected sores
- Lesions that have merged into larger lesions
- Symptoms that require hospitalization
People with rash or lesions in the eye, mouth, throat, genitals, and anus (butthole)
People with weakened immune systems
Children under 18 years of age
People with an active skin condition/disease such as eczema, psoriasis, or atopic dermatitis
People who are pregnant or breast/chest feeding

Providers should strongly consider antiviral treatment for these populations; see CDC treatment guidance for more information.

What are the clinical considerations for people living with HIV?

According to the CDC, people with HIV-associated immunosuppression or people with HIV who are not virologically suppressed can be at increased risk of severe mpox disease. See CDC clinical considerations for people living with HIV for more information on treatment and prophylaxis for mpox in people living with HIV.

Which medications can be given to treat mpox?

The medication most commonly used is tecovirimat (TPOXX), which is approved for smallpox and is available for treatment of mpox under an expanded access investigational new drug protocol.

TPOXX remains available under the CDC-held expanded access Investigational New Drug (EA-IND) protocol. Healthcare workers and medical facilities need to enroll in the TPOXX IND Registry in order to prescribe TPOXX through the EA-IND protocol. Request a consultation with CDC Emergency Operations at 770-488-7100 if you have a patient who requires oral or intravenous (IV) TPOXX or who is in an urgent clinical situation.

When considering the use of tecovirimat, clinicians and patients should understand 1) the lack of data on tecovirimat effectiveness in people with mpox, 2) the lack of data indicating which patients might benefit the most from tecovirimat, and 3) the concern for resistance to tecovirimat, which could render the drug ineffective for any treated patients. Initial analysis of data from two randomized control trials (PALM007 and STOMP) showed that tecovirimat was safe, but that it did not reduce the time to resolution of mpox lesions in those who received tecovirimat compared to those who received placebo. These findings suggest that most people with mild symptoms of mpox will recover with supportive care and pain management. Future studies need to determine whether tecovirimat is an effective treatment for patients with severe disease and immunocompromising conditions

For patients who do not meet EA-IND eligibility criteria, supportive care and pain management will help most patients with mpox recover.

What are the clinical considerations for pain management for people with mpox?

The CDC provides detailed information about pain control including treatments for specific symptoms and lesion sites.

What should I do if my patient tests positive for clade I mpox?

You should immediately notify your local health jurisdiction if your patient tests positive for clade I mpox.

The clinical features, infection control and prevention measures, and clinical management for someone with clade I mpox remains the same for clade II mpox. Historically, clade I mpox does lead to more severe disease outcomes. There is evidence that clade I mpox is more transmissible, and potentially more severe, with case fatality rates reported up to 10%. However, initial analyses from the ongoing clade I outbreak in the Democratic Republic of the Congo indicate that people with clade I mpox who are provided high-quality supportive care have a significantly lower mortality than those who were not connected to care.

For up-to-date information on clade I mpox see CDC Current Situation.

What should I do if my patient might have been exposed to someone with mpox?

Contact your local health jurisdiction, who can help assess the exposure and determine if post-exposure prophylaxis (vaccination) is recommended. CDC recommends post-exposure prophylaxis be given within four days from the date of exposure in order to prevent onset of the disease. If given between 4-14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.

If the patient is asymptomatic, counsel the patient about the symptoms of mpox, as well as the need to isolate and contact a health care provider if symptoms occur. If the patient is symptomatic, evaluate the patient for mpox, and consider mpox testing. If you decide to proceed with mpox testing, advise the patient to isolate at home while the test is pending.

What should I tell a patient with mpox about the expected course of illness?

The clinical course of mpox is variable. Counsel the patient about potential complications and reasons to seek follow-up care. The duration of symptoms and the contagious period also vary; usually the contagious period lasts for two to four weeks. People with mpox are no longer contagious when all the scabs on the skin have fallen off and a fresh layer of intact skin has formed underneath. CDC provides more information on the clinical course of illness.

What advice should I give my patient with mpox about reducing the risk of transmission to others?

CDC provides detailed information on reducing the risk of transmission including steps that people with mpox can take, how long they need to isolate, and prevention measures for their home.

Where can I find information on infection control for mpox in health care settings?

CDC provides detailed information on infection control including patient placement, PPE, waste management, environmental infection control steps, and other topics.

Where can I find more clinical guidance on mpox?

Please visit CDC mpox website for any additional, up-to-date clinical guidance.

Where can I find more information available about mpox and pets/animals?

We are still learning which species of animals can be infected with mpox. However, it is possible that people with mpox could transmit to animals. Patients with mpox should be advised to avoid contact with mammals. See the Washington State Guidelines on Mpox in Animals for more information.