Outbreak of Mpox in King County

Actions requested

• Be aware of a recent increase in mpox cases in King County, including among previously vaccinated individuals. In 2023, constant, low numbers of mpox cases continue to be reported in the United States.
• Continue to recommend vaccination with a complete 2-dose series of JYNNEOS for people at greater risk for mpox infection.
• Vaccination against mpox remains an important risk-reduction measure.
• People who previously received only one JYNNEOS vaccine dose should receive a second dose as soon as possible.
• People who develop mpox after completing a two-dose JYNNEOS vaccine series may experience less severe symptoms than those who have not completed the vaccine series.
• Avoid conducting extensive risk assessment in people who request vaccination to avoid stigma and other barriers experienced by those who could benefit from vaccine
• Mpox vaccine may also be given as post-exposure prophylaxis (PEP) to people who are not already fully vaccinated and who have not already had mpox who present with known or presumed exposure to mpox virus. As PEP, vaccine should be given as soon as possible, ideally within 4 days of exposure but administration 4–14 days after exposure may still provide some protection against mpox
• Additional vaccine administration considerations for specific populations are available on the CDC website
• Refamiliarize yourself with mpox symptoms, specimen collection, laboratory procedures, and treatment options
• Consider mpox when determining the cause of a diffuse or localized rash, including patients who were previously infected with mpox or vaccinated against mpox
• Details noted in patient history, including sexual history may identify possible mpox exposures or epidemiological risk factors
• Perform a complete physical examination, including a thorough skin and mucosal (e.g., oral, genital, anal) examination which may reveal lesions of which the patient was unaware
• Mpox may present with milder symptoms in those who were previously vaccinated. Lesions can be few and isolated, pain or discomfort in the throat or rectum can occur with or without classic lesions, and fevers can be absent.
• Patients benefit from individually tailored supportive care and pain management strategies
• Continue to consider tecovirimat (also known as TPOXX or ST-246) as first-line therapy for  patients with especially among those with severe complications, severe disease or who are at high risk for severe disease.
• Encourage patient enrollment both in person and remotely into the STOMP STUDY for recently diagnosed and symptomatic mpox patients. This study evaluates effectiveness and safety of oral tecovirimat, through the UW Positive Research at Harborview Medical Center.

• Counsel at risk patients about how to reduce the risk of mpox transmission, which often occurs through close, sustained physical contact, almost exclusively associated with sexual contact in the current outbreak.