Monkeypox for Healthcare Providers

Overview

NYSDOH continues to provide the guidance, resources, and infrastructure needed for healthcare providers in New York to have the information on case reporting, testing, treatment, and vaccination to care for New Yorkers with suspected or confirmed monkeypox. The latest guidance for healthcare providers is here.

Reporting

Healthcare providers must immediately report suspected cases of monkeypox to the local county health department (LHD) in the county in which the patient resides:

  • New York City residents suspected of monkeypox infection should be reported to the New York City Department of Health and Mental Hygiene (NYCDOHMH) Provider Access Line (PAL) at 866-692-3641.
  • Contact information for reporting New York State residents who reside in counties outside of New York City is available here.

If you are unable to reach the LHD where the patient resides, please contact the NYSDOH Bureau of Communicable Disease Control at: 518-473-4439 during business hours (Monday—Friday, 9AM – 5PM) or 866-881-2809 evenings (after 5PM), weekends, and holidays.

Testing

Patients with rashes initially considered characteristic of more common infections (e.g., varicella zoster or sexually transmitted infections) should be carefully evaluated for a characteristic monkeypox rash (see main page for images). Submissions of specimens of lesions should be considered, especially if the person has epidemiologic risk factors for monkeypox infection.

Testing for orthopoxvirus is currently available at several laboratories, including but not limited to commercial and public health laboratories (NYSDOH Wadsworth Center Laboratory and the New York City Public Health Laboratory). The process for testing is in accordance with CDC guidance and based on the testing process that CDC has laid out nationwide. Additional directions for ensuring adequate collection of a lesion specimen are available from CDC here.

NYSDOH Wadsworth Center has released streamlined guidance for the validation of molecular detection assays for orthopoxvirus and/or monkeypox virus. This guidance, available here, is available for clinical laboratories that have a Clinical Laboratory Evaluation Program (CLEP) permit and are interested in building this capability.

Laboratories

Testing for orthopoxvirus is available at the following commercial laboratories:

  • Aegis Sciences Corporation1 (PFI 9512)
  • Applied DNA Clinical Labs, LLC3 (PFI 9546)
  • ARUP2 (PFI 4196)
  • Columbia University Laboratory4 (PFI 7313)
  • Erie County Public Health Laboratory1(PFI 1980)
  • LabCorp1 (PFI 2502)
  • LabQ Clinical Diagnostics3 (PFI 8120)
  • Mayo Clinic1 (PFI 3263 and PFI 8221)
  • Mirimus, Inc.3 (PFI 9532)
  • Montefiore Medical Center3 (PFI 2465)
  • Mount Sinai Laboratory3 (PFI 5227)
  • Northwell Health Laboratories 3 (PFI 4197)
  • NYU Langone Hospitals – Tisch Hospital Clinical Labs3 (PFI 5153)
  • Quest Diagnostics Nichols Institute; Juan Capistrano, CA2 (PFI 2478)
  • Quest Diagnostics Nichols Institute; Chantilly, VA2 (PFI 3745)
  • Sonic Healthcare1 (PFI 8922)
  • UNITEC Laboratories Inc3 (PFI 9039)
  • UR Medicine Labs2 (PFI 8305)
  1. FDA-cleared assay for orthopoxvirus
  2. Orthopoxvirus and monkeypox virus laboratory developed test
  3. Monkeypox virus laboratory developed test
  4. Non-variola orthopoxvirus laboratory developed test

Questions about testing at these facilities should be directed to the appropriate laboratory. Contact information for laboratories can be found by searching the laboratory PFI number here.

Public Health Laboratories

Testing for orthopoxvirus, the family of viruses to which monkeypox belongs to, is available at NYSDOH Wadsworth Center Laboratory and the New York City Public Health Laboratory. Specimen collection and submission in NYS (outside of NYC) must be coordinated with the LHD and/or NYSDOH.

Instructions and details regarding specimen collection and submission in New York City (NYC) can be foundhere.

NYSDOH Wadsworth Center will accept specimens collected and transported in viral transport media (VTM) OR collected and transported dry. Specimens in VTM can be tested for orthopoxvirus, varicella zoster virus, and herpes simplex viruses I and II. Specimens collected dry can only be tested for orthopoxviruses. Testing for other viruses should be done locally. Additional instructions and details regarding specimen collection and submission to the NYSDOH Wadsworth Center can be found here.

Vaccination

JYNNEOS (aka: IMVANEX, IMAVUNE)

New York State is currently offering the JYNNEOS vaccine as a 2-dose series for the prevention of monkeypox among adults ages 18 years and older. As vaccine supply becomes available from the federal government, NYSDOH continues to roll-out the JYNNEOS vaccine using a phased approach, in accordance with CDC guidance. Vaccine resources for providers are listed here:

NYCDOHMH receives vaccine directly from the federal government, which they distribute directly within their jurisdiction. For more information on NYCDOHMH's program in New York City, please visit the page here or contact NYCDOHMH directly.

Treatment

Monkeypox Provider Treatment Network

If you have diagnosed a patient with monkeypox, you may refer them to one of these MPV provider treatment network sites (outside of NYC) to be evaluated for potential treatment.

Mild to Moderate Disease

For those with mild to moderate disease, at low risk for severe disease, treatment includes:

  • Supportive care including fluids and wound hygiene/care
  • Analgesics as needed
  • Topical or aerosolized diphenhydramine (Benadryl) or lidocaine for lesion associated pruritus and pain respectively

Supportive Care

This first level of care includes the maintenance of fluids, pain management, treatment of bacterial superinfections of skin lesions, and treatment of any possible co-occurring sexually transmitted or superimposed bacterial skin infections.

Skin lesions should be kept clean and dry to prevent further secondary infection. Pruritus can be treated with an oral antihistamines and topical agents such as calamine lotion, cortisone 10, or petroleum jelly. For oral lesions, prescription medicated mouthwashes can be used to manage pain. Oral antiseptics are helpful in keeping lesions clean. Topical gels such as benzocaine/lidocaine can be used for temporary relief, while eating and drinking.

Proctitis can occur with or without lesions and is often manageable with supportive care, stool softeners may be beneficial. Topical gels such as benzocaine/lidocaine can be used for temporary relief as well. Sitz baths can also be used for proctitis. Pain management may be beneficial utilizing over-the-counter medication such as acetaminophen or prescription medications (narcotics risk constipation). Additionally, proctitis may cause rectal bleeding, which should be evaluated by a healthcare provider. Nausea and vomiting can be controlled with the use of anti-emetic as deemed appropriate. Diarrhea should be managed through proper hydration and electrolyte replacement.

Moderate to Severe Disease

Infection Control Guidelines

Standard precautions should be applied for all patient care, including for patients with suspected monkeypox. If a patient seeking care is suspected to have monkeypox, infection prevention and control personnel should be notified immediately. Activities that could resuspend dried materials from lesions, e.g., use of portable fans, dry dusting, sweeping, or vacuuming should be avoided.

Additional guidance on environmental infection control can be found at the links below:

Provider Webinars

NYSDOH continues to host a series of webinars for healthcare providers to provide a situational update on the evolving monkeypox outbreak in New York City and New York State. We invite you to join NYSDOH's Dr. Eugene Heslin as we discuss this evolving monkeypox outbreak affecting New Yorkers as well as the ongoing NYSDOH and NYCDOHMH response.