Mpox for Healthcare Providers
Overview
NYSDOH provides guidance, resources, and infrastructure on case reporting, testing, vaccination, treatment, and infection control for healthcare providers to care for New Yorkers with suspected or confirmed mpox. The latest guidance for healthcare providers is here.
Case Reporting
Healthcare providers must immediately report suspected cases of mpox. (Mpox Case Definitions) to the local county health department (LHD) in the county in which the patient resides:
- In New York City, report suspected cases to the New York City Department of Health and Mental Hygiene at 866-692-3641.
- In New York State outside of New York City, contact the local health department where the patient resides.
If you are unable to reach the local health department where the patient resides, please contact the New York State Department of Health Office of Sexual Health and Epidemiology at: 518-474-3598 during business hours (Monday—Friday, 9AM – 5PM) or 866-881-2809 evenings (after 5PM), weekends, and holidays.
Testing
Providers should be alert for patients who present with rashes/lesions consistent with mpox. (See Mpox rash images). Mpox testing should be considered, especially if the person has risk factors for mpox infection.
Testing for mpox is currently available at numerous approved clinical laboratories, including but not limited to those listed below:
- New York City Public Health Laboratory (Read instructions for submitting specimens in NYC)
- New York State Department of Health Wadsworth Center Laboratory (Read instructions for submitting specimens to Wadsworth)
- Erie County Public Health Laboratory
- Westchester County Department of Laboratories and Research
The process for testing is in accordance with guidance from the Centers for Disease Control and Prevention.
Instructions and details regarding specimen collection and submission in New York City (NYC) can be found here.
Additional instructions and details regarding specimen collection and submission to the New York State Wadsworth Center can be found here.
Contact your routine reference laboratory for specific specimen submission procedures for mpox testing, or contact your local health department for further guidance. Contact the Wadsworth Center for any additional questions related to mpox testing (wcid@health.ny.gov).
Vaccination
Any New Yorker at risk for mpox is eligible for the two-dose JYNNEOS vaccine (aka: IMVANEX, IMAVUNE).
New York State has access to a sufficient supply of JYNNEOS vaccine to distribute to interested New York State healthcare providers.
Get Your Supply of JYNNEOS Vaccine:
- In New York City, more information can be found here or by emailing poxvax@health.nyc.gov.
- Outside of New York City, contact mpox@health.ny.gov.
Vaccine Resources for Healthcare Providers:
- Provider Agreement for Vaccine During Emergencies
- JYNNEOS Vaccine Guidance (Also available in Spanish)
- Storage and Transport Guidance for JYNNEOS Vaccine
- JYNNEOS Vaccine Screening Checklist (Also available in Spanish)
- Screening and consent form (Also available in Spanish)
- What to Expect After Your Vaccine (PDF) (Also available in Spanish)
- Standing Order Templates:
- New York State Department of Health: Subcutaneous | Intradermal
- CDC: Subcutaneous | Intradermal
- JYNNEOS subcutaneous and intradermal training for vaccinators
Treatment
Mild to Moderate Disease
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.
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 includes:
- Keeping skin lesions clean and dry to prevent further secondary infection (Oral antiseptics help keep lesions clean; Topical gels such as benzocaine/lidocaine can be used for temporary relief, while eating and drinking).
- Treating pruritus with oral antihistamines and topical agents (e.g., calamine lotion, cortisone 10, or petroleum jelly).
- Prescribing medicated mouthwashes for oral lesions to manage pain.
- Recommending stool softeners and sitz baths to help manage proctitis which can occur with or without lesions.
- Managing pain with medications such as acetaminophen or prescription medications (narcotics risk constipation).
- Managing nausea and vomiting with anti-emetics, and diarrhea with proper hydration and electrolyte replacement.
Moderate to Severe Disease
Currently no treatments are approved specifically for mpox. However, multiple agents have been developed for smallpox, which may be beneficial in treating mpox. These include:
- Tecovirimat (TPOXX) – information on obtaining and using TPOXX for the treatment of mpox can be found here
- Vaccinia Immune Globulin Intravenous (VIGIV)
- Cidofovir (Vistide)
- Brincidofovir (CMX001 or Tembexa)
Treatment with Tecovirimat (TPOXX)
Providers caring for a patient diagnosed with mpox have the following options to refer them for Treatment with tecovirimat/TPOXX:
- STOMP – Study of Tecovirimat for Mpox: More information available here
- Mpox Provider Treatment Network:If you have diagnosed a patient with mpox, you may refer them to one of these mpox provider treatment network sites (outside of NYC) to be evaluated for potential treatment.
- TPOXX – More information on obtaining tecovirimat/TPOXX from the Centers for Disease Control and Prevention is available here.
Infection Control
- If you suspect a patient has mpox, immediately notify infection prevention and control personnel.
- Apply standard precautions for all patient care, including for patients with suspected mpox.
- Place patients with suspected or confirmed mpox in a single-person room - special air handling is not required. Keep door closed if safe to do so.
- Healthcare workers who enter the patient's room should use gowns, gloves, eye protection. (e.g., goggles or a face shield that covers the front and sides of the face), and a respirator (e.g., N95 or higher).
- Perform procedures likely to spread oral secretions in an airborne infection isolation room.
- Avoid activities that could resuspend dried materials from lesions (e.g., portable fans, dry dusting, sweeping, or vacuuming).
Standard cleaning and disinfection procedures should be done using an EPA-registered hospital-grade disinfectant with an emerging viral pathogen claim.
Detailed guidance on infection prevention and control:
- Healthcare Delivery Settings (Spanish version)
- Non-Healthcare Congregate Settings (Spanish version)
- CDC Infection Prevention and Control of Mpox in Healthcare Settings
Detailed guidance on environmental infection control:
- Handling Soiled Laundry
- Disinfectants for Emerging Viral Pathogens (EVPs): List Q
- CDC Guidelines for Environmental Infection Control in Health-Care Facilities
- Guidance on Packaging and Treatment of Mpox Medical Waste
Provider Webinars
- NYSDOH & NYCDOHMH June 2023 Virtual Briefing for Elected Officials - Video, Slides (PDF)
- May 9, 2023 Healthcare Provider Update Webinar - Video, Slides (PDF)
- Mpox/MPV Vaccination and Care for Adolescents: Access and Best Practices - Video, Slides (PDF)
- Part IV: August 25, 2022 - Video, Slides (PDF)
- Part III: August 4, 2022 - Video, Slides (PDF)
- Part II: July 21, 2022 - Video
- Part I: July 14, 2022 - Video, Slides (PDF)
Additional Provider Resources:
New York State Provider Resources
- Update on Commercialization of JYNNEOS Vaccine – March 28, 2024 (PDF)
- Health Advisory - November 27, 2023 (PDF)
- Health Advisory - June 13, 2023 (PDF)
- Health Advisory - May 1, 2023 (PDF)
- Dear Colleague Letter - March 23, 2023 (PDF)
- Symptomatic/Asymptomatic Guidance for HC Workers (PDF). Also available in Spanish (PDF)
- Guidance for EMS Professionals on Suspected Cases of Mpox (PDF)
- NYSDOH Health Alert Notice for providers in New York State - July 8, 2022 (PDF)
- NYSDOH Health Alert Notice for providers in New York State - June 17, 2022 (PDF)
- NYSDOH Health Alert Notice for providers in New York State - May 22, 2022 (PDF)
CDC Resources
- Interim Clinical Considerations for Use of JYNNEOS and ACAM2000 Vaccines during the 2022 U.S. Mpox Outbreak
- JYNNEOS Smallpox and Mpox Vaccine Intradermal Vaccine Preparation and Administration Summary: ALTERNATIVE DOSING REGIMEN (PDF)
- Safer Sex, Social Gatherings, and Mpox
- Case Definitions for Clinicians