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Monkeypox virus infection

Key sources
The following summarized guidelines for the evaluation and management of monkeypox virus infection are prepared by our editorial team based on guidelines from the World Health Organization (WHO 2022) and the Center for Disease Control (CDC 2022; 2021; 2019).


1.Screening and diagnosis

Epidemiology: view one case of monkeypox virus infection as an outbreak.
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  • Case definition

  • Indications for testing

  • Differential diagnosis

2.Diagnostic investigations

Initial evaluation: obtain the following in patients with monkeypox virus infection:
clinical examination using appropriate infection prevention and control measures
asking about possible sources of infection and the presence of similar illnesses in the patient's community and contacts (both backward to identify the source and forward contact tracing to reduce onward transmission)
collecting and dispatching specimens for monkeypox laboratory examination
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  • Specimen collection

  • Specimen handling

  • Laboratory testing (safety measures)

  • Laboratory testing (NAAT)

  • Laboratory testing (serology)

  • Laboratory testing (electron microscopy)

  • Laboratory testing (viral culture)

  • Laboratory testing (interpretation)

3.Medical management

Specific treatment: recognize that at this time there are no specific treatments available for monkeypox infection, but monkeypox outbreaks can be controlled using the smallpox vaccine, cidofovir, tecovirimat, and vaccinia immune globulin.
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4.Preventative measures

Vaccination in high-risk groups: as per CDC 2022 guidelines, administer pre-exposure prophylaxis against orthopoxviruses with either JYNNEOS or ACAM2000 in persons at risk for occupational exposure to orthopoxviruses (such as research laboratory personnel working with orthopoxviruses, clinical laboratory personnel performing diagnostic testing for orthopoxviruses, designated response team members, and healthcare personnel administering ACAM2000 or caring for patients infected with orthopoxviruses).
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  • Post-exposure vaccination

5.Follow-up and surveillance

Contact tracing: initiate contact tracing to control the spread of the monkeypox virus to allow the interruption of transmission and help people at a higher risk of developing severe disease to more quickly identify their exposure. Interview case-patients to elicit the names and contact information of all such persons. Notify contacts within 24 hours of identification.
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6.Quality improvement

Networking and reporting
As per CDC 2022 guidelines:
Report possible human cases of monkeypox to the local hospital epidemiologist and/or infection control personnel, the state health department, and the national center for disease control and prevention.
Consult with the state epidemiologist, state health laboratory, and the national center for disease control and prevention before sending specimens to the center for disease control and prevention.