On November 17, 2022, the CDC released Health Update, Managing Monkeypox in Patients Receiving Therapeutics. While cases rates have declined, new cases continue to be identified, including persons experiencing serious disease. Two cases of laboratory-confirmed tecovirimat resistance have been identified nationally; these were both in individuals with immunocompromising conditions with severe manifestations of MPX who were treated with prolonged (>14days) courses of tecovirimat. The CDC guidance highlights that cidofovir, brincidofovir, and vaccinia immune globulin intravenous (VIGIV) each can be administered concurrently with tecovirimat for certain patients with (or at high risk for) severe monkeypox. Providers should continue to test for MPX as well as HIV and sexually transmitted infections in every sexually active person with suspected MPX.

To date, Orange County has reported 292 cases of MPX with 5% of cases requiring hospitalization. Paralleling the national trend, five cases have been identified in the county in the last three weeks.

Providers should continue to test for monkeypox testing in patients who have compatible illness. Testing continues to be available through most commercial laboratories.

CDC’s Interim Clinical Guidance on the Treatment of Monkeypox provides information on available therapeutics, including tecovirimat, as well as providing guidance on the management of severe disease. Tecovirimat can be accessed locally from OCHCA following the guidance available here.

JYNNEOS vaccine is available through the county for MPX post-exposure prophylaxis (PEP) and for those at risk for MPX. Those considered at risk include the following:

• Any man or trans person who has sex with men or trans persons
• Any man or trans person who is taking or is eligible for HIV PrEP
• Anyone living with HIV, particularly those with a CD4 count <350/mm3, an unsuppressed HIV viral load, or an opportunistic infection
• People who have had any of the following in the past 6 months:
• Sex at a commercial sex venue
• Sex in association with a large public event in a geographic area where MPX transmission is occurring
• Sexual partners of people with the above risks
• People who anticipate experiencing the above risks, including individuals with multiple sex partners
• Health Care Workers who are likely to collect laboratory specimens from persons with MPX (e.g., persons working in sexual health clinics or clinical settings that serve at risk populations)

Patients who are eligible for JYNNEOS vaccination can be referred to https://othena.com/ to schedule an appointment.