Monkeypox Information for Healthcare Providers

Testing

As most cases of monkeypox resolve without treatment and are not severe, referral for testing to local emergency departments/urgent care centers is not usually necessary. Please see the SURV alert from 7/13/2022 for more details on testing options.

Please note: the phone number listed in the SURV alert is for provider use only. You may refer patients to the Maricopa County Department of Public Health (MCDPH) CARES Team at 602-506-6767.

Some cases seen in the 2022 outbreak have an atypical presentation, so have a low threshold for testing when a patient presents with an unexplained rash. Some people experience a rash or sores first, followed by other symptoms; some people only experience a rash or sores.

Treatment

Most people get well from monkeypox without needing any medicines or other treatment. There is no medicine that the FDA has approved for monkeypox treatment. However, Tecovirimat (TPOXX or ST-246) is an antiviral medication available through an Expanded Access Investigational New Drug (EA-IND) protocol for the treatment of monkeypox infection.

Background on Tecovirimat

Tecovirimat, also referred to as TPOXX, is an antiviral medication approved by the United States Food and Drug Administration (FDA) for the treatment of smallpox, and is now being used to treat monkeypox infection under an Expanded Access Investigational New Drug (IND) protocol from the Centers for Disease Control and Prevention (CDC). It is available for children and adults as an oral capsule and IV formulation. While data are not available on the effectiveness of TPOXX in treating monkeypox infections in people, animal studies have shown it is effective in treating disease and reducing the risk of death from Orthopoxviruses. Clinical trials in people have shown the drug is safe with only minor side effects. One case report describes a shortened duration of illness and viral shedding in a patient who received TPOXX (Adler, 2022).

Eligibility

Your patient may be eligible for TPOXX treatment if:

  • Your patient is a confirmed or high suspect monkeypox case AND  
    • has severe disease (e.g. hospitalized, encephalitis, confluent lesions) OR  
    • is hospitalized for monkeypox or other co-morbidities OR
    • has a compromised immune system (e.g., HIV1, active cancer diagnosis/treatment, 
      immunotherapy) OR
    • is over 8 years of age OR
    • is pregnant or breastfeeding OR
    • has mucous membrane involvement (e.g., eyes, mouth, anus or genitals) OR
    • has significant facial lesions at-risk for permanent scarring OR
    • has secondary complications (e.g., bacterial infection, diarrhea, dehydration, concurrent 

      disease, severe pain)

Staging TPOXX

We have staged TPOXX supply at outpatient clinics that see high numbers of high-risk patients for monkeypox. TPOXX supply has also been staged at major healthcare systems across the county for both inpatient and outpatient prescribing. If you are a clinician who cares for high-risk patients and are affiliated with a large healthcare system, inquire internally regarding access to TPOXX prescribing.

Expanding TPOXX Consultation Capacity

In partnership with the Banner Poison and Drug Information Center (BPDIC), clinicians without access to staged TPOXX supply can now call BPDIC at 602-747-7111 to obtain TPOXX. BPDIC will review clinical eligibility based on CDC criteria with the prescribing clinician and when appropriate submit an order for dispensing to MCDPH. MCDPH will arrange for the TPOXX course to be delivered to the prescriber.

Streamlined EA-IND Process for Prescribers

The FDA and CDC have streamlined the process for ordering TPOXX. Prescribers must obtain informed consent, complete FDA form 1572 and complete the patient intake form. All required forms can be found on the CDC website. Interval follow-up and the clinical outcome form are no longer required.

Experience with Tecovirimat in Maricopa County

Approximately 20% of people diagnosed with monkeypox in Maricopa County in this outbreak have been treated with TPOXX. Frequent indications include painful oral, anal or penile lesions and bacterial superinfection. It has been prescribed for about 40 patients as of August 29, 2022, many of whom have reported significant improvement after just a few days of starting treatment. There have been delays getting tecovirimat to patients given the lack of providers and facilities willing and able to prescribe this medication.

Monkeypox is a painful, often debilitating illness. Prompt initiation of tecovirimat can lessen suffering and reduce the risk of complications. We urge facilities and providers to take steps to be able to prescribe tecovirimat to ensure timely treatment for their patients. 

For more information, including information about supportive care for monkeypox, we suggest that providers visit the NYC Health Department’s Monkeypox Information for Providers webpage.

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Vaccines

Onboarded providers with an active ASIIS PIN can now request Jynneos vaccine through MCDPH. Jynneos vaccine supply is limited and being prioritized to certain high-risk individuals. Maricopa County Department of Public Health (MCDPH) cannot guarantee requests will be filled in the amounts and time periods desired.

To request vaccine, please complete this request form.