LAC DPH Health Update: Monkeypox Updates Including Expedited Testing for PEH and Alternative JYNNEOS Dosing August 12, 2022 Centers for Disease Control and Prevention, clinical guidance, Emergency Use Authorization, epidemiology, EUA, FDA, Healthcare Provider Monkeypox Hub, intradermal injection, JYNNEOS, LA County, LAC DPH, LAHAN, Long Beach, Los Angeles, Los Angeles County, monkeypox, monkeypox vaccine, orthopoxvirus-positive, Pasadena, persons experiencing homelessness, Providers, Public Health Laboratory, subcutaneous injection, tecovirimat, TPOXX 1430 Key Messages Community transmission of monkeypox continues in LA County. Providers who suspect monkeypox in persons experiencing homelessness (PEH) are asked to submit specimens for testing to the LAC DPH Public Health Laboratory (PHL) in order to expedite decisions on the individual’s placement. Patients being tested for monkeypox infection should be instructed to isolate to protect others pending their final diagnosis. See monkeypox isolation instructions. The JYNNEOS monkeypox vaccine has received FDA emergency use authorization (EUA) to be given by intradermal (ID) injection to individuals age 18 years and older and by subcutaneous (SC) injection to those under age 18. CDC has updated clinical guidance on vaccination. Patients with lesions or pain that interfere with the activities of daily living and patients at high risk for severe disease should be considered for treatment with tecovirimat (TPOXX). There is no shortage of tecovirimat. See Monkeypox Treatment. Situation The Centers for Disease Control and Prevention (CDC) reports over 10,000 confirmed monkeypox/orthopoxvirus cases. In Los Angeles County, as of August 12, 2022, more than 700 monkeypox/orthopoxvirus cases have been confirmed. Direct skin-to-skin contact, including sexual contact, with a symptomatic person with monkeypox continues to be the most significant risk factor associated with transmission. In this outbreak, most of the reported cases have been among gay, bisexual, or other men who have sex with men (MSM). However, it is important to remember that anyone, irrespective of gender identity or sexual orientation, can acquire and spread monkeypox. For LA County case counts and situation updates, visit the Los Angeles County Department of Public Health (LAC DPH) monkeypox webpage for the general public. Providers should reference the healthcare provider monkeypox webpage ph.lacounty.gov/monkeypoxhcp for detailed clinical guidance and resources. Actions Requested of Providers: Test the rash of any patient with suspected monkeypox. This includes any patient with a new characteristic rash and patients with risk factors for monkeypox and a new rash. The rash associated with monkeypox can be confused with other rashes encountered in clinical practice including herpes, syphilis, and varicella and co-infections have been reported. See CDC Monkeypox Suspect Case Definition. Submit specimens for monkeypox testing through commercial labs if possible, with the exception of specimens from persons experiencing homelessness (PEH). If providers suspect monkeypox in a person experiencing homelessness, they are asked to submit specimens to the LAC DPH PHL to expedite test results and decisions on PEH placement needs. In addition, providers who do not have access to commercial orthopoxvirus testing may submit samples from suspect cases to the LAC DPH PHL. Consultation and approval is required before submitting specimens for testing at the LAC DPH PHL. See Monkeypox Virus Testing. Instruct patients with suspected monkeypox to isolate immediately pending test results. If an alternative diagnosis is made, isolation can be discontinued. Patients with confirmed monkeypox should continue to isolate in accordance with LAC DPH monkeypox isolation instructions. Report all LA County residents with orthopoxvirus-positive and/or presumptive positive test results if using a commercial lab. See the Reporting section of the Healthcare Provider Monkeypox Hub for information on secure online reporting and other options. It is not necessary to report results of tests processed by LAC DPH PHL. Monkeypox Vaccine Update JYNNEOS Emergency Use Authorization In order make the limited supplies of JYNNEOS vaccine available to more people, LAC DPH is aligning with CDC’s recent recommendation to allow an alternative dosing regimen. The FDA authorized JYNNEOS to be administered as an injection volume of 0.1mL intradermally as a 2-dose series to individuals 18 years of age and older at high risk of monkeypox infection who do not have a history of keloid formation. The FDA EUA also authorizes JYNNEOS to be administered as an injection volume of 0.5mL subcutaneously as a two-dose series to individuals under the age of 18 who are at high risk of monkeypox infection. This regimen is also available for individuals ages 18 and over who have a history of keloid formation. Healthcare providers who are providing JYNNEOS vaccination should refer to the Monkeypox Vaccine Provider website for further guidance and training. Current Groups Eligible for JYNNEOS Vaccine The current groups eligible for vaccination remain the same. Eligibility for JYNNEOS vaccine will expand as vaccine supply increases and/or the epidemiology of the outbreak changes. For information on monkeypox vaccination, including eligibility and how to refer patients for vaccination, see Monkeypox Vaccination and Post Exposure Prophylaxis. Clinical Consultation or Monkeypox Testing Approval Providers who need clinical consultation or are requesting approval for monkeypox testing at our Public Health Laboratory can call: Los Angeles County DPH Acute Communicable Disease Control Weekdays 8:30am–5pm: call 213-240-7941. Weekend and holidays 8:00am-5pm: call 213-974-1234 and ask for the physician on call. Evenings - for urgent situations only: call 213-974-1234 and ask for the physician on call. Long Beach Health and Human Services Weekdays 8am-5pm: call 562-570-4302. After hours: call the duty officer at 562-500-5537. Pasadena Public Health Department Weekdays 8am-5pm: call 626-744-6089. After hours: call 626-744-6043. Monkeypox Provider Hub Refresh your browser to view the latest version.