As cases of Monkeypox (MPX) continue to increase across the United States, the Mobile County Department of Health (MCHD) expects an increase in the need for MPX testing in our area.
The MCHD requests that medical providers who have patients with signs and symptoms concerning for MPX perform specimen collection in their offices/facilities. As the current outbreak of MPX continues, we request that the providers seeing the patients perform specimen collection on the initial visit if determined clinically appropriate while waiting for approval through Alabama Department of Public Health (ADPH).
Sample collection only requires simple, sterile swabs (dry nylon, polyester, or Dacron) and sterile tubes that the swabs can be stored in and sealed. Two swabs per lesion/site should be collected and labeled as such. No viral media is required for transport. Refrigerate or freeze specimens within one hour of collection. Specimen processing can only be performed at public health laboratories and some commercial laboratories and procedures for respective laboratories is as follows.
ADPH Bureau of Clinical Laboratories (BCL):
Step 1: To have testing approved by the ADPH, the MPX Testing and Consultation Form for Healthcare Providers must be filled out, and this can be found here: https://redcap.link/monkeypoxconsultation.
Step 2: Once approved, follow the detailed instructions on sample collection that can be found at: https://www.alabamapublichealth.gov/monkeypox/assets/mpx-specimen-guidance.pdf. Samples can be collected and stored while waiting for testing approval from ADPH.
Note: If a medical provider does not have access to the necessary materials to perform sample collection, these can be requested by calling the MCDH at 251-690-8868, and a kit can be dispatched to your clinic. Additionally, if a sample is collected, the MCHD can assist with specimen transport to the BCL by calling the number above.
The Centers for Disease Control and Prevention (CDC) has authorized some commercial laboratories to perform MPX testing.
Step 1: Check to see if your commercial laboratory provider is authorized to perform MPX testing.
Step 2: Contact the commercial laboratory to determine acceptable specimens and specimen collection procedures.
If notified of a positive test for Monkeypox (MPX):
Step 1: Please contact MCHD, 251-690-8175. MCHD is facilitating access to therapeutics for people who may have exposed to monkeypox through Infectious Disease Clinics/Practices in the Mobile County. MCHD has an approved IND protocol for medical treatment using tecovirimat (TPOXX) through Infections Disease Clinics. The release of the medication requires notification and distribution through the Strategic National Stockpile.
Step 2: Refer patient to either Infectious Disease Alabama Medical Group or Infectious Diseases USA Health.
Vaccine Strategies to Prevent Monkeypox:
When properly administered before or after a recent exposure, vaccines can be effective tools at protecting people against monkeypox illness. MCHD is facilitating access to vaccines in the community. The following vaccination strategies are being used in the United States:
Monkeypox Vaccine Post-Exposure Prophylaxis (PEP): For the current outbreak, this approach can be considered as “standard PEP” for monkeypox. People can be vaccinated following exposure to monkeypox to help prevent illness from monkeypox virus. It is important that states and other jurisdictions identify contacts of confirmed or probable monkeypox cases to offer vaccine for PEP and to monitor for any early signs of illness. CDC recommends that the vaccine be given within 4 days from the date of exposure for the best chance to prevent onset of the disease. If given between 4 and 14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease. However, when coupled with self-isolation and other prevention measures when symptoms first occur, PEP is important for controlling outbreaks and preventing further transmission of monkeypox.
Outbreak Response Monkeypox Vaccine Post-Exposure Prophylaxis (PEP)++: For the current outbreak, this expanded approach can be considered as “individual-directed PEP” for monkeypox; public health officials refer to it as “expanded PEP” or “PEP plus-plus” or “PEP++”. People with certain risk factors are more likely to have been recently exposed to monkeypox. The PEP++ approach aims to reach these people for post-exposure prophylaxis, even if they have not had documented exposure to someone with confirmed monkeypox. When coupled with self-isolation and other prevention measures when symptoms first occur, PEP++ may help slow the spread of the disease in areas with large numbers of monkeypox cases—which would suggest a higher level of monkeypox virus transmission.
Monkeypox Vaccine Pre-Exposure Prophylaxis (PrEP): This approach refers to administering vaccine to someone at high risk for monkeypox (for example, laboratory workers who handle specimens that might contain monkeypox virus). At this time, most clinicians in the United States and laboratorians not performing the orthopoxvirus generic test to diagnose orthopoxviruses, including monkeypox virus, are not advised to receive monkeypox vaccine PrEP.
Kevin Philip Michaels, MD, MPH, FACOEM
Mobile County Health Department