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Mpox

Public health officials are tracking cases of Mpox (MPV) that have been reported in countries that don’t normally report monkeypox including the United States. US case counts map here (https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html)

Anyone who has been in close contact with someone who has Mpox is at risk to be infected. Early data suggest that gay, bisexual, and other men who have sex with men make up a high number of cases in the current outbreak.

Symptoms

Symptoms of Mpox can include:

  • Fever
  • Headache
  • Muscle aches and backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion
  • A rash that can look like pimples or blisters that appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. The rash goes through different stages before healing completely. The illness typically lasts 2-4 weeks. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash. A person is infectious from symptom onset until scabs fall off and a fresh layer of healthy skin has formed. The illness can last as long as 3-4 weeks. Most people do not have serious complications from MPV but will need to stay home until they are no longer infectious.

How it Spreads

  • The Mpox virus is spreading mostly through close, intimate contact with someone who has Mpox. At this time, data suggest that gay, bisexual, and other men who have sex with men make up the majority of cases in the current Mpox outbreak.  However, anyone, regardless of sexual orientation or gender identity, who has been in close, personal contact with someone who has Mpox is at risk.
  • Close personal contact includes:
    • Direct contact with Mpox sores or rashes on an individual who has Mpox.
    • Contact with respiratory droplets or oral fluids from someone with Mpox, particularly for those who are around someone with Mpox for a long period of time.
    • Mpox can also spread through contact with objects or fabrics (e.g., clothing, bedding, towels) that have been used by someone with Mpox.
    • Symptoms develop approximately 12 days after a person has been exposed but may be as early as 5 days and as late as 21 days.

Mpx Prevention

Vaccination is an important tool in preventing the spread of Mpox. It takes time to build protection from the vaccine. Protection builds in the days and weeks after the first dose, but the vaccine will provide the best protection two weeks after the second dose. There is still much that is unknown about the virus and the level of protection that the vaccine provides. Regardless of vaccination status, there are several ways to reduce the risk of getting Mpox. These changes are especially important when you are between your first and second dose of the vaccine.

The following steps should be taken by all persons to prevent getting Mpox:

  • Avoid close, skin-to-skin contact with people who have a rash that looks like Mpox.
  • Do not touch the rash or scabs of a person with Mpox.
  • Do not kiss, hug, cuddle or have sex with someone with Mpox.
  • Avoid contact with objects and materials a person with Mpox has used.
  • Do not share eating utensils or cups with a person who has Mpox.
  • Do not handle or touch the bedding, towels, or clothing of a person with Mpox.
  • Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after using the restroom.
  • Avoid close, skin-to-skin contact, and sex (oral, anal, vaginal) with people whose infection status is unknown or with a history of recent travel to areas that are part of the current MPV outbreak.
  • Having multiple or anonymous sex partners may increase your chances for exposure to MPV. Limiting your number of sex partners may reduce the possibility of exposure.
  • Talk to your partner about any recent illness and be aware of new or unexplained rash on your body or your partner's body, including the genitals and anus.
  • If you or your partner have recently been sick, currently feel sick, or have a new or an unexplained rash, do not have sex and see a healthcare provider.

Mpox Resources

  • Mpox Call Center - The monkeypox call center being run by the Iowa Department of Health and Human Services (Iowa HHS) is no longer in service. Questions related to Mpox may be directed to the Division of Public Health’s main line at (515) 281-7689.
  • Mpox Email - This established email address, Mpxvaccine@idph.iowa.gov, will remain available to support sites administering Mpox vaccines. Sites participating in vaccine distribution should continue following guidance from the Bureau of Immunization.

Healthcare

A high index of suspicion for Mpox is warranted when evaluating people with the characteristic rash, particularly for the following groups:

  • Men who report sexual contact with other men and who present with lesions in the genital/perianal area,
  • People reporting a significant travel history in the month before illness onset, or
  • People reporting contact with people who have a similar rash or have received a diagnosis of suspected or confirmed Mpox. 

RECOMMENDATIONS FOR MPOX SUPPORTIVE CARE

Supportive care includes maintaining hydration and pain management.

SKIN LESIONS

  • Keep lesions clean and dry when not showering or bathing to prevent bacterial superinfection.
  • Manage pruritus with oral antihistamines, inert anti-irritant topical agents such as calamine lotion or petroleum jelly, and cooling lotions such as menthol and camphor lotions.
  • Take warm oatmeal baths to reduce pruritus and pain.
  • Advise to seek medical care if they observe an increase in pain, redness, swelling or milky/cloudy fluid at the site of the sores.

ORAL LESIONS

  • Rinse mouth with salt water at least four times a day.
  • Keep lesions clean by using alcohol-free oral antiseptics, such as chlorhexidine mouthwash.
  • Suck on ice chips or ice pops to reduce pain or use compounds such as “magic” or “miracle” mouthwashes used to treat mucositis.
  • Use topical treatments (e.g., benzocaine gels) for temporary pain relief and to facilitate eating and drinking.
  • Painful genital and anorectal lesions
  • Take warm sitz baths lasting at least 10 minutes several times per day.
  • Use topical benzocaine/lidocaine gels or creams.

PROCTITIS

  • Use stool softeners such as docusate at the first sign of proctitis.
  • Take sitz baths to calm inflammation.
  • Take pain medications such as acetaminophen and ibuprofen.
  • Apply topical anesthetics such as dibucaine ointment (often used for hemorrhoids) or lidocaine gel.

GASTROINTESTINAL SYMPTOMS

  • Control nausea and vomiting with antiemetic drugs.
  • Manage diarrhea with appropriate hydration and electrolyte replacement.
  • Generally, avoid anti-motility agents given the potential for ileus.

Titanji B, Tegomoh B, Nematollahi S, KonomosM, Kulkarni PA. Monkeypox-A Contemporary Review for Healthcare Professionals. Open Forum Infectious Diseases.2022. https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofac310/6...

World Health Organization. Clinical Management and Infection Prevention and Control for Monkeypox-Interim Rapid Response Guidance. June 10, 2022.

https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1

Mpox Specimen Collection Guidance

Sample collection instructions from the State Hygienic Lab: http://www.shl.uiowa.edu/testmenu/menupages/mpox.xml

Iowa Mpox Vaccination Sites

  •   BlackHawk County
  • Cerro Gordo County
  • Des Moines County
    • Des Moines County Public Health
      • Call to determine eligibility: 319-753-8290
  • Dubuque County
    • Dubuque Visiting Nurse Association
      • Call to determine eligibility: 563-556-6200
  • Johnson County
  • Linn County
  • Polk County
    • Polk County Health Department
      • Schedule appointments at:  www.immunizepolk.com
      • Questions:  PCHD Call Center 515-323-5221
      • The health department only creates appointments if there is enough vaccine available;  if there are no appointments available, Jynneos vaccine is no longer available
    • Primary Health Care Outreach- University
  • Pottawattamie County
    •  Pottawattamie County Health Department
      • Call to determine eligibility: 712-242-1155
      • All requests will be reviewed and individuals will receive a call back with an appointment time if eligible for vaccination
      • If there are no appointments available, website will be updated
  • Scott County
    • Scott County Health Department
      • Schedule Appointments and determine eligibility at: 563-326-8618
      • Callers should identify they are calling with questions regarding mpox
      • Eligible vaccine recipients will be offered same day access
        • Monday and Tuesday, Thursday and Friday from  8:15 am - 4:00 pm;
        • Appointments are REQUIRED
  • Story County
  • Washington County
    • Washington County Health Department
      • Call to determine eligibility: (319) 653-7758
  • Webster County
    • Webster County Health Department
      • Call to determine eligibility: 515-573-4107
  • Woodbury County