Report all suspect mpox cases to SFDPH
All suspect mpox cases must be reported within 1 working day to STD Reporting, preferably by email or fax.
Please submit a Confidential Morbidity Report form (CMR) by email to lincs@sfdph.org or by fax to (628) 217-6603 and write “suspect mpox” in the disease field at the top of the form. 24/7 reporting of suspect mpox by telephone is no longer required and is not the preferred method.
Vaccination
Jynneos mpox vaccine supply is no longer scarce. SF receives vaccine allotments from the state health department based on a formula using current mpox case counts and eligible population size. SFDPH currently has sufficient doses to offer vaccine to the general public.
Eligibility. Eligibility criteria has been removed. Anyone who wants protection from mpox infection may receive mpox vaccine. Vaccine providers can offer mpox vaccine to any patients who may be at risk, and persons who request vaccination should receive it without having to attest to specific risk factors. See Health Update: Expanded Mpox Vaccination Recommendations (Updated Dec 9, 2022)
Storage, Handling, and Expiration. See CDC resources for Jynneos vaccine for info on storage and handling under the new EUA for intradermal dosing.
See Jynneos may be stored refrigerated for up to 8 weeks – do not refreeze and this Jynneos storage and expiration Q&A.
Administration. Jynneos dosing is available through BOTH 0.5mL subcutaneous administration OR 0.1mL intradermal administration.
Subcutaneous administration is the standard route, but intradermal may be used under an Emergency Use Authorization (EUA) for persons ages 18 years and older. See CDC Monkeypox vaccination Considerations and SFDPH guidance to support the use and availability of ID dosing.
On 9/28/22 CDC updated its Jynneos administration guidance to state the following: “Intradermal administration involves injecting the vaccine superficially between the epidermis and the hypodermis layers of the skin, typically of the volar aspect (inner side) of the forearm. If the volar aspect of the forearm is not an option (e.g., strong patient preference), intradermal administration of vaccine may be performed at the upper back below the scapula or at the deltoid.”
Resources for training on how to properly administer ID doses are available through CDC.
Pediatric Vaccination. As of 8/9/22 an Emergency Use Authorization (EUA) by FDA allows for administration of Jynneos to persons younger than age 18 years. There is no lower limit to the age of children who can receive Jynneos under the EUA. See CDC MPX vaccination Considerations. The pediatric dose is 0.5 mL given subcutaneously.
Process for Minor Consent to Receive Mpox Vaccine. See SFDPH minor consent guidance for the process by which minors ages 12 years and older may consent to receive Jynneos vaccine.
Are you a provider interested in vaccinating your patients? Jynneos is now available commercially through Bavarian Nordic.
Questions? Please email immunization.dph@sfdph.org
Treatment with tecovirimat
Tecovirimat (TPOXX) efficacy for the treatment of mpox disease is unknown and is currently being studied through the STOMP trial. TPOXX is FDA approved for the treatment of smallpox and is available through an Expanded Access Investigational New Drug (EA-IND) protocol for the treatment of mpox. Criteria used in SF as indications for tecovirimat are aligned with CDC and can be found here.
In most cases, supportive care and symptomatic treatment is sufficient. This includes pain relievers, topical cortisone, and benzocaine/lidocaine gels for painful proctitis. In rare cases a patient may need pain management beyond over the counter pain relivers.
Though rare, TPOXX resistance has been observed with prolonged treatment courses (>14 days). See the November 17, 2022 CDC Health Update for more details, as well as for information on other treatments that can be administered concurrently with tecovirimat for certain patients with severe mpox.
STOMP Clinical Study Information
Please inform your patients about an ongoing clinical trial, the Study of Tecovirimat for Human Monkeypox Virus (STOMP). This trial is actively enrolling participants, and the goal of the trial is to learn more about TPOXX safety and effectiveness. If your patient is interested, please call 415-535-9495 or email ID-Research.ZSFG@ucsf.edu.
Persons who are out of the area or cannot come to Ward 84/86 at ZSFGH but want to access TPOXX through the study can enroll remotely. Use the Call Center (with the patient in the room, or give them the call center number): 1-855-876-9997 (U.S. only); Website: https://www.stomptpoxx.org/main
If your patient is not interested in the STOMP trial, SF providers can obtain and prescribe tecovirimat. SFDPH encourages all providers and clinics who are testing for and diagnosing mpox to have access to tecovirimat and can assist with obtaining the medication for your site. Instructions to become a tecovirimat prescriber can be found here. Clinicians can also contact us for assistance by emailing lincs@sfdph.org.
If your site does not currently have access to tecovirimat, you can refer patients with an urgent need for mpox treatment to a tecovirimat prescribing site. A list of TPOXX prescribing sites in San Francisco can be found here. After referring a patient, please contact SFDPH to become a tecovirimat prescriber.