LAC DPH Update: Monkeypox-Commercial Lab Testing, Reporting, & Vaccine Availability July 13, 2022 California, CDC, Center for Disease Control and Prevention, CMR, Communicable Disease Control and Prevention, Confidential Morbidity Report, herpes, HIV, LA County, LAC DPH, Los Angeles, Los Angeles County Department of Public Health, Monkeypox, MSM, Public Health, STD, syphilis, Vaccine, Vaccine Update, varicella 1188 Key Messages Community transmission of monkeypox continues in LA County. Commercial testing is now available through Labcorp. Additional laboratories are expected to have testing available later this month. Providers should submit specimens through commercial labs if possible. Healthcare providers must report all LA County residents with positive and/or presumptive positive orthopoxvirus test results from commercial laboratories. Monkeypox vaccine supplies remain very limited and are prioritized for residents at highest risk of exposure. Vaccine eligibility will be expanded on July 11. See details below. Situation The Center for Disease Control and Prevention’s (CDC) reports over 700 confirmed monkeypox/orthopoxvirus cases in the U.S. In Los Angeles County, as of July 7, 2022, 54 monkeypox cases have been confirmed in county residents with no hospitalizations or deaths. Among recent cases, close, sustained skin-to-skin contact, including sexual contact, with a symptomatic person with monkeypox appears to be the most significant risk factor associated with transmission. In this outbreak, many 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. Commercial testing for monkeypox is now available through Labcorp. Labcorp is using the CDC’s orthopoxvirus test (which detects all non-smallpox related orthopoxviruses, including monkeypox). CDC anticipates additional commercial laboratories will come online this month which will increase access to testing. For LA County current case counts and situation updates, visit the monkeypox webpage for the general public. Providers should reference the Los Angeles County Department of Public Health (LAC DPH) healthcare provider monkeypox webpage. Actions Requested of Providers Test any patients with suspected monkeypox. This includes any patient with a new characteristic rash or 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. Instruct patients with suspected monkeypox infection to isolate immediately. They should avoid close contact with other people pending the results of testing. Submit specimens for monkeypox testing through commercial labs if possible. If you do not have access to commercial orthopoxvirus testing, you can submit samples from suspect cases to the LAC DPH Public Health Lab (PHL) after obtaining approval from LAC DPH. Report all LA County residents with orthopoxvirus positive and/or presumptive positive test results from commercial laboratories. Providers should report cases on-line via the LAC DPH secure monkeypox reporting portal Monkeypox Confidential Morbidity Report (CMR). If providers experience technical difficulties with using the on-line report form, reports may be completed using the standard CMR form and submitted via fax to (888) 397-3778 or (213) 482-5508. Provider reporting is not necessary for positive tests conducted by the LAC DPH PHL. Monkeypox Confidential Morbidity Report (CMR) Monkeypox Vaccine Update Due to the continued limited supply of the JYNNEOS monkeypox vaccine from the federal government, vaccination is prioritized for LA County residents at high-risk of exposure. In alignment with the nationwide strategy, the JYNNEOS vaccine is being offered, by invitation only. LAC DPH or clinic partners will directly communicate to eligible patients to provide details on how and where to access the JYNNEOS vaccine. LAC DPH will expand eligibility as vaccine supply increases. Currently: Offered by invitation only to the following select groups identified through public health investigation: Persons confirmed by LAC DPH to have high- or intermediate-risk contact with a confirmed monkeypox case. Persons who attended an event/venue where there was high risk of exposure to an individual(s) with confirmed monkeypox through skin-to-skin or sexual contact. LAC DPH will work with event/venue organizers to identify persons who may have been present and at risk of exposure while at the venue. In addition, effective Monday July 11, by invitation only to: Patients of community STD and HIV clinics, Public Health Centers, and other community clinics located across Los Angeles County who meet specific clinical criteria. Gay and bisexual men and transgender women with a diagnosis of rectal gonorrhea and/or early syphilis within the past 3 months. High-risk cohorts in the LA County jail. 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. After-hours: 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. This communication was sent by Sharon Balter, MD, Director, Division of Communicable Disease Control and Prevention, Los Angeles County Department of Public Health To view this and other communications or to sign-up to receive LAHANs, please visit http://publichealth.lacounty.gov/lahan.