Monkeypox (MPX)

Monkeypox

Learn the signs and symptoms of MPX and how to prevent its spread

MPX is a rare disease that can make you sick. People with MPX develop a rash which may be located on or near the genitals (penis, testicles, labia, and vagina) or anus (butthole) and could be on other areas like the hands, feet, chest, face, or mouth. The rash can initially look like pimples or blisters and can last up to 2-4 weeks. MPX does not usually cause serious illness; however, it can result in hospitalization or death.

If you are a healthcare provider, be alert for patients who have a rash consistent with MPX regardless of other factors such as recent travel, gender, or sexual orientation. Tennessee Department of Health (TDH) is committed to working with you to identify and care for individuals with MPX. 

What do you need to know about MPX? 

Who is at risk of contracting MPX? 

MPX is primarily spread through close, physical contact between people. This means anyone can get MPX. However, based on the current outbreak, certain populations are being affected more than others, including men who have sex with men.

Based on previous outbreaks, some groups may be at heightened risk for severe outcomes if they contract MPX. This includes people with weakened immune systems, elderly Tennesseans, and pregnant people.

What are the symptoms of MPX?

• Rashes, bumps, or blisters on or around the genitals or in other areas like your hands, feet, chest, or face.

• Flu-like symptoms such as:
    Fever
    Headache
    Muscle aches
    Chills
    Fatigue

• These symptoms may occur before or after the rash appears, or not at all.

How does MPX spread?

• Close, physical contact between people including:

• Direct contact with MPX sores or rashes on an someone who has MPX.

• Respiratory droplets or oral fluids from someone with MPX, particularly for those who have close contact with someone or are around them for a long period of time.

• It can also be spread through contact with objects or fabrics (e.g., clothing, bedding, towels) that have been used by someone with MPX.

How can I protect myself?

• Ask your sexual partners whether they have a rash or other symptoms consistent with MPX.

• Avoid skin-to-skin contact with someone who has a rash or other MPX-related symptoms.

• If you are exposed or experience symptoms, make sure to reach out to a health care provider.

• Consider getting vaccinated against MPX

• Follow trusted sources of health information, including TDH, CDC, and your local county health department.

What does a MPX rash look like?

RashImages
RashImages2

What should I do if I was exposed or have MPX symptoms?

Tennesseans who experience symptoms consistent with MPX, such as characteristic rashes or lesions, should contact their health care provider. See additional resources below

Resources

Community Resources

MPX Handout: What All Tennesseans Should Know – English | Spanish

MPX Interim Guidance for Childcare

MPX Interim Guidance for Schools

MPX Interim Guidance for Congregate Living Settings

Additional Information from the Centers for Disease Control and Prevention (CDC)

About Monkeypox

Signs and Symptoms

Prevention

Prevention in Specific Settings

How it Spreads

Treatment

Sexual Health

Learn about the 2022 Outbreak

What you need to know about the monkeypox vaccine in Tennessee.

When properly administered before or soon after exposure, vaccines can help protect against monkeypox illness.

The vaccine most commonly used for preventing monkeypox infection is JYNNEOS (also known as Imvamune or Imvanex) which has been licensed by the U.S. Food and Drug Administration (FDA).

In the United States, there is a very limited supply of JYNNEOS and it is solely distributed by the Centers for Disease Control and Prevention (CDC). Tennessee has received several allocations of vaccine from the CDC since July 5th but additional vaccine is not expected by the federal government until Fall 2022.

While the vaccine is approved as a two-dose series, given the severely limited national supply of JYNNEOS, beginning August 8, 2022 the Department of Public Health and our vaccine partners are prioritizing first doses for as many people as possible. This approach is intended to provide the broadest possible protection against the spread of monkeypox virus in Tennessee and is consistent with a growing number of states, jurisdictions and municipalities.

People who get vaccinated should continue to protect themselves from infection by avoiding close, skin-to-skin contact, including intimate contact, with someone who has monkeypox.

Data on JYNNEOS can be found on the CDC website .

The CDC has also made available the live replicating smallpox vaccine ACAM2000. However, this vaccine has several characteristics that may make it unsuitable for use in the current context, including considerably greater risk to the recipient compared with JYNNEOS. Data on ACAM2000 can be found on the CDC website.

As of July 27, 2022, the Tennessee Department of Health is offering JYNNEOS vaccine to:

1. Known contacts who were identified by public health via case investigation, contact tracing, and risk exposure assessments (post-exposure prophylaxis/PEP)

2. Presumed contacts who meet the following criteria (PEP++)

  • Are aware that a sexual partner was diagnosed with monkeypox in the past 14 days
  • Have had multiple sexual partners in the past 14 days in a jurisdiction with known monkeypox

3. Gay, bisexual, or other men who have sex with men (MSM), and/or transgender, gendernonconforming or gender non-binary individuals who report any of the following in the last 90 days (pre-exposure prophylaxis / PrEP):

  • Having multiple sex partners or anonymous sex
  • Being diagnosed with a sexually transmitted infection (STI) or HIV
  • Living with HIV
  • Receiving medications to prevent HIV infection (HIV PrEP)

Please contact your local health department for more information on vaccine access in your area.

Please use the resources below to learn more about JYNNEOS vaccine. If you have further questions, please call our Case and Community Support team at 615-770-6940.

JYNNEOS Vaccination Information – English | Spanish

Vaccine Allocation

What to Expect after Vaccination – English | Spanish

Vaccine Allocation by Jurisdiction (HHS)

What healthcare providers need to know about monkeypox clinical guidance and vaccine administration, eligibility, and availability in Tennessee.

About JYNNEOS

The JYNNEOS vaccine (also known as Imvamune or Imvanex) has been approved by the U.S. Food and Drug Administration for those 18 years of age and older at high risk for monkeypox infection. This vaccine is a two-dose series, with the second vaccine being administered 28 days after the first.

Eligibility for JYNNEOS

Vaccination is available to Tennessee residents who meet the CDC’s eligibility criteria, prioritizing those most at risk of exposure to someone with monkeypox.

  • Standard post-exposure prophylaxis (PEP), administration of JYNNEOS withing 4 days of known exposure to monkeypox to avoid infection or between 4- and 14-days post-exposure to reduce severity of symptoms. Exposed individuals receiving vaccine will need to self-monitor for symptoms and prepare to isolate.
  • In addition to PEP, the PEP++ approach aims to reach individuals who are at high risk or exposure to monkeypox for post-exposure prophylaxis, even if they have not had documented exposure to someone with confirmed monkeypox.
  • Gay, bisexual, or other men who have sex with men (MSM), and/or transgender, gendernonconforming or gender non-binary individuals who report any of the following in the last 90 days (pre-exposure prophylaxis / PrEP):
    • Having multiple sex partners or anonymous sex
    • Being diagnosed with a sexually transmitted infection (STI) or HIV
    • Living with HIV
    • Receiving medications to prevent HIV infection (HIV PrEP)

Availability of JYNNEOS

If you have a patient who my have been exposed to monkeypox, please contact your local health department to discuss availability of vaccine access in your area: 

Additional Resources

 









What public health needs to know about monkeypox and response efforts in Tennessee.

Investigation, Notification, and Monitoring 

Case report form - This form should be used to complete case investigation.

Exposure notification script - If needed, use this sample script to notify close contacts of their exposure by phone call.

Faxed lab data entry guide for NBS

NBS User Guide for MPX eCR

Monitoring templates:

1. Cases

2. Contacts

Send templates with information for cases and close contacts to monkeypox.monitoring@tn.gov. Staff do not have to wait until all contacts have been reached before sending files.

Case response guidance

This guidance includes information on how to find, investigate, report, and monitor cases. Additional information on treatment and vaccine are also included in the document.

Please see the typical flow of laboratory testing here. Specimen collection information and requisition information can be found here.

State Public Health Laboratory

Diagnostic testing for monkeypox is also available at the Tennessee State Public Health Laboratory for established patients of local health department clinics or under/un-insured patients. Please contact your health department to obtain approval prior to submitting specimens. Specimens will not be tested at the state public health laboratory without prior approval.

Commercial Laboratories

Diagnostic testing for monkeypox is available at Aegis, Labcorp, Mayo Clinic Laboratories, Quest, and Sonic. Prior approval from the health department is not required to order tests at a commercial laboratory.

Reporting

Any laboratory that performs diagnostics testing for monkeypox should report test results to the Tennessee Department of Health. This includes real-time PCR testing for Orthopoxvirus, non-variola Orthopoxvirus, or Monkeypox virus. All results (positive, negative, equivocal) should be reported. Reports should be sent using existing electronic laboratory reporting (ELR) channels to ensure rapid initiation of case investigations, and results should also be shared concurrently with the ordering provider, per routine. Laboratories should send compliant HL7 messages, if possible. It is critical to utilize standard terminology while reporting. Guidelines for reporting terminology can be found here.