Paul Adamson MD MPH Profile picture
Jun 29, 2022 14 tweets 9 min read Read on X
Information from today's @CDCgov clinicians' webinar on #monkeypox.

There have been 305 confirmed cases so far in the US

Interesting that @CAPublicHealth site has 65 listed, but only 43 in the CDC graphic
1/n Image
Number of cases detected over time.

Many cases are among men who have sex with other men.

But it is important to remember that anyone can be infected (and spread) #monkeypox, regardless of sex, gender, or sexual orientation.
2/ ImageImage
Presentation is a bit atypical.

Lesions can appear different in one area of the body, compared to another.

Performing a full skin and mucosal exam is important.

Diagnosis with another #STI doesn't rule out #monkeypox
3/
Clinical symptoms of #monkeypox:

Atypical features include:
- rash can start *prior to* prodrome, which has been hallmark of monkeypox
- rash can start at mucosal surfaces
- some cases presenting without lymphadenopathy

4/ Image
Dr. Mena presented a really interesting clinical case, with great clinical photos and timeline.

Case highlighted that rash can occur before fever/prodrome, lesions can be at different stages of development (but deep- and the fact that co-infection with other #STDs can occur

5/ Image
Presented history, exam, tests, and management of the patient's partner, who had a rash (chest, buttock, axilla) and axillary LAD.

However, partner's lesions were swabbed and all neg for orthopoxvirus.

Case also underscores importance of obtaining a thorough sexual history
6/
Countermeasures for #monkeypox section.

Table summarizing #Jynneos and #ACAM2000

7/ Image
ACIP contraindications to the use of the #Jynneos and #ACAM2000 #vaccines for #monkeypox

8/ Image
#Vaccination strategies for #monkeypox
- Difficulty performing contact tracing, unknown contacts
- Currently limited supply of Jynneos
- Efforts are being made to allocate vaccines in areas of high transmission, for #PEP

Which is why we really need to increase testing.
9/ Image
Briefly covered treatment considerations

Notably people living w/ #HIV might be at high risk for severe disease.

Also anyone with severe disease, pregnant people, or with atopic dermatitis

And information about #tecovirimat.

Vaccines and meds not commercially available
10/ Image
Q&A:

Q: For swabbing, do you need to unroof the lesion?
A: No, vigorous swabbing should be enough

Q: Do smallpox/chickenpox vaccines provide protection against monkeypox?
A: Smallpox vaccine expected to, but unclear how long immunity lasts. We need to learn more. VZV = no
11/
Q: Possible to get re-infected?
A: Generally, no. But need to learn more w/ current outbreak.

Q: Does #monkeypox spread easily, easier than #COVID19?
A: Primarily spread through close, usually skin-to-skin, contact. We expect transmission to be much lower than COVID-19.
12/
Few questions about swabs.
Q: Can swabs be taken before the lesions are pustular?
A: Lesions (vesicles, pustules, or scabs) can be swabbed.

Reminder: #monkeypox lesions contain infectious virus, so important to keep lesions covered.
13/
Really interesting lecture. Thanks to @CDCgov for hosting.

Webinar and slides will be available here: emergency.cdc.gov/coca/index.asp

/end

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More from @PAdamsonMD

Feb 22, 2021
Good news: 1.7M #COVID19 #vaccine doses given in #LosAngeles!
Bad news: vaccination program is leaving behind Black and Hispanic seniors, perpetuating existing #healthdisparities

This is an *access* issue, as current system relies on technology, outreach, and transportation
These are the same maps we saw for access to testing and #COVID19 infections throughout the pandemic.

It is disheartening that the same communities that were hardest hit by the pandemic have the lowest access to #vaccines @skarlamangla

Community health should not be based upon community wealth, but we see this throughout our health system. Sadly, our vaccination program feeds directly into this system. We need to remove barriers to access for our underserved communities. @ronlin
latimes.com/california/sto…
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