Thread by @PAdamsonMD

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

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/

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/

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/

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/

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

8/

#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/

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/

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