Mpox info and guidance for health professionals

Report all suspect mpox cases to SFDPH

All suspect mpox cases must be reported within 1 working day to STD Reporting. The reporting method is different based on the suspected clade: 

If clade I mpox is suspected, please report the suspected case to SFDPH by phone at (628) 217-6639 from Monday to Friday, 8 am to 5 pm. For weekend reporting, call (415) 554-2830 and follow the instructions to page the on-call physician.

If clade II mpox is suspected, 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.

Vaccination

Vaccine Supply. The manufacturer of mpox vaccine, Bavarian Nordic, commercially launched the product in April 2024. Jynneos is available for clinics, pharmacies, and health systems to purchase from their usual vaccine distributors.  There is no shortage at this time. 

All remaining doses of the free, federally provided product that has been available since 2022, expire by 9/30/2024 or 10/31/2024 (check the label), and after that time only the commercially offered doses will be available.  

An mpox vaccine locator tool is available to help patients locate vaccinators providing doses. 

Insurance Coverage. Most insurance plans currently cover or will soon cover the cost of Jynneos vaccination for members who meet clinical eligibility criteria. 

Eligibility. CDC eligibility criteria for mpox vaccination have been published and will be updated as needs evolve.  It is anticipated that pharmacies offering mpox vaccination will adhere to CDC eligibility.  Please note that SFDPH eligibility for mpox vaccine includes 3 additional clarifying criteria as well as the CDC criteria. 

Jynneos is FDA-approved for adults, to be given via the subcutaneous route.  

An FDA Emergency Use Authorization (EUA) lists two additional indications for Jynneos:

1. Subcutaneous administration in children under 18 years of age.  There is no lower limit to the age of children who can receive Jynneos and the dosage is the same as the adult dose (0.5 mL).
2. Intradermal administration in adults.  

Administration.  Jynneos dosing is available to adults through BOTH 0.5mL subcutaneous administration OR 0.1mL intradermal administration. Pediatric dosing is solely via the subcutaneous route. 

If intradermal administration is utilized, this 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.”

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.

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.