MPOX

Information for Health Departments

Mpox in North Carolina

North Carolina’s first case was identified on June 23, 2022. Nearly all mpox cases in North Carolina have been in men who have sex with men, consistent with findings from other jurisdictions. NCDHHS is working with local health departments and community partners to identify and respond to every case of mpox.  Addressing disparities and advancing health equity is central to our response. NCDHHS will publish demographic data weekly to provide insight into who in North Carolina is getting mpox and vaccines.

Current case summary and demographics

Mpox virus can be spread person-to-person through infected body fluids (including saliva and lesion fluid), items that have been in contact with infected fluids or lesion crusts, and respiratory droplets. The incubation period is usually 7−14 days but can range from 5−21 days. People with mpox are infectious from the start of symptoms (before the rash forms) until the lesions heal and new skin forms underneath scabs and the scabs have all fallen off.

Mpox Testing

Testing is widely available and encouraged if you had close contact with someone who has been diagnosed with mpox, or have symptoms of mpox including unexplained bumps, sores, blisters, or pimples that look like mpox. There is no shortage of testing supplies, and people with symptoms of mpox should go to their health care provider or a or local health department to get tested. Samples must be collected by a health care professional, and they must follow a specific procedure to collect a good sample for testing. NCDHHS recommends providers test any patient with a suspicious lesion or sore.

Mpox Vaccinations 

Vaccines are available to protect against mpox or to reduce disease severity. NCDHHS has expanded the vaccine eligibility criteria to include:

1. Anyone who had close contact in the past two weeks with someone who has been diagnosed with mpox; or
2. Gay, bisexual, or other men who have sex with men, or transgender individuals, who are sexually active; or 
3. People who have had sexual contact with gay, bisexual, or other men who have sex with men, or transgender individuals in the past 90 days; or
4. People living with HIV, or taking medication to prevent HIV (PrEP), or who were diagnosed with syphilis in the past 90 days.
5. People who have had any of the following in the past 6 months:
   • Sex at a commercial sex venue
   • Sex in association with a large public event
6. Sexual partners of people with the above risks
7. People who anticipate experiencing the above risks
    

As of 8/19/2022, 18,448 doses of Jynneos have arrived in NC. More doses will become available under phase 4 of the U.S. Department of Health and Human Service’s (HHS’s) National Vaccine Strategy.  A pilot program from the White House and HHS will also offer additional vaccines to states hosting large LGBTQI+ events. Find a list of vaccine locations.

Current vaccine administration and demographic data

General information on Mpox

Mpox is a rare disease caused by an orthopox virus typically found in West and Central Africa. As such, most cases in the US, prior to 2022, have been travel associated. A previous outbreak in 2003 associated with pet rodents did result in local transmission in the US.

The disease typically begins with a prodrome of fever, exhaustion, headache, and sometimes sore throat and cough. Lymph nodes may swell in the neck, armpits, or groin, on one or both sides of the body. Shortly after the prodrome symptoms, a rash appears. In some of the recent cases, the first symptom was a rash. The rash goes through four stages; flat (macular), to raised (papular), to fluid-filled (vesicular), to pus-filled (pustular) and may umbilicate (the center may open or sink in) before scabbing over and resolving. This happens over a period of 2-3 weeks. Lesions may be all over the body, including the palms, feet, and head, or located only on specific body parts such as the genitals or around the buttocks. The rash may be painful and during healing stages may itch.

Mpox Resources

Mpox Communications Toolkit

Resources for Providers, Community Partners, Correctional Entities, and Local Health Departments (LHDs):

• Communicable Disease Manual for LHDs
• Guidance for Correctional Entities _^(08/02/22)
• HBCU/MSI Student Health Director Memo _^(09/08/22)
• Interim Guidance for NC Healthcare Providers -Tecovirimat (TPOXX) in Treatment of Mpox _^(05/09/23)
  • Providers that wish to be added as an oral TPOXX site
• JYNNEOS Vaccine Standing Order - Template 1 _^(12/14/22)
• JYNNEOS Vaccine Standing Order - Template 2 _^(12/14/22)
• JYNNEOS FAQs _^(12/13/22)
• Mpox and Corrections Townhall Webinar _^(08/03/22) Recording, Slides, Q & A
• Mpox Collection and Submission Infographic _^(04/25/23)
• Mpox Infection Prevention Talking Points _^(09/01/22) 
• Mpox NCIR Inventory Management User Guide _^(08/05/22)
• Mpox Provider Enrollment Roadmap _^(08/16/22) 
• Provider Memo - Mpox and STIs - _^(10/24/22)
• Provider Memo - Mpox Prevention, Evaluation, and Response -  _^(12/01/22)
  • Mpox Update Webinar for Providers _^(09/08/22)  Recording, Slides, Q & A
• Providers interested in offering the mpox vaccine should start here: Mpox Vaccine Enrollment and Capacity Survey
• Quick Fact Sheet for Correctional Entities _^(08/02/22)
• Requesting Therapeutics 
• Take Pride Now
• Vaccine Toolkit    _^(12/15/22)
• Webinar (07/28/22) - Mpox Update for Providers
• CDC: Interim Clinical Treatment Considerations for Severe Manifestations of Mpox — United States, February 2023
• CDC: Clinical Considerations for Treatment and Prophylaxis of Mpox Virus Infection in People with HIV
• CDC: DCL - Mpox Considerations for Sexual Health Services
• CDC: DCL – Mpox Pain Management
• CDC: Interim Clinical Considerations for Use of JYNNEOS and ACAM2000 Vaccines during the 2022 U.S. Mpox Outbreak
• CDC: MMWR - Interim Guidance for Prevention and Treatment of Mpox in Persons with HIV Infection
• CDC: Toolkits for Community, Work, and School
• CDC: Videos Providing Mpox Recommendations and Updates from CDC Leadership and Partners
• CDCHAN-00490: Potential Risk for New Mpox Cases
• SAMHSA: DCL - SAMHSA Grant Resources for Mpox-related Activities

Resources for the Public

• Equity Data Report on Cases, Vaccines and Testing _^(08/10/22)
• Frequently Asked Questions _^(04/21/23) (Spanish) _^(04/21/23)
• Mpox Vaccine Locations | Mpox Treatment Locations 
• Mpox Pocket Guide (Spanish) _^(01/05/23)
• Mpox: Quick Facts (Spanish) _^(08/05/22)
• Mpox: What You Need to Know (Spanish) _^(04/21/23)
• NCDHHS Mpox Press Releases
• Town Hall, ENC and NCDHHS: How to Get Checked, Tested and Protected _^(07/29/22)
• Town Hall, ENC and NCDHHS _^(08/30/22) 
• Webinar, NCDHHS and NCAAN: The Mpox Files - The North Carolina Landscape _^(09/26/22) Recording, Slides
• HIV.gov: Video Resources - 14 Top Mpox Questions  
• CDC: General Information on the JYNNEOS and ACAM2000 Vaccines
• CDC: How to Prevent Mpox (Spanish)
• CDC: If You are Sick (Spanish)
• CDC: Mpox in Pets and Other Animals
• CDC: Mpox Resources and Updates (Spanish) 
• CDC: Mpox Vaccination Basics (Spanish) 
• CDC: Patient’s Guide to Mpox Treatment with TPOXX
• CDC: Schools, Early Care and Education Programs, and Other Settings Serving Children or Adolescents
• CDC: Social Gatherings, Safer Sex, and Mpox (Spanish)
• CDC: Travel Notices – Mpox in Multiple Countries
• CDC: Videos Providing Mpox Recommendations and Updates from CDC Leadership and Partners
• CDC: What You Need to Know About Mpox if You are a Teen or Young Adult (Spanish)
• WHO: Key Facts
• Zoonotic Diseases

Brief History of Mpox

It is most often found in small mammals such as rodents, including rats, mice, squirrels, rabbits, and prairie dogs. The first outbreak of mpox in the U.S. was reported in 2003 among people who got sick after coming in contact with infected pet prairie dogs. Historically, most cases of mpox occurred after a person came into contact with an infected wild animal or animal product.