Monkeypox Update for Virginia

June 14, 2022

Dear Colleague:

Doubtless you have read in the news about the recent appearance of cases of monkeypox in the United States that are not connected with travel to endemic areas. Over 1,000 cases have been identified in multiple countries where monkeypox is not endemic; as of this date, none of these has resulted in a fatality; the US has counted fewer than 50 cases. Most, but not all, non-endemic cases have occurred in persons who identify as men who have sex with men (MSM).

At present it appears unlikely that most practitioners will encounter a case of monkeypox, but it is important to consider in patients with an unexplained rash, especially MSM, those with close contact with a known case of monkeypox, and those who have a history of travel to endemic areas. For a full description of information for clinicians, click here.

The clinical presentation may vary from classical monkeypox. Some patients reported little to no prodrome, with a skin lesion being the first or only symptom. Lesions may begin on or be confined to the genital and perianal regions, appearing similar to more common sexually transmitted infections, and coinfection with STIs may exist. Providers should maintain a high suspicion for monkeypox in patients with epidemiologic risk factors or rash illness consistent with monkeypox, even if the patient reports little or no prodrome. Immediately report suspected cases to the local health department (LHD).

If indicated, the LHD can facilitate public health testing, treatment for patients, and postexposure prophylaxis for high-risk close contacts. Testing is only available through Virginia’s state public health laboratory, DCLS, and requires 2-4 swabs of lesions on different body areas. No specific treatment has been approved in the US, but some treatment options may be beneficial. Treatments can be accessed through the federal government under an EA-IND protocol. Two vaccines, JYNNEOS and ACAM2000, are available for post-exposure prophylaxis. CDC recommends that vaccine be given within 4 days, and up to 14 days, from the date of exposure in high-risk contacts and considered for intermediate risk contacts on a case-by-case basis.

Please access the resources below as needed.

VDH Resources:

Again, please feel free to contact your local health department for additional information. Many thanks for your continued partnership.

Colin M. Greene, MD, MPH
State Health Commissioner

Attachment: VDH Info Sheet for HCP_060922