Mpox Updates for Virginia
December 11, 2023
Dear Colleague:
This letter provides mpox updates on an outbreak in the Democratic Republic of the Congo, recommendations for providers, and upcoming trainings in early 2024.
Democratic Republic of Congo Mpox Update
On December 7, the Centers for Disease Control and Prevention (CDC) released a Health Alert Network (HAN) health advisory, Mpox Caused by Human-to-Human Transmission of Monkeypox Virus with Geographic Spread in the Democratic Republic of the Congo (DRC). Although Clade I Monkeypox virus (MPXV) is endemic in DRC, there has been a significant increase in cases in 2023, with more than 12,000 clinically-diagnosed cases, more than 500 deaths, and geographic expansion into new areas. Clade I MPXV historically has been associated with person-to-person spread through non-sexual contact. For the first time, Clade I MPXV has been documented to spread by sexual contact, including cases in men who have sex with men.
The global mpox outbreak that began in May 2022 was caused by a different virus subtype (Clade II MPXV) that is less virulent and less transmissible than Clade I. Cases continue to be reported in the United States and have mostly affected gay, bisexual, and other men who have sex with men. CDC has tested a subset of specimens from U.S. cases, and all have been caused by Clade II MPXV. Although the risk of Clade I MPXV infections in the U.S. is low, providers should have a high index of suspicion in patients with recent travel to DRC and mpox-like symptoms, which may include a diffuse rash and lymphadenopathy.
VDH Recommendations for Providers
VDH encourages providers to collect a detailed travel and sexual health history on all patients with suspected mpox. For patients with travel to DRC in the 21 days before symptom onset, providers should rapidly report the case to the local health department (LHD) by phone or in VDH’s online Morbidity Report Portal and collect two swabs per lesion for mpox testing Currently, the Division of Consolidated Laboratory is validating a clade-specific test. Until that test is available at DCLS, specimens that are pre-approved by the LHD should be sent to DCLS for testing at CDC. Providers can submit specimens to commercial laboratories for testing of patients with suspected mpox who do not report travel to DRC in the 21 days before symptom onset.
VDH encourages providers to recommend JYNNEOS vaccine for people at risk of mpox. Vaccination is one of the best prevention measures. JYNNEOS is expected to be effective against Clade I and Clade II MPXV infections. In addition, treatments (e.g., tecovirimat, brincidofovir) are expected to be effective for both Clade I and Clade II MPXV infections.
Most patients who have recovered from mpox (including infection with Clade II MPXV) or have been vaccinated with JYNNEOS or ACAM2000 are expected to have cross-protection to Clade I MPXV. However, clinicians are recommended to consider mpox as a possible diagnosis if a consistent clinical presentation occurs, even in those who are vaccinated or were previously diagnosed with mpox. Providers who suspect mpox should also test sexually active patients for STIs and HIV per their routine procedures.
Upcoming VDH Training for Providers
In January and February 2024, VDH will host four regional mpox trainings. These free, in-person trainings are intended for healthcare providers, including those who care for patients at risk of getting mpox and those who provide HIV or STI care services. VDH staff and local clinicians will share information about mpox epidemiology, testing and treatment strategies, vaccination, incorporating mpox into routine HIV and STI care, and lessons learned during the 2022–2023 outbreak. We will provide a maximum of three AMA PRA Category 1 Credits™ for the training. Providers can register or learn more by visiting the VDH Mpox Training webpage.
| Location | Date (all sessions are 8:30 A.M–12:30 P.M.) |
| Fairfax (Northern session) | Tuesday, January 23, 2024 |
| Charlottesville (Central/Northwest session) | Wednesday, January 31, 2024 |
| Wytheville (Southwest session) | Thursday, February 8, 2024 |
| Chesapeake (Eastern session) | Wednesday, February 14, 2024 |
Thank you again for your continued partnership. Please visit the VDH mpox website for healthcare providers for the most current information about mpox in Virginia.
Sincerely,
Karen Shelton, MD
State Health Commissioner