Orange County Health Care Agency (OCHCA) has been notified of its first probable monkeypox virus case. Probable cases are those who test positive for orthopoxvirus DNA by polymerase chain reaction (PCR) assay. Probable cases will be sent to the Centers for Disease Control and Prevention (CDC) for monkeypox virus confirmation. Probable cases are managed as monkeypox virus cases while awaiting laboratory confirmation.

The case met epidemiologic criteria, specifically, men who have sex with men (MSM). The case did have prodrome but has not required hospitalization for his illness. We are currently investigating to identify any contacts and additional cases.

The 2022 monkeypox outbreak continues to evolve, with over 4,000 cases identified in previously non-endemic countries, and 244 cases (as of 6/27/22) in 27 states in the US. In Southern California, 28 cases have been reported by Los Angeles County Department of Public Health (as of 6/29/22) and 4 cases in San Diego County (as of 6/24/22).

Epidemiologic criteria for consideration of monkeypox include any of the following within 21 days of illness onset:

• Reports having contact with a person or persons with a similar appearing rash or with a person who has received a diagnosis of confirmed or probable monkeypox OR
• Had close or intimate in-person contact with persons in a social network experiencing monkeypox infections. This includes MSM who meet partners through an online website, digital application (“app”), or social event (e.g., a bar or party) OR
• Traveled within 21 days of illness onset outside the United States to a country with confirmed cases of monkeypox or where Monkeypox virus is endemic OR
• Had contact with a dead or live wild animal or exotic pet that is an African endemic species, or used a product derived from such animals (e.g., game meat, creams, lotions, powders, etc.)

Images of rash associated with monkeypox virus infection are available on the CDC HAN as well as on the OCHCA monkeypox website.

Suspect cases of monkeypox are advised to isolate, while awaiting lab results. Most cases have not required hospitalization and can safely isolate at home. The CDC provides guidance and considerations for home isolation on their website, Isolation and Infection Control: Home.

PPE used by healthcare  providers evaluating patients with suspect, probable, or confirmed monkeypox should include:

• Gown
• Gloves
• Eye protection (i.e., goggles or a face shield that covers the front and sides of the face)
• NIOSH-approved particulate respirator equipped with N95 filters or higher

Additional, information is available through the CDC’s page Infection Prevention and Control of Monkeypox in Healthcare Setting.

No commercial testing for monkeypox is available. Requests for testing must come via local public health authorities. If you suspect that you have a patient with Monkeypox contact the OCHCA Communicable Disease Control Division at 714-834-8180 immediately,  and we can discuss the case and if appropriate arrange testing of specimens. Follow this this link for information on appropriate specimen collection requirements. 

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