MPOX

Information for Health Departments

World Health Organization (WHO) Declares Mpox a Global Health Emergency

The mpox virus has two genetic clades: I and II. Clade I is endemic to central Africa, and Clade II to west Africa. A subclade of Clade II (Clade IIb) has been associated with the 2022-23 mpox outbreak that has predominantly affected gay, bisexual, or other men who have sex with men (MSM) in the United States and globally. Clade I is more contagious and causes more severe illness than Clade II.

On August 14, 2024, the World Health Organization (WHO) labeled the outbreak in the Democratic Republic of the Congo (DRC) a Public Health Emergency of International Concern. TThis outbreak, resulting from the Clade 1 virus, is more widespread than previous outbreaks the DRC has seen. It has resulted in clade I mpox transmission in multiple countries including Burundi, Central African Republic, Rwanda, and Uganda. Travel-associated clade I cases have also been reported in Germany, India, Kenya, Sweden, Thailand, the United Kingdom, Zambia and Zimbabwe so far in 2024.

The first case of clade I mpox in the United States was detected in California in November 2024 following the patient's travel to an affected area. The North Carolina Department of Public Health Division is urging those who may be at risk to get vaccinated. This recommendation will help prevent mpox cases linked to international travel from spreading in North Carolina communities. Vaccination with the 2-dose JYNNEOS vaccine series can protect against mpox infection from both Clades I and II and can reduce severity of illness if infection does occur
 

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 

Current vaccine administration and demographic data

Vaccines are free and available, regardless of immigration status. Vaccination can protect against mpox infection or to reduce disease severity if infection does occur. NCDHHS has expanded the vaccine eligibility criteria to include:

• Anyone who has or may have multiple or anonymous sex partners; or
• People who know or suspect they have been exposed to mpox in the last 14 days; or
• Anyone else who considers themselves to be at risk for mpox through sex or other intimate contact; or
• Anyone whose sex partner is eligible per the criteria above; or
• If you are traveling to a country with a clade I mpox outbreak and anticipate any of the following activities during travel, regardless of gender identity or sexual orientation:
  • Sex with a new partner
  • Sex at a commercial sex venue (e.g., a sex club or bathhouse)
  • Sex in exchange for money, goods, drugs, or other trade
  • Sex in association with a large public event (e.g., a rave, party, or festival)

Find a vaccine location

• Providers interested in offering the mpox vaccine should start here: Mpox Vaccine Enrollment and Capacity Survey
• Enrolled providers can request vaccines here: Vaccine Request Link

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
• Communication Relevant to Mpox for People Living with HIV (PLWH) _^(02/08/24)
• Guidance for Correctional Entities _^(08/02/22)
• HBCU/MSI Student Health Director Memo _^(09/08/22)
• JYNNEOS Vaccine Standing Order - Template 1 _^(12/14/22)
• JYNNEOS Vaccine Standing Order - Template 2 _^(12/14/22)
• JYNNEOS FAQs _^(12/13/22)
• Making Mpox Vaccine Recommendations: Additional Considerations _^(07/26/24)
• 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 _^(01/25/24) 
• Mpox Update Provider Memo _^(12/16/24) 
• Mpox Update Webinar for Providers _^(09/08/22)  Recording, Slides, Q & A
• Mpox Vaccine Equity Event Toolkit _^(12/02/24) Spanish _^(12/02/24)
• Mpox Vaccine Toolkit    _^(12/15/22)
• Providers interested in offering the mpox vaccine should start here: Mpox Vaccine Enrollment and Capacity Survey
• Enrolled providers can request vaccines here: Vaccine Request Link
• Provider Memo - Mpox and STIs - _^(10/24/22)
• Provider Trainings arranged through NCHTEC _^(02/28/24)
• Quick Fact Sheet for Correctional Entities _^(08/02/22)
• Take Pride Now
• Webinar (07/28/22) - Mpox Update for Providers
• CDC: Interim Clinical Treatment Considerations for Severe Manifestations of Mpox — United States, February 2023
• CDC: Clinical Overview of Mpox
• CDC: DCL - Mpox Considerations for Sexual Health Services
• CDC: Interim Clinical Considerations for Use of Vaccine for Mpox Prevention in the United States
• CDC: Clinical Considerations for Mpox in Immunocompromised People 
• CDCHAN-00490: Potential Risk for New Mpox Cases
• NCSH: Toolkit to Help Providers Educate Patients
• SAMHSA: DCL - SAMHSA Grant Resources for Mpox-related Activities

Resources for the Public

• Mpox Equity Report Update _^(08/15/23)
• Equity Data Report on Cases, Vaccines and Testing _^(08/10/22)
• Frequently Asked Questions _^(09/22/23) (Spanish) _^(04/21/23)
• Mpox Pocket Guide (Spanish) _^(01/05/23)
• Mpox: Quick Facts (Spanish) _^(08/05/22)
• Mpox: What You Need to Know _^(09/22/23)  (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 Mpox Vaccine
• CDC: Preventing Mpox
• CDC: If You are Sick
• CDC: Mpox Resources and Updates
• CDC: Social Gatherings, Safer Sex, and Mpox
• CDC: What You Need to Know About Mpox if You are a Teen or Young Adult 
• 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.