Symptoms usually appear 7-14 days after exposure but can occur up to 21 days after exposure.

If you know that you have been exposed (close physical contact) to a person who had symptoms of mpox at the time of your exposure, you should contact your healthcare provider as you may be eligible for a post-exposure prophylaxis vaccine. Receiving the vaccine within 4 days of exposure can prevent infection and within 14 days of exposure can reduce symptoms.

You need to watch for symptoms, and if a rash develops, isolate and then seek medical attention for evaluation and testing.

If you are a close contact of a confirmed mpox case, please reach out to your local health department and or provider. Post-exposure prophylactic vaccination must be given within 14 days of exposure.

Mpox can spread to anyone through close, personal, often skin-to-skin contact, including:

• Direct contact with mpox rash, scabs, or body fluids from a person with mpox.
• Touching objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with mpox.
• Contact with respiratory secretions.

A person with mpox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2–4 weeks.

Protect yourself from getting mpox:

• Avoid close, skin-to-skin contact with people who have a rash that looks like mpox.
• Avoid contact with objects and materials that a person with mpox used.
• Wash your hands often.

Someone who has mpox can spread infection to others from the time symptoms start until the rash has fully healed (scabs have fallen off) and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks. People who do not have mpox symptoms cannot spread the virus to others. At this time, it is not known if mpox can spread through semen or vaginal fluids.

Here's guidance from the Centers for Disease Control and Prevention about how to clean at home.

Anyone with a rash that looks like mpox should talk to their healthcare provider, even if they don’t think they had contact with someone who has mpox. People who may be at higher risk might include, but are not limited to, those who:

• Had contact with someone who had a rash that looks like mpox or someone who was diagnosed with confirmed or probable mpox
• Had skin-to-skin contact with someone in a social network experiencing mpox activity; this includes men who have sex with men who meet partners through an online website, digital application (“app”), or social event (e.g., a bar or party)
• Traveled outside the U.S. to a country with confirmed cases of mpox or where mpox activity has been ongoing
• Had contact with a dead or live wild animal or exotic pet that exists only in Africa or used a product derived from such animals (e.g., meat, creams, lotions, powders, etc.)

Materials Needed for Collection and Handling Instructions - CDC

How to Collect Specimen and Protect Clinical Staff - CDC

Several commercial labs are now testing for orthopox virus which detects mpox. Please work with your lab staff to send specimen to these commercial labs: Aegis Science, Labcorp, Mayo Clinic Laboratories, Quest Diagnostics and Sonic Healthcare. Results will be transmitted to the IDOH. Prior IDOH authorization is not required to submit specimens to commercial laboratories.

If you are unable to submit to one of these five labs, you may submit a specimen for testing through the Indiana Department of Health (IDOH)

Specimens should be submitted via LimsNet, an online system that will make results available as PDF files the minute they are released at IDOH Laboratories. Specimens should be submitted through the Biothreat submission page in LimsNet. To get a free LimsNet account established at your facility for electronic submission and results reporting, call the help desk at (317) 921-5506 or email LimsAppSupport@health.in.gov.

Mpox Specimen Submission Instructions - IDOH (updated 8/10/22)
Mpox Virus Testing Considerations Prevent False Positive Test Results - CDC

Home Isolation Guidance - CDC
Contact the local health department for wraparound services to individuals in isolation.

Notifying Close Contacts - CDC
Contact the local health department for assistance with contact tracing.

If You're A Close Contact, What You Can Do - CDC

JYNNEOS (also known as Imvamune or Imvanex) is a  vaccine licensed by the U.S. Food and Drug Administration (FDA) for preventing mpox infection. In the United States, there is currently a limited supply of JYNNEOS, although more is expected in coming weeks and months.

On Aug. 9, the FDA authorized emergency use of JYNNEOS vaccine to increase vaccine supply by allowing healthcare providers to use the vaccine by intradermal injection for individuals 18 years of age and older who are determined to be at high risk for mpox infection.

The EUA now allows for an alternative regimen with an injection volume of 0.1mL to be administered between the layers of the skin (intradermally). Two doses of the vaccine given four weeks (28 days) apart will still be needed. This expanded EUA will means that each vial will have five doses rather than one, expanding the number of doses available to help contain the spread of mpox.

The EUA also allows the standard subcutaneous administration regimen for JYNNEOS with an injection volume of 0.5mL for anyone under 18 years old.

• JYNNEOS Vaccine Guidance (CDC)
• JYNNEOS Intradermal Administration
• JYNNEOS Cheat Sheet
• JYNNEOS Healthcare Provider Fact Sheet
• JYNNEOS Storage and Handling
• After vaccination palm card for patients (English and Español)

Use the Vaccine Administration and Consent (English)(Español) to ensure doses provided to your clinic have been administered and accounted for.

Ensure documentation for each JYNNEOS dose administered is documented here: Vaccine Administration and Consent Form. Providers do not have to fill out the separate CDC vaccine accountability form.

If you are a provider who has already been approved to receive and administer JYNNEOS vaccine, please use this link to reorder. Please note, upon receipt, we will be cross-referencing the doses administered and entered into the Vaccine Administration and Consent Form to ensure doses provided to your clinic have been administered and accounted for prior to distributing additional vaccine.

Pre-exposure Prophylaxis

• The Indiana Department of Health (IDOH) has consulted its statewide vaccine allocation committee about the equitable and ethical distribution of the JYNNEOS vaccine.
• Indiana has only been allocated a small amount meant to be used primarily to treat people who have been a close contact of a case to prevent severe disease.
• If you are a close contact of a confirmed mpox case, please reach out to your local health department and or healthcare provider.
• Post-exposure prophylactic vaccination must be given within 14 days of exposure.
• IDOH has begun to vaccinate people who are at high risk for severe illness and high risk for exposure with the limited remaining vaccine and has been contacting those patients directly.
• When the state is allocated more vaccine, we will expand vaccine eligibility to groups at high risk for exposure. Please continue to monitor this page for updates.

This form should be used for providers interested in administering JYNNEOS vaccine (PrEP) to their patients and/or community: Provider Enrollment for JYNNEOS Vaccine

Post-exposure Prophylaxis

The Centers for Disease Control and Prevention (CDC) recommends post-exposure prophylaxis for high or intermediate risk contacts of mpox cases.

JYNNEOS (also known as Imvamune or Imvanex) is licensed by the U.S. Food and Drug Administration (FDA) for preventing mpox infection. The sooner an exposed person gets the vaccine, the better. CDC recommends that the vaccine be given within 4 days from the date of exposure to prevent onset of the disease. If given 4–14 days after the date of exposure, vaccination may reduce the symptoms of disease but may not prevent the disease.

There is a limited supply of JYNNEOS, although more is expected in coming weeks and months. Please submit a PEP request form to order JYNNEOS for patients who have been exposed to a confirmed case.

Quick Reference Guide to Post-exposure Prophylaxis

Treatment

Tecovirimat (also known as TPOXX or ST-246) is FDA-approved for the treatment of human smallpox disease caused by Variola virus in adults and children. However, its use for other orthopoxvirus infections, including mpox, is not approved by the FDA. Therefore, CDC holds a non-research expanded access Investigational New Drug (EA-IND) protocol that allows for the use of tecovirimat for primary or early empiric treatment of non-variola orthopoxvirus infections, including mpox, in adults and children of all ages.

This request form is to be utilized by providers or local health departments (LHDs) only. Patients should contact their providers to inquire about obtaining TPOXX for treatment.

A unique survey entry must be completed for each individual TPOXX request.

Information for Healthcare Providers on Obtaining and Using TPOXX (Tecovirimat) for Treatment of Mpox from the CDC.

Information for Healthcare Providers on Using TPOXX (Tecovirimat) for Treatment of Mpox from ASPR.

Treatment Information for Healthcare Professionals - CDC
If a probable case (orthopox positive) is identified, IDOH will report the result to the clinician and facilitate a consultation call with CDC and the clinician for treatment assessment and ordering.

Information for Healthcare Professionals - CDC

Please utilize the pre-positioned TPOXX for patient treatment.

• Fill out the REDCap survey to share the usage with IDOH.
• If there is no TPOXX within your practice area, IDOH can relocate some from elsewhere in the state.
• If there is no pre-positioned TPOXX available to you, see if your patient qualifies for STOMP Clinical Trial.

If your patient does not qualify for STOMP please contact Colette Jacob, CJacob@health.in.gov, so the CDC can be contacted for consultation.

• Once your bottles/vials of TPOXX expire, please check ASPR for extensions that have been given. These are listed by lot number.
• Once you have verified that it is expired, dispose of the medication in the same manner that your location uses for all expired medications.
  • FDA Safe Disposal of Medicines