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RIDOH Provider Advisory

May 24, 2022

Monkeypox: Key Points for Rhode Island Clinicians

The Rhode Island Department of Health (RIDOH) is sharing key points and information as a follow-up to CDC Health Advisory Network (HAN) Health Advisory 466, Monkeypox Virus Infection in the United States and Other Non-endemic Countries—2022, distributed on May 20.
 
Background
Multiple cases of monkeypox have been reported in May in several countries that do not normally report monkeypox, including in Europe and North America. A United States case involving a Massachusetts resident was reported on May 18, 2022. There have been no suspected cases reported in Rhode Island at this time. Like health departments nationwide, RIDOH is engaged in active case finding in partnership with CDC.
 
Action Steps: Identify, Isolate, Inform
RIDOH believes that an informed provider community is a prepared provider community. In the interest of awareness and preparedness, here are some important key points for providers to know.
 
Providers are urged to remember three key steps: Identify, Isolate, Inform.

IDENTIFY: Providers should consider monkeypox in a differential diagnosis in patients with new onset rash and lymphadenopathy

  • Monkeypox remains exceedingly rare in the United States.
  • A provider should consider the following risk factors when considering a monkeypox diagnosis:
    • Travel to areas with endemic monkeypox or recent cases of monkeypox.
    • Contact with a person with monkeypox or an unusual rash.
    • Men who report sexual contact with other men.
  • A monkeypox rash is defined by the following characteristics:
    • Lesions are well circumscribed, deep-seated, and firm.
    • Lesions may umbilicate or become confluent.
    • Lesions typically start on face and extremities (centrifugal).
    • Lesions appear on palms of hands and soles of feet.
  • While initial generalized symptoms (fever, headache, etc.) are common, many recent cases have started with a rash.
  • While the rash classically appears on extremities and the face, lesions may present initially on the genitals or perianal area.
  • Providers who diagnose and treat sexually transmitted infections should also consider monkeypox in patients with new onset perianal or genital lesions.
ISOLATE: Any suspected cases of monkeypox should be placed in a negative air pressure room as soon as possible.
  • If a negative pressure room is unavailable, place patients in a private exam room.
  • Use proper PPE while treating patients: gloves, gown, N95, and eye protection.
  • Minimize the number of providers caring for a patient.
  • If possible, hold patient until RIDOH is contacted.
  • A person in infectious from symptom onset (whether prodrome symptoms or rash) until lesions. have crusted, fallen off, and grown new skin, typically around 14 days.
  • Additional infection control measures can be found here.
INFORM: Any suspected cases of monkeypox must be immediately reported to RIDOH by calling 401-222-2577 (8:30 a.m.-4:30 p.m. Monday-Friday) or 401-276-8046 (after hours).
  • RIDOH staff will support and case manage the whole process of specimen collection and submission in real time.
  • Once a case is lab confirmed, RIDOH will conduct contact tracing and put contacts on active symptom monitoring. Contacts do not need to be quarantined.
  • If a patient needs hospital medical attention, RIDOH will assist in coordinating transportation and hospital arrival.
 
RIDOH will offer an update on Monkeypox at Public Health Out Loud—Grand Rounds on Wednesday, June 1, from 12-1 p.m.
  • Dr. Eleftherios Mylonakis, MD, PhD, FIDSA, chief of infectious diseases at Rhode Island and The Miriam hospitals and Dr. Philip Chan, MD, MS, RIDOH consultant medical director, will provide an update on monkeypox.
  • Call-in information will be distributed on Friday, May 28.
Remember:
  • Identify patients with rashes consistent with monkeypox.
  • Isolate suspected cases in negative-pressure or private rooms.
  • Inform RIDOH immediately of any suspected cases.
Resources
  • RIDOH monkeypox web page
  • Clinician Outreach and Communication Activity (COCA) Call, Webinar, May 24, 2022 - What Clinicians Need to Know about Monkeypox in the U.S. and Multiple Countries. The session will be archived here.
Rhode Island healthcare providers

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