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Mpox

Mpox

In August 2022, the U.S. declared mpox a public health emergency shortly after WHO named mpox a global health emergency. The outbreak is impacting patients, communities, pharmacists, and other health care professionals worldwide.
Under the PREP Act, HHS authorizes pharmacists, pharmacy interns and pharmacy technicians, as appropriate, to administer mpox vaccines and therapeutics, under certain conditions.
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Background

The mpox virus is an orthopoxvirus and belongs to the same family of viruses as smallpox. Symptoms of mpox resemble those of smallpox, although they are less severe and seldom deadly.

For individuals at high risk of contracting mpox, taking steps to reduce transmission is key. Vaccination strategies are critical for prevention (pre-exposure prophylaxis) and following exposure (postexposure prophylaxis) to prevent the disease or reduce symptom severity. Testing and treatment are available for individuals who believe they may have contracted the virus.

Signs and symptoms

  • Lesions are a key characteristic of mpox. The lesions form a rash that may be limited to a few lesions or more widespread across the body. The lesions are commonly located on or near the genital regions and can present on other areas like the hands, feet, chest, face, or mouth. Rashes associated with mpox can initially appear like pimples or blisters and may be painful or itchy, and they will go through several stages, including scabs, before healing.
  • Other symptoms include fever, chills, swollen lymph nodes, exhaustion, muscle aches and backache, headache and respiratory symptoms (e.g., sore throat, nasal congestion, or cough).

Vaccines

CDC recommends vaccination for

  1. People who have been exposed to mpox
    • Administer within 4 days from the date of exposure to prevent onset of the disease.
    • If it is given within 4–14 days from the date of exposure, vaccination may reduce symptoms of disease but may not prevent the disease.
  2. People who may be more likely to get mpox, including
    • People who have been identified by public health officials as a contact of someone with mpox
    • People who are aware that at least one of their sexual partners in the past two weeks has been diagnosed with mpox
    • People who had multiple sexual partners in the past two weeks in an area known to have mpox infections
    • People whose jobs may expose them to orthopoxviruses

Two vaccines are available to protect against mpox:

CDC recommendations for coadministration with COVID-19 vaccines

  • Individuals, particularly adolescent or young adult males, consider waiting 4 weeks after orthopoxvirus vaccination (either JYNNEOS or ACAM2000) before receiving a Moderna, Novavax, or Pfizer-BioNTech COVID-19 vaccine.
  • This updated guidance is due to the observed risk for myocarditis and/or pericarditis after receipt of ACAM2000 orthopoxvirus vaccine and mRNA (i.e., Moderna and Pfizer-BioNTech) and Novavax COVID-19 vaccines as well as the unknown risk for myocarditis and/or pericarditis after JYNNEOS administration.

Testing and treatment

Testing can be used to confirm a mpox infection if a rash is present. Pharmacists and pharmacy team members can encourage patients to reach out to their local health department if the patient believes they may have mpox or have been exposed to someone who has mpox.

Currently, there are no therapies approved for mpox infections. However, antivirals used to treat smallpox may be beneficial against mpox. Available treatments are largely reserved for individuals at risk of severe disease.

Pharmacists should be aware of the following treatment options:

Addressing stigma

It is important that pharmacists promote accurate and appropriate information to patients and use language that is medically appropriate and unbiased. To learn more about addressing the stigma around mpox, reference CDC’s resources on reducing stigma in mpox communication and community engagement and health equity guiding principles for inclusive communication.