Commercial lab testing
Commercial laboratory testing is now available. Providers should submit specimens through commercial labs, if possible.
Testing will continue to be available through the Texas Department of State Health Services, with prior approval. This process is coordinated through Austin Public Health. Providers should contact 512-972-5555 to begin the submission process of monkeypox specimens for testing if commercial labs are not available.
Infection control guidelines
Standard Precautions should be applied for all patient care, including for patients with suspected monkeypox. If a patient seeking care is suspected to have monkeypox, infection prevention and control personnel should be notified immediately. Activities that could resuspend dried material from lesions, e.g., use of portable fans, dry dusting, sweeping, or vacuuming should be avoided.
A patient with suspected or confirmed monkeypox infection should be placed in a single-person room; special air handling is not required. The door should be kept closed (if safe to do so). The patient should have a dedicated bathroom. Transport and movement of the patient outside of the room should be limited to medically essential purposes. If the patient is transported outside of their room, they should use well-fitting source control (e.g., medical mask) and have any exposed skin lesions covered with a sheet, wound dressing, or gown. Intubation and extubation and any procedures likely to spread oral secretions should be performed in an airborne infection isolation room (AIIR).
PPE used by healthcare personnel who enter the patient’s room should include:
- Eye protection (i.e., goggles or a face shield that covers the front and sides of the face); and a
- NIOSH-approved particulate respirator equipped with N95 filters or higher.
Tecovirimat (TPOXX) information
Currently there is no treatment approved specifically for monkeypox virus infections. However, antivirals developed for use in patients with smallpox may prove beneficial against monkeypox. CDC provides Interim Clinical Guidance for the Treatment of Monkeypox.
Many people infected with monkeypox virus have a mild, self-limiting disease course in the absence of specific therapy. However, the prognosis for monkeypox depends on multiple factors, such as previous vaccination status, initial health status, concurrent illnesses, and comorbidities among others. More information can be found on the CDC’s Interim Clinical Guidance for the Treatment of Monkeypox.
For information regarding who is eligible for tecovirimat (TPOXX) treatment, see the CDC Guidance for Tecovirimat.
Tecovirimat may be considered for treatment in people infected with monkeypox virus:
- With severe disease (e.g., hemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalization)
- Who are at high risk of severe disease:
- People with immunocompromising conditions (e.g., HIV/AIDS, leukemia, lymphoma, generalized malignancy, solid organ transplantation, therapy with alkylating agents, antimetabolites, radiation, tumor necrosis factor inhibitors, high-dose corticosteroids, being a recipient with hematopoietic stem cell transplant <24 months post-transplant or ≥24 months but with graft-versus-host disease or disease relapse, or having autoimmune disease with immunodeficiency as a clinical component)
- Pediatric populations, particularly patients younger than 8 years of age
- Pregnant or breastfeeding women
- People with a history or presence of atopic dermatitis, people with other active exfoliative skin conditions (e.g., eczema, burns, impetigo, varicella zoster virus infection, herpes simplex virus infection, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis, or Darier disease [keratosis follicularis])
- People with one or more complication (e.g., secondary bacterial skin infection; gastroenteritis with severe nausea/vomiting, diarrhea, or dehydration; bronchopneumonia; concurrent disease or other comorbidities)
- With aberrant infections involving accidental implantation in eyes, mouth, or other anatomic areas where Monkeypox virus infection might constitute a special hazard (e.g., the genitals or anus)
For more information on the tecovirimat process at Austin Public Health and to initiate tecovirimat treatment for your patient, please follow the instructions here.
Can I charge my patient for Tecovirimat?
From the CDC, no, the drug should be provided at no cost. There is no funding available to assist with laboratory testing. Testing plasma PK samples collected and sent by the hospital to the lab contracted to test PK samples and/or blood or specimens sent via the health department to CDC for serology or virologic testing would not have a cost to the patient.
Additional provider information
- Monkeypox laundry guidance
- Monkeypox information sheet for health care providers
- Tecovirimat request process document
- Monkeypox testing information for providers
- What clinicians need to know about monkeypox
- Monkeypox guidance for congregate settings
- Texas DSHS monkeypox website
- WHO monkeypox website
- CDC monkeypox website