For Health Care Providers

Clinical Guidance and Resources

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TPOXX

MPX Tecovirimat treatment information for providers

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AlCo Health Advisories

Important information about the local MPX epidemic

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Case Reporting

Confidential Morbidity Report (CMR) Form

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CDPH Guidance

Health advisories and resources from CDPH and CDC

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CDC Guidance

Information for health care professionals

Mpox Updates (September 3, 2025)

There has been a recent increase in mpox in Alameda County, as well as other areas in the San Francisco Bay Area (see CDPH Health Advisory). In Alameda County, we have had a 4-fold increase in mpox cases since July 2025.

Mpox is characterized by a diffuse or localized rash; the rash can be preceded by a prodrome or other symptoms in some people (see CDC Clinical Features of Mpox). Mpox is usually transmitted by close and sustained physical contact. Mpox has two clades, Clade II was the cause of the large global outbreak in 2022, and is still circulating. Clade I mpox is primarily occurring outside the United States. Both clades are prevented by JYNNEOS vaccine (mpox vaccine). One dose of the vaccine has 36-75% efficacy, and two doses has 66-89% efficacy for prevention of mpox (see JYNNEOS Vaccine Effectiveness).

Providers should:

Test for mpox when a patient presents with new rash and other symptoms (see Compatible Signs and Symptoms).
Recommend mpox vaccination for persons at risk , and a second dose for anyone who has not completed the 2-dose series. Getting more than 2 doses (“booster”) is not recommended. In Alameda County, anyone who thinks they need the vaccine should get it.
Vaccines are available at many chain pharmacies and certain clinics—see Mpox Vaccine Locator. JYNNEOS (mpox) vaccine will also be available with limited supply at Oakland PRIDE, Oakland LGBTQ center, and Steamworks (9/5, 9/6, 9/9).
Ensure persons know the signs and symptoms of mpox illness so they are evaluated and tested in a timely way if they are symptomatic.
Submit a confidential morbidity report (CMR) to Alameda County Public Health Department for suspect and confirmed cases of mpox that reside in Alameda County.
Ask about planned travel and recommend mpox vaccine for those at risk.
For persons with suspect mpox that have had recent travel to specific locations or contact with someone with known mpox clade I, test for mpox Clade I. Contact Alameda County Public Health Department at sexualhealth@acgov.org and follow the procedures for testing for Clade I mpox by sending the test to the Viral and Rickettsial Disease Laboratory (VRDL).

Clinical Case Recognition of Mpox

Below are resources to support with clinical Mpox case recognition:

Clade I Mpox

Mpox infections caused by the clade I monkeypox virus (MPXV) are currently on the rise in the Democratic Republic of the Congo (DRC), and have begun spreading to neighboring countries. Recently, a case was detected in Sweden. As of now, no cases have been detected in the United States.

Clade I mpox is more infectious and more fatal when compared to the currently circulating mpox clade II.
Medical countermeasures being used in the current global outbreak, such as the mpox vaccine and antiviral medications like Tecovirimat (TPOXX), are expected to be effective against clade I mpox.
The World Health Organization has declared this outbreak a public health emergency of international concern.

Healthce providers should:

Continue to recommend mpox vaccination (JYNNEOS) for those who may be at risk for mpox; encourage patients with one dose to complete the two-dose series.
Ask all patients with mpox-like illness about 1. recent travel to DRC or neighboring countries; 2. being a close contact to travelers returning from these locations; and 3. contact with mpox clade I illness within the prior 21 days.
Conduct the following steps if the patient meets the criteria described above:
1. Notify the Alameda County Public Health Department by emailing SexualHealth@acgov.org;
2. Test for mpox with infection control practices, using a routine test kit; AND
3. Submit a specimen for clade-specific testing to the California Department of Public Health (see Mpox Virus Detection, CDPH).

Reporting Suspected or Confirmed Cases of Mpox

Report all probable (e.g., positive orthopox virus by PCR) or confirmed Mpox (e.g., positive Mpox virus by PCR) cases to ACPHD within 1 working day by submitting a completed Confidential Morbidity Report (CMR) form by fax to (510) 273-3744.

For any suspect case who has signs or symptoms of Mpox and resides in a congregate setting (e.g., homeless shelter, skilled nursing facility, correctional facility) while testing is pending, please review CDC guidance and ensure individuals can comply with guidance on isolation. Also, please notify ACPHD within 24 hours by calling (510) 267-3250 during business hours Monday through Friday 8AM to 5PM, and (925) 422-7595 after 5PM on weekdays and on weekends.

Case definitions for suspect, probable, and confirmed cases of monkeypox are provided by the CDC here: CDC Case Definitions for Use in the 2022 Monkeypox Response.

Pediatric Mpox Screening Resources

Pediatric Suspect MPX Screening Form 20220902

Minor Consent for Mpox Treatment

The Consent to Medical Services for the Treatment of Monkeypox (Mpox) in Minors is now live and can be found within the Information for Health Care Providers and also under the local health jurisdiction (LHJ) subpage, under the section for Vaccines Distribution and Administration.

Mpox Tecovirimat Treatment (TPOXX)

Many patients with mpox have a mild, self-limited disease and recover without medical intervention. Most patients with mpox who require treatment are being managed as outpatients. However, the prognosis for mpox depends on multiple factors, including immune status, previous vaccination, co-morbid, initial health status.

 Supportive Care Suggestions should be initiated for all patients who have mpox infection. This may include topical or systemic medications or other clinical interventions to control pain, itching, nausea and vomiting. Patients should be monitored closely to ensure resolution of illness without complications that would require further intervention. Patients with confirmed or suspected mpox should also be screened for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs).

Patients who are at high risk for severe disease or progress to severe mpox, despite supportive care and treatment, should be considered for prompt tecovirimat treatment. Tecovirimat (also known as TPOXX or ST-246) is an FDA-approved antiviral medication for the treatment of human smallpox disease in adults and children.

The Centers for Disease Control and Prevention (CDC) holds an expanded access Investigational New Drug (EA-IND) protocol that allows for the use of stockpiled tecovirimat to treat mpox during an outbreak. See CDC Guidelines for Tecovirimat Use for more details.