Monkeypox virus

Updated 8/5/22, 12:00 pm

 

An ongoing, global outbreak of Monkeypox continues to spread in the US and Wisconsin. Testing is now available in several national reference laboratories. Refer to CDC and Wisconsin resources for guidance on which patients to test. This is an evolving situation, and testing guidance may change in the future.

 

Resources

  • CDC Monkeypox webpage
  • MMWR: Epidemiologic and Clinical Characteristics of Monkeypox Cases, August 5, 2022
  • CDC Health Alert Network, HAN 466: Monkeypox Virus infection in the United States and other non-endemic countries.
  • CDC Health Alert Network, HAN 468: Updated Case-finding Guidance: Monkeypox Outbreak – United States, 2022.
  • CDC Health Alert Network, HAN 471: Update for Clinicians on Testing and Treatment for Monkeypox
  • Wisconsin DHS Monkeypox webpage and Monkeypox resource
  • Wisconsin DHS Health Alert Network, HAN #44: Monkeypox: Recommendations for Detection and Reporting
  • Wisconsin DHS Health Alert Network, HAN #46: Monkeypox Detected in Wisconsin Resident
  • Wisconsin DHS Health Alert Network, HAN #47: Expanded Monkeypox testing.
  • APHL Monkeypox Biosafety Fact sheet for laboratorians

 

Public Health Testing Eligibility

  • Patients must have lesions and symptoms consistent with monkeypox and meet one or more of the following public health testing criteria to qualify for fee-exempt testing at the Wisconsin State Laboratory of Hygiene.
    • Patient is uninsured or underinsured (for whom cost would pose a barrier to getting tested).
    • The patient’s clinician is unable to send specimens to one of the commercial or clinical labs conducting monkeypox testing.
    • Patient is a known contact to a monkeypox case.
    • Patient reported skin-to-skin contact with someone in a social network experiencing monkeypox activity; this includes men who have sex with men.
    • Other priority testing (such as patients from areas with confirmed cases of monkeypox) as authorized by DHS.
  • Note: If testing is needed on a patient not meeting these criteria, please consider testing at a reference laboratory. These specimens will not be tested or forwarded by Wisconsin State Laboratory of Hygiene (WSLH).

Specimen Collection

  • Collect two paired swabs from at least one lesion. If possible, submit paired specimens from multiple lesions on different body parts and with different appearances. Swab or brush lesions vigorously. De-hooding the vesicles prior to swabbing is recommended but not required. Acceptable swab types include sterile nylon, polyester, rayon or dacron swabs with a plastic shaft. (No cotton swabs or swabs with wooden shafts).
  • Dry swabs are preferred, but lesion crusts in dry containers or swabs in viral transport media (VTM) are also accepted. Please note that specimens submitted in UTM are not acceptable at this time.
  • Break off and send swab ends, the handles are not needed. Place each swab or lesion crust in a separate sterile container and each container in a separate biohazard bag. Clearly label each specimen container with the patient name and date of birth, date and time of collection, the type of specimen collected and the exact body site it was collected from (important for identifying paired specimens). (NOTE: Swab snapping instructional videos created for COVID testing may be helpful for Monkeypox testing submitters. Scroll down the WSLH COVID-19 web page to find the videos.)

Testing

  • WSLH uses an RT-PCR test for non-variola orthopox viruses using CDC LRN protocols.
  • If a specimen tests positive for a non-variola orthopox virus WSLH will report the results to the submitter, WDHS, and the CDC. Due to the ongoing outbreak, a positive result is currently presumptive for West African clade Monkeypox.
  • The second, paired specimen may be sent to the CDC for monkeypox virus- specific testing. Please do not send specimen directly to the CDC. If a second swab is not submitted to WSLH there will be no monkeypox specific testing at CDC.
  • All Monkeypox testing is fee-exempt. The submitter and patient will not receive a bill.
  • Routine testing is available, Monday-Friday. Pre-approval for routine testing is no longer required. If weekend testing is needed contact the WI Department of Health Services (WDHS) Bureau of Communicable Diseases (BCD) at (608-267-9003 or 608-258-0099 after hours). The WDHS will screen suspect cases and notify the WSLH if weekend testing is approved. Otherwise, specimens arriving on the weekends without pre-approval will be tested the following Monday.

Storage

  • Refrigerate (2–8°C), or freeze (≤ -20°C) within an hour of collection. Refrigerated specimens expire after 7 days and frozen specimens after 60 days. Specimens that are expired upon receipt at WSLH or CDC will be rejected.

Packaging and Transport

Submit all specimens with a completed Requisition Form A. Write in monkeypox in the “other” section of the form. You can request forms from WSLH Clinical Orders at 1-800-862-1088 or WSLH Customer Service at 1-800-862-1013.

  • Place a completed Form A for each specimen in the outside pocket of each biohazard bag. DO NOT place the completed form inside the bag touching the specimen.
  • Package the specimen as Category B (UN3373 biological substance). Ship with frozen cold packs at a minimum, dry ice is strongly recommended.
    • Specimens received ≥8°C will be rejected.
    • Refrigerated specimens expire after 7 days but frozen specimen may be test up to 60 days post collection
  • Gold Cross courier service (1-800-990-9668) may be used to transport suspect Monkeypox specimens fee exempt to the WSLH.
    • Order by NOON for same-day pick-up for NEXT DAY delivery (Sun-Fri)
    • Specimen received on Saturday will be tested on Monday.
    • Please hold specimen (4 to -80C) on Saturday so they don’t sit in a warehouse over the weekend.

Specimen Rejection Criteria

  • Specimens received at room temperature
  • Specimen received outside of the acceptable storage range
  • Specimens without 2 patient identifiers
  • Unvalidated specimen types (blood, saliva, calcium alginate swabs, cotton tips, or wood shafts)

CDD Customer Service Hours:

  • Monday-Friday: 7:45 AM – 4:30 PM

CDD Specimen Receiving Hours:

  • Monday-Friday: 6:00 AM – 4:30 PM
  • Saturday: 6:30 AM – 12:30 PM

Contact Information:

  • CDD Customer Service: 1-800-862-1013
  • Clinical Orders: 1-800-862-1088
  • Gold Cross Courier: 1-715-839-9989