California Department of Public Health (CDPH) Dear Colleague Letter

This letter is a call to action to Californian health care providers to remain vigilant in mpox prevention, recognition, and testing, especially during the upcoming 2023 spring and summer season as people gather for festivals and events, including LGBTQ Pride Month in June.


CDC Health Update: Potential Risk for New Mpox Cases

Healthcare providers (HCP) are urged to remain diligent for possible mpox cases and should refamiliarize themselves with mpox presentation, specimen collection, testing procedures, treatment options, and reporting.


CDPH Advisory: Updates on Identification, Laboratory Testing, Management and Treatment, and Vaccination for Mpox Virus Infection in California

It is highly important to test for HIV and other sexually transmitted infections (STIs) when testing for mpox and providing HIV and STI treatment as soon as possible for those who test positive.

3/3/23 MMWR: Interim Clinical Treatment Considerations for Severe Manifestations of Mpox — United States, February 2023
11/4/22 CDC: Completing a Mpox-Related Death Certificate
10/18/22 CDC Science Brief: Detection and Transmission of Mpox Virus
8/23/22 Santa Cruz County Public Health JYNNEOS Mpox Vaccine Clinical Guidance has been updated

Report all Suspect mpox Cases to Santa Cruz County Public Health.

  • All suspect mpox cases must be reported within 1 working day to Santa Cruz County Communicable Disease Control, preferably by email or fax.
  • Please submit a Confidential Morbidity Report form by email to HSACD@santacruzcounty.us or by fax to (831) 454-5049.
  • Please note, providers do not need to report contacts to cases or potential exposures to Santa Cruz County Public Health.


For patients presenting with concern for mpox infection:

Commercial Reference Labs. Mpox testing is now available through LabCorp, Quest, ARUP and other reference labs are rapidly developing capacity to test.

  • For most Santa Cruz County Healthcare providers a commercial reference laboratory will be the best option for streamlined Mpox testing and resulting.
  • Please check with the reference lab regarding their lab-specific submission forms and requirements for specimen collection, labeling, and transport.
  • There is no need to contact Santa Cruz County Public Health for approval to test at commercial laboratories, but providers must still report all suspect cases within 1 working day.

Santa Clara County Public Health Lab is still accepting specimens for monkeypox testing reserved for abnormal clusters of cases and severely ill individuals, and uninsured or underinsured patients where other testing options are not available. For Public Health Lab specific submission forms and requirements for specimen collection please reference the Mpox PHL Testing Guidance.

There continues to be adequate vaccine supply. Vaccine providers can offer vaccine to any patients who may be at risk, and persons who request vaccination should receive it without having to attest to specific risk factors.

Storage, Handling, Expiration and Administration

Pediatric Vaccination

As of 8/9/2022, the FDA authorized emergency use of JYNNEOS vaccine for persons under 18 for subcutaneous administration. Please review the EUA fact sheet.

If you are a provider in need of JYNNEOS vaccines or have any questions, please reach out immunizations@santacruzcounty.us.

People with suspected mpox should isolate while awaiting testing results and if confirmed positive, continue isolation until all lesions are healed or criteria are met per the CDPH Mpox Home Isolation Guidance for the General Public.

Supportive care and treatment of symptoms should be initiated for all patients with suspected mpox infection. This may include topical medicines or other clinical interventions to manage symptoms with particular focus on management of pain and pruritis. Please see NYC Health treatment guidance and CDC resources below.

Tecovirimat (also called TPOXX), an antiviral medication available through an expanded access Investigational New Drug (EA-IND) protocol for the treatment of mpox infection, is available—see ordering information below.

Providers should consider tecovirimat treatment for high-risk suspect cases who have pending lab testing results and suspect cases who are experiencing severe symptoms.

Antiviral treatment of mpox infection should be considered for people with severe infection, illness complications (including pain not controlled with supportive care), and risk factors for progression to severe infection (children <8 years of age, immunocompromised or pregnant people, or those with a history of atopic dermatitis or eczema). Antiviral treatment (such as with TPOXX) should not be considered a substitute for pain management.

CDC TPOXX Required Paperwork

Ordering TPOXX

To place an order for TPOXX, please fill out the linked TPOXX Resource Request Form and CDPH’s TPOXX Request and Data Collection Form and email it to immunizations@santacruzcounty.us. A member of our team will confirm receipt of your request and begin processing your order. Orders will be shipped directly to the address listed on your resource request form. Please note, the CDC required TPOXX paperwork must be completed within seven (7) days of TPOXX treatment initiation.