Monkeypox Toolbox (CAC users only) [https://olb.navy.awesp.health.mil/sites/nmcphc/pps/SiteAssets/WebPartPages/Monkeypox-Toolbox.aspx]: This toolbox provides guidance and references to support prevention and response activities to the 2022 Monkeypox outbreak. Resources will be updated regularly to ensure the most relevant and accurate information is available.
 
Overview: Since May 2022, more than 1,800 cases of Monkypox have occurred globally, with >80% of cases occurring in Europe. As of June 14, 65 cases have been reported in the U.S., and at least 47 other countries have reported cases. Globally cases continue to be reported at a rate of approximately 85 per day. Several Active Duty cases have been identified, and likely, a small number of additional cases will continue to emerge. Most cases have been identified through sexually transmitted infection (STI) clinics, with 94% of cases occurring in men who have sex with men (MSM). Monkeypox can be serious, with this strain demonstrating a 1% mortality. Clinicians, particularly in STI clinic settings should have a high clinical suspicion of Monkeypox, particularly in patients who identify as MSM and present with rashes and fever. All suspected cases should be isolated and referred to a level of care in which definitive testing and treatment can occur.  
 
Force Health Protection Measures: Currently, World Health Organization (WHO) assesses the global risk of Monkeypox as moderate. Risk to U.S. Military forces remains low, although sporadic cases are expected. Transmission is through close contact with body fluids, which can be present in skin lesions, scabs and clothing/linens of affected individuals. Navy and Marine Corps Public Health Center (NMCPHC) recommends Navy and Marine Corps units remain alert and follow standard public health safeguards to include proper handwashing and good hygiene, avoid shared clothing/linens and a renewed emphasis on safe sexual practices.  Suspected cases should be immediately isolated until definitive testing is completed.
 
Medical Surveillance: Local preventive medicine surveillance activities should include regular outreach to STI, primary care, and other providers to enhance clinical suspicion and reporting. Preventive medicine staff should be notified immediately when cases are suspected to ensure completion of appropriate contact tracing and reporting. Post-exposure vaccination may be indicated for a close contact and should be administered as quickly as possible for maximum effectiveness.
 
Providers at all levels should be aware of the clinical presentation of Monkeypox, details of which can be found on the Centers for Disease Control and Prevention (CDC’s) website: https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html
Monkeypox can be serious, and neither testing nor treatment is readily available in a forward deployed setting. DHA has provided guidance for both testing and treatment, but the importance of early medical reach back cannot be understated. For testing and treatment options in the DoD, see Defense Health Agency Memo on Clinical Guidance for Monkeypox Infections [https://olb.navy.awesp.health.mil/sites/nmcphc/pps/SiteAssets/WebPartPages/Monkeypox-Toolbox.aspx] or reach out to the Immunization Healthcare Division’s 24/7 Support Center at 877-438-8222.
 
ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) may be used to supplement the surveillance activities above. However, the existing rash, dermatologic, and cutaneous lesions widgets are too general to track an uncommon disease like Monkeypox. Armed Forces Health Surveillance Division (AFHSD) has created a more specific Monkeypox query using the WHO case definition [https://www.who.int/emergencies/outbreak-toolkit/disease-outbreak-toolboxes/monkeypox-outbreak-toolbox#:~:text=to%20the%20illness-,Confirmed%20case,(PCR)%20and%2For%20sequencing] which Navy medical departments in areas with Monkeypox cases may find useful to supplement case finding efforts. Navy ESSENCE users who are interested in using this query should reach out to their area Navy Environmental Preventive Medicine Unit (NEPMU) [https://www.med.navy.mil/Navy-Marine-Corps-Public-Health-Center/Field-Activities/] or the DRSi helpdesk at usn.hampton-roads.navmcpubhlthcenpors.list.nmcphc-ndrs@mail.mil.
 
Reporting: Reporting ensures situational awareness and Service/DOD-wide collation and tracking of the disease. Navy medical departments should immediately report suspected, probable, and confirmed cases of Monkeypox to the (1) local/regional Public Health Emergency Officer (PHEO), (2) area NEPMU [https://www.med.navy.mil/Navy-Marine-Corps-Public-Health-Center/Field-Activities/] as described below, and (3) local, state and/or host nation public health officials. NEPMU staff may be able to guide/assist in the reporting process.
 
Reporting to the NEPMU should occur via Disease Reporting System internet (DRSi) whenever possible. Operational units without adequate internet access should report via message, phone, or email. Cases should be entered into DRSi using the diagnosis category “any other unusual event” and reports should include comments regarding recent travel history, exposure history, and high-risk activities. Further information on reporting, to include how to obtain an account, is available at NMCPHC’s Medical Surveillance and Reporting webpage [https://www.med.navy.mil/Navy-Marine-Corps-Public-Health-Center/Preventive-Medicine/Program-and-Policy-Support/Disease-Surveillance/] or by contacting the DRSi helpdesk at usn.hampton-roads.navmcpubhlthcenpors.list.nmcphc-ndrs@mail.mil.   
 
NEPMU Threat Assessment: NEPMUs conduct country threat assessments regularly. For pre-deployment information, case investigation support, risk assessment, and assistance in obtaining definitive laboratory testing contact your NEPMU [https://www.med.navy.mil/Navy-Marine-Corps-Public-Health-Center/Field-Activities/].