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    Case Definitions Clinical Overview Clinical Features Vaccine for Mpox Prevention in the U.S. Diagnostic Testing Clinical Care Infection Control Guidance Laboratory Information View All
September 13, 2024
  Reporting Results from Orthopoxvirus, Non-Variola Orthopoxvirus, and Mpox Virus Diagnostic Testing
          What to know
            * Timely and comprehensive laboratory testing and result reporting is a critical piece of the public health response to mpox.
            * These data help public health officials understand more about the spread of the mpox virus.
            * Testing and result data can help predict increases in testing demand and plan for potential supply chain issues for reagents and other testing materials.
        Who should report
          * Any laboratory that performs diagnostic testing for mpox should report test results to state, tribal, local, or territorial (STLT) health departments. This includes real-time polymerase chain reaction or PCR testing for orthopoxvirus, non-variola orthopoxvirus, or Monkeypox virus.
          * Report all results (positive, negative, equivocal) unless otherwise specified by the applicable health department.
              + Report positive results within 24 hours of testing, or immediately by telephone to the appropriate STLT health department per the regulations in the appropriate jurisdiction.
          * Report test results to the health department in the patient's state or territory of residence.
        What to report
        Laboratories should make every reasonable effort to provide the following data elements when reporting results to state and jurisdictional health departments.
         1. Test order—use appropriate Logical Observation Identifiers, Names and Codes (LOINC) terms (see table below)
         2. Test order date (date format)
         3. Test result
             1. Performed Test—use appropriate LOINC terms (see table below)
             2. Test result value – For quantitative results include units of measure, if applicable—coded in Unified Codes for Units of Measure (UCUM). For qualitative results use appropriate Systematized Nomenclature of Medicine- Clinical Terms (SNOMED-CT) code (see table below).
         4. Test result date (date format)
         5. Patient ID** (unique identifier assigned to an individual)
         6. Patient name (Last name, First name, Middle Initial)
         7. Patient street address
         8. Patient phone number with area code
         9. Patient date of birth
        10. Patient age
        11. Patient race
        12. Patient ethnicity
        13. Patient sex/gender
        14. Patient residence zip code
        15. Ordering provider name
        16. Ordering provider zip code
        17. Ordering provider address
        18. Ordering provider phone number
        19. Performing facility name and Clinical Laboratory Improvement Amendments, or CLIA number
        20. Performing facility zip code
        21. Accession # / Specimen ID** (unique identifier assigned to a specimen)
        22. Specimen Source
             1. Specimen Type—use appropriate SNOMED-CT codes from the specimen hierarchy (see table below for some examples), or HL70487 codes
             2. Source site—when the specimen type is a crust or a swab, it may be necessary to indicate where on the body this was taken from—use appropriate SNOMED-CT codes from the anatomic body site hierarchy (see table below for examples); in addition, more detailed topography like laterality may be needed. Include this in the code for the source site, or send in as an additional element—properly coded using SNOMED-CT codes from the qualifier hierarchy
        23. Specimen collection date (date format)
        **Patient ID and Accession #/Specimen ID are necessary to identify multiple specimens from an individual once the data is deidentified.
        To protect patient privacy, any data CDC receives from state and jurisdictional health departments will be deidentified and will not include patient-level information.
        Note: Laboratories are strongly encouraged to obtain complete information, including:
         1. Information about the patient to facilitate a rapid public health response; this includes complete patient contact information (name, date of birth, street address, phone number) so that public health may quickly contact the patient, provide treatment if necessary, and limit transmission
         2. Demographic data (gender, race, and ethnicity) data to support critical health equity priorities
         3. Information about the specimen, including the type, the source site (with topography, for example, right, left, distal) and collection method to support clear differentiation of the multiple submitted specimens, as well as better understanding of the clinical relevance
             1. Clinical history, if known, including symptoms, onset dates, travel history, epidemiological links to other cases, and treatment with any medical countermeasures (Medical Countermeasures Available for the Treatment of Mpox); also co-morbidities (International Classification of Diseases, or ICD diagnoses) that accompany the lab order
        This may require updates to the laboratory test order process, including:
          * Updating electronic laboratory order interfaces to ensure necessary information (from the electronic health record, or the ordering physician, or both) is fully populated
          * Educating physicians (and those who place test orders on their behalf) about data needs at the time of test order
        Laboratories should not reject specimens if data elements are missing and there is enough information to perform testing.
        How to report
        Laboratories should follow these best practices when reporting test results:
          * Submit laboratory diagnostic test results directly to STLT health departments according to state or local law, or policy
          * Send reports using existing electronic laboratory reporting (ELR) channels to ensure rapid initiation of case investigations
              + Share results concurrently with the ordering provider
          * Send compliant HL7 messages, if possible, and prioritize the data elements described in the "How to Use Standard Terminology" section (see below)
          * Engage with your STLT health department to ensure compliance with STLT-specific implementation guides, if available in your jurisdiction
          * Coordinate with your STLT health department to review data feeds before you submit results
        How to use standard terminology
        Laboratories should use standardized LOINC and SNOMED-CT codes. This improves the accuracy of reporting results for Orthopoxvirus, non-variola Orthopoxvirus, and Mpox virus and helps ensure that test types are represented uniformly across the United States.
        LOINC codes represent the "question" a test asks of a specimen (for example, does this specimen have mpox?), and SNOMED-CT codes represent the diagnostic "answer" (for example, what was detected?). Find more background on these terminology standards here:
          * LOINC Term
          * SNOMED CT
          * UCUM
        Whenever possible, laboratories should use standard codes that already exist.
                        Test
                        Test Performed LOINC Long Name
                        LOINC Code
                        Orthopoxvirus
                        Orthopoxvirus Deoxyribonucleic acid, or DNA [Presence] in Specimen by Nucleic Acid Amplification, or NAA with probe detection
                        41853-3
                        Non-variola Orthopoxvirus
                        Orthopoxvirus non-variola DNA [Presence] in Specimen by NAA with probe detection
                        100434-0
                        Mpox Virus
                        Mpox virus DNA [Presence] in Specimen by NAA with probe detection
                        100383-9
                        Mpox Virus Clade II
                        Mpox virus clade II DNA [Presence] in Specimen by NAA with probe detection*
                        100888-7
                        Mpox Virus Clade I
                        Mpox virus clade I DNA [Presence] in Specimen by NAA with probe detection*
                        100889-5
                        Parapoxvirus
                        Parapoxvirus DNA [Presence] in Specimen by NAA with probe detection
                        100885-3
                        Orf Virus
                        Orf virus DNA [Presence] in Specimen by NAA with probe detection
                        100886-1
                        Pseudocowpox Virus
                        Pseudocowpox virus DNA [Presence] in Specimen by NAA with probe detection
                        100887-9
                        Orthopoxvirus IgG
                        Orthopoxvirus IgG Ab [Presence] in Serum or Plasma by Immunoassay
                        100891-1
                        Orthopoxvirus IgM
                        Orthopoxvirus IgM Ab [Presence] in Serum or Plasma by Immunoassay
                        100892-9
                  Result Value
                  SNOMED-CT Codes
                  Detected*
                  260373001
                  Inconclusive
                  419984006
                  Equivocal
                  42425007
                  Not detected*
                  260415000
                  Test not done
                  373121007
        * These are the preferred terms to use, when reporting results from PCR testing; other presence/absence terms like positive/negative are possible and should be mapped to these terms.
                  Specimen Type
                  SNOMED-CT Codes
                  Scab specimen (crust)
                  435541000124108
                  Swab from lesion of skin
                  472862007
                  Swab from lesion
                  16210971000119108
                  Oral swab
                  418932006
                  Rectal swab
                  258528007
                  Example Source Site
                  SNOMED-CT Codes
                  Oral cavity
                  74262004
                  Rectum
                  34402009
                  Genital structure
                  71934003
                  Upper Arm (between shoulder and elbow)
                  40983000
                  Shoulder
                  16982005
                  Elbow
                  127949000
                  Hand
                  85562004
                  Thigh
                  68367000
                  Left hand
                  85151006
                  Right thigh
                  11207009
                  Example Topography***
                  SNOMED-CT Codes
                  Right
                  24028007
                  Left
                  7771000
                  Proximal
                  40415009
                  Distal
                  46053002
        *** These could also be included in the Source Site values above; for example: Left hand (85151006) or Right thigh (11207009).
        How to get assistance with electronic reporting
        CDC can provide technical assistance to laboratories that are not currently reporting electronically to their STLT health department and would like to establish electronic reporting. Contact the CDC Electronic Data Exchange inbox at edx@cdc.gov and use "Mpox Technical Assistance Request" as the subject line.
        On This Page
            * Who should report
            * What to report
            * How to report
            * How to use standard terminology
            * How to get assistance with electronic reporting
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  September 13, 2024
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