Monkeypox Vaccination Eligibility Questionnaire (9/19/2022)

1. Have you traveled to a country where Monkeypox is an endemic disease? (i.e. Central and West Africa)
2. In the past 14 days have you had close or intimate contact with someone with a similar rash or confirmed case of Monkeypox?
3. Do you have multiple sex partners?
4. Do you have intimate or sexual contact with a person/people you did not previously know? (i.e. dating apps, commercial sex venues, or other methods of anonymous sex)
5. Do you attend venues where you have close physical contact with other people and anonymous or group sex may occur? (i.e. raves, clubs, parties, bars and other crowded places)
6. Are you employed in a laboratory that handles cultures of orthopox virus?
7. Are you employed in a laboratory that performs testing for orthopoxviruses?
8. Are you a healthcare worker who performs orthopoxvirus generic testing to diagnose orthopox viruses?
9. Have you been diagnosed with gonorrhea or syphilis in the past 6 months?
10. Are you an individual living with HIV?”
11. Do you use, or are you eligible to use, HIV PrEP (medication to prevent HIV infection, i.e. Truvada, Descovy, or Apretude)?
12. Do you engage in commercial and/or transactional sex? (i.e. sex in exchange for money, shelter, food, and other goods/needs).