In early spring 2022, with reports growing about mpox cases internationally, the DHEC Division of Acute Disease Epidemiology (DADE) staff began to follow updates from the Centers for Disease Control and Prevention (CDC). In May of 2020, the CDC issued a health alert regarding a positive mpox case in Massachusetts and DADE shared it through DHEC’s Health Alert Network (HAN).

Following CDC guidelines, DHEC leadership and DADE staff began discussing South Carolina’s approach to mpox as well as working on guidance documents. Planning also began regarding the need to provide education and updates about mpox to the public, health care providers and facilities, and the media.

Among other things, DHEC developed targeted communications for those at risk and balanced messaging for the whole community; acquired the maximum doses made available from the very limited national supply and rapidly vaccinated the identified close contacts of cases when indicated; and developed a response to vaccinate those at high risk in each public health region by appointment for as long as the vaccine lasts.

Below is a reverse timeline of some key activities that have been undertaken to date.

• On September 7, DHEC held a virtual media briefing with student journalists at our state's colleges and universities to provide an update on mpox as well as to share messages that might reach those on college campuses who might be at higher risk of exposure. 
• On August 18, DHEC held a virtual briefing with leadership, health services staff and public information staff at our state's colleges and universities to share information and prevention messages about mpox as well as to request their help in communicating with people at higher risk of exposure and their overall student body. 
• On August 4, DHEC held a virtual briefing with leadership and health services staff at our state's HBCUs to share information and prevention messages about mpox as well as to request their help in communicating with people at higher risk of exposure and their overall student body.
• On August 1, DHEC distributed a Health Alert Network (HAN) update for clinicians on Mpox in People with HIV, Children and Adolescents, and People who are Pregnant or Breastfeeding. This marked the sixth related health notification DHEC has released about the virus since May 20.
• DHEC followed up an effort to educate clinicians and laboratories on how to evaluate a patient with suspected mpox and perform testing safely [CDC info for health care providers] by developing a Clinicians Guide to Mpox flyer on July 25. 
• On July 22, DHEC began notifying partners such as the SC HIV Planning Council, PrEP providers, LGBTQ+ organizations and others that those at high risk of being exposed to mpox could begin making appointments July 25 to be vaccinated, with some vaccinations beginning July 26. The appointment must be made via the DHEC CareLine (1-855-472-3432) and vaccine clinics will be held at 14 health departments across the state.
• On July 20, DHEC ran an intra-agency communication exercise to prepare to deliver and administer vaccine across the state.  
• On July 19, began holding twice weekly (Tuesdays and Thursdays) Mpox Response Core Team Meetings.
• On July 14, DADE and the STD/HIV and Viral Hepatitis Division held a virtual briefing with about 36 advocates and others in and connected with the LGBTQ+ community to share information and prevention messages about mpox as well as to request their help in communicating with people at high risk and their overall constituency.
• On July 8, DHEC issued a news release announcing South Carolina’s first confirmed mpox cases and gave close contacts post-exposure prophylaxis (PEP) that same day thanks to strong regional epidemiologic investigation and early contact tracing efforts.
• On July 6, DHEC distributed a HAN about commercial lab testing availability, diagnosing and reporting mpox.
• On June 13, an Mpox webpage (scdhec.gov/mpox) was placed on the DHEC website updating the public regarding what DHEC is doing as it monitors the international and U.S. outbreaks and directing people to CDC’s website for more and developing information.
• On June 3, updates were made to allow mpox contacts to be recorded in the South Carolina's Infectious Disease and Outbreak Network (SCION).
• On June 3, a one-pager on mpox was completed for distribution at a Pride event on June 4. 
• On June 2, a DADE mpox workgroup led by Dr. Maro Tori began meeting to work on guidance for the regions and others. The group met weekly.
• On May 24, Director Edward Simmer sent an email to all DHEC staff providing basic information about mpox and updating what DHEC was doing.
• On May 25, DHEC issued a news release noting that monitoring had ended for the two close contacts on the flight with an individual from the United Kingdom who tested positive.
• On May 23, DHEC received and responded to two of the earliest media inquiries on mpox.
• On May 20, DHEC issued a CDC health advisory that was distributed following a confirmed mpox case in Massachusetts on May 18. A holding statement was developed in preparation of media inquiries.
• On May 5, DHEC began a 21-day monitoring period for two people identified as close contacts on a flight with an individual from the United Kingdom who tested positive for mpox.
• While there were alerts regarding a limited number of contacts and potential and confirmed mpox cases in 2020 and 2021, an uptick in international cases as well as potential cases in the United States caught the eye of the CDC in spring of 2022. DHEC began monitoring the CDC’s efforts and following its guidelines in May 2022.