Clade I mpox (MPXV) pathway actions: patients referred to emergency departments for clinical assessment and testing by a health care professional

Update – 19 March 2025: The Advisory Committee on Dangerous Pathogens recently assessed evidence gathered by the UK Health Security Agency for clade I mpox and advised that it no longer met the criteria of a high consequence infectious disease (HCID). Therefore, the chief medical officers of the 4 nations have agreed that mpox will no longer be managed as a HCID within healthcare settings. Further information is available on the gov.uk website.

The following pathway provides actions for when patients are rereferred to emergency departments (ED) for clinical assessment and testing after being identified as a possible case of mpox.

Download the referred to ED mpox pathway and checklist in PDF format (PDF 77KB)

Patient has been identified as a possible or probable case of mpox by a health care professional (HCP) including designated medical contacts for returning workers.

HCP should contact ED to agree arrangements for transfer (e.g. likely time of arrival, arrival point, what to do on arrival, including phone number to notify of arrival).

Actions if clinically unwell

Assessment indicates patient is clinically unwell and should be transported by ambulance, or is unable to self-transfer whilst maintaining isolation.

HCP to contact regional ambulance service to arrange transfer, clearly stating the patient is a suspected Mpox case.

Patient to be managed as per local pathways and in line with suspected mpox pathway for patients self-presenting at emergency departments

Actions if clinically stable

Assessment indicates patient is clinically stable and can transport themselves to attend ED via their own transport, whilst maintaining isolation.

Confirm with patient arrangements for transfer:

  • maintain isolation
  • where to present
  • who to contact upon arrival

Patient to be managed as per local pathways and in line with suspected mpox pathway for patients self-presenting at emergency departments

Pathway checklist

Patients referred to ED Clade I mpox pathway checklist – probable or possible cases:

  • Have you isolated the patient?
  • Have you assessed the patient’s ability to self-transfer?
  • Have you confirmed transfer/arrival arrangements with the receiving department?
  • Have you confirmed arrangements with the patient, including a phone number to contact upon arrival?

Preparedness actions

  • Providers to ensure that all clinical services are aware of the public health messaging and that a differential diagnosis of Mpox should be considered in any patient that meets the operational case definition.
  • Providers should review current IPC plans, PPE availability, waste management and staff training to ensure that arrangements are in place to safely assess and treat patients presenting with suspected Mpox.
  • Providers should review existing plans and clinical pathways ensuring that staff are aware of the arrangements for isolation, clinical management, specialist infection advice,  PPE and associated infection control measures.