Clade I mpox (MPXV) pathway actions: patients self-presenting at emergency departments

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 self-presenting at emergency departments (ED) and are identified as at risk of possible mpox.

Download the self-presenting to ED mpox pathway and checklist in PDF format (PDF 70KB)

Is there a high index of suspicion that this patient is a suspected mpox case?

If yes, does the patient have clinical signs and symptoms of being a suspected case?

  • A prodrome where there is known prior contact with a confirmed or suspected mpox case in the last 21 days before symptom onset, or
  • An mpox compatible rash anywhere on the skin, mucosae or symptoms of proctitis and at least one of the following in the 21 days before symptom onset –
    • recent new sexual partner
    • contact with known or suspected case of mpox
    • a travel history to a country where mpox is currently common
    • link to infected animal or meat

(N.B. If a rash is highly suggestive of mpox, but a risk factor cannot be identified liaise with local infection specialist/microbiologist as to whether to consider mpox testing alongside the more common differential diagnosis)

If there are no clinical signs:

  • Consider alternative diagnosis, seeking advice as required as part of normal clinical pathways.
  • Liaise with local infection specialists/microbiology if clinical suspicion remains to agree next steps – including assessment for conditions such as malaria which could also cause illness in a returning traveller.

If yes, there are clinical signs:

  • Isolate as per local pathways and clinically assess in line with National Infection Prevention and Control measures for clinically suspected and confirmed cases of mpox in healthcare settings.
  • Liaison with local infection specialist/microbiology to discuss next steps, begin symptomatic treatment and ensure isolation and appropriate PPE is maintained throughout.
  • Local infection specialist/microbiology to discuss risk assessment with Imported Fever Service (0844 778 8990).

Pathway checklist

Patients self-presenting to ED Clade I mpox pathway checklist – probable or possible cases:

  • Have you isolated the patient?
  • Have you got access to the appropriate PPE (including donning and doffing procedures) to undertake a clinical assessment?
  • Speak to your local infection specialist/microbiologist for advice. Contact with the Imported Fever Service should be via your local infection specialist only
  • Notify the relevant people in your department as per local pathways and agree clinical management plan whilst awaiting test results

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