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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
Links and guidance
- Mpox: guidance on when to suspect a case of mpox
- Clade 1 mpox – affected countries list
- National infection prevention and control manual (NIPCM)
- Addendum on high consequence infectious disease (HCID) personal protective equipment (PPE)
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