Date published: 5 September, 2024
Date last updated: 2 April, 2025
Vaccination, Winter news and guidance

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
Date published: 5 September, 2024
Date last updated: 2 April, 2025