In March 2025, the Advisory Committee on Dangerous Pathogens (ACDP) advised that clade I mpox no longer meets the criteria for a high consequence infectious disease (HCID) and recommended derogation. This was based on evidence that clade I mpox has a low case fatality rate with a similar clinical severity to that of clade II cases, no evidence of community or healthcare transmission from cases imported into the UK, and that a safe and effective vaccine is available and being deployed to eligible individuals. The public health agencies of the four UK nations subsequently agreed that mpox will no longer be managed as an HCID by the NHS and other healthcare providers, or by the wider public health system.

Mpox remains a serious infection for some individuals and the UK’s strategic goal continues to be to eliminate person-to-person transmission in the UK. Therefore, there will be ongoing public health management of cases and contacts, including vaccination where appropriate.

This webpage provides advice and recommendations to healthcare providers on how to manage patients with mpox caused by any clade of mpox virus, following the removal of HCID status for all mpox clades.

Clinical assessment of patients with suspected mpox

Clinicians should be alert to the possibility of mpox in patients presenting with compatible symptoms and relevant risk factors.  Mpox should be suspected if there is:

1. a prodrome (fever, chills, headache, exhaustion, myalgia, arthralgia, backache, lymphadenopathy), in an individual with contact with a confirmed or suspected case of mpox in the 21 days before symptom onset

Or:

2. an mpox-compatible rash anywhere on the skin (face, limbs, extremities, torso), mucosae (including oral, genital, anal), or symptoms of proctitis, and at least one of the following in the 21 days before symptom onset:

• recent new sexual partner
• contact with a known or suspected case of mpox
• travel to a country where mpox is currently common (not including people who have transited through the affected country without leaving the airport)
• link to an infected animal or meat

Or:

3. an mpox-compatible rash anywhere on the skin (face, limbs, extremities, torso), mucosae (including oral, genital, anal), or symptoms of proctitis, where there is no risk factor and no alternative common differential diagnosis.^* These patients should be discussed with local infection services to determine the approach to investigation and management.

^*alternative common differential diagnoses include varicella zoster virus (which causes chickenpox and shingles), herpes simplex virus, enterovirus (which causes hand, foot and mouth disease), and bacterial infections such as staphylococcal and streptococcal infections.

The following groups of individuals are at greater risk of severe disease and may require hospitalisation. These patients should be discussed with an infectious disease specialist, and transfer to an infectious disease unit may be appropriate.

• pregnant patients
• immunocompromised patients
• children (16 years or under)

Where patients are considered high risk for severe illness, infection specialists may wish to discuss with the UKHSA Imported Fever Service (IFS) on 0844 778 8990 for clinical advice and to discuss expedited testing.

Notification of suspected cases and positive samples

Mpox remains a notifiable disease. All suspected cases must be notified to the regional health protection team urgently by telephone call within 24 hours.

Mpox virus (MPXV) is a notifiable causative agent. Laboratories must ensure that their laboratory systems are reporting correctly to SGSS data systems, as per the guidance on mpox diagnostic testing.

Unless typing is available locally, all samples testing positive for MPXV must be sent to the UKHSA Rare and Imported Pathogens Laboratory (RIPL) for clade typing. Biological samples and infected materials from patients with mpox are classified as category B infectious substances. These should be handled and transported as per standard procedures for biological samples.  Please see the RIPL Specimen referral guidelines and service user manual for further information.

Infection prevention and control (IPC) and personal protective equipment (PPE)

Patients presenting to healthcare settings with symptoms suggestive of mpox should be isolated in a single room as soon as mpox is suspected. They should also be provided with a fluid-resistant surgical mask (FRSM) to wear, unless contraindicated. Guidance on patient placement and assessment of infection risk is available in section 2.1 of the NIPCM.

All staff attending the patient or cleaning their surroundings should wear appropriate PPE for the level of exposure. Staff responsible for cleaning and decontaminating healthcare environments where patients with suspected or confirmed mpox are managed must be appropriately trained in the correct use of all products and PPE. Transmission-based precautions should be informed by clinical risk assessment, considering the task to be performed, the patient’s presenting symptoms, and their infectious state. For clinically well patients with a limited rash and no respiratory symptoms, the recommended baseline transmission-based precautions are droplet precautions, as described in Appendix 5b of the NIPCM. A higher level of respiratory protection is advised for managing patients with respiratory symptoms, and full airborne precautions should be implemented for patients who are severely unwell and being managed in hospital or awaiting a bed. Airborne precautions should be implemented when performing aerosol-generating procedures on any patient with suspected or confirmed mpox. Appendix 1 provides examples of the recommended PPE ensembles for different levels of exposure.

Providers should review existing IPC plans, clinical pathways, PPE availability, waste management protocols, and cleaning procedures to ensure that arrangements are in place to safely assess and treat patients presenting with suspected mpox. They should also ensure that staff are appropriately trained in PPE and IPC measures, and are familiar with the arrangements for isolation, clinical management, and obtaining specialist infection advice.

Management of patients at home

Clinically well, ambulatory patients should be managed at home where the primary clinician judges this to be safe and clinically appropriate. Ongoing clinical and public health support should be provided for clinical management and isolation.

Patients should be advised to isolate at home and avoid close contact with others for the duration of their infectious period, as per the guidance on isolating at home. In patients with limited lesions, covering the lesions and wearing a face mask reduces the risk of onwards transmission whilst infectious.

Patients isolating at home can clean clothes and domestic equipment with standard detergents and cleaning products. Patients who live in shared accommodation should isolate in an individual room, avoid using shared facilities at peak times and ensure shared facilities are cleaned after use. If entering communal areas whilst infectious, patients should stay at least 1m away from others, cover lesions and wear a face mask.

Management of patients in community and outpatient settings

Clinically well patients who require assessment or management at a healthcare facility should travel via private transport where possible. Where private transport is not available, public transport can be used but patients should avoid busy periods, cover any lesions and wear a face mask.

Patients attending ambulatory healthcare settings should be placed in a single room for assessment. The patient should be provided with an FRSM to wear, provided they are clinically stable and able to tolerate the mask. Patients moving between areas should cover any lesions and wear an FRSM, unless contraindicated. Staff assessing or caring for the patient should wear appropriate PPE.

The risk of transmission via fomites can be substantially reduced by employing standard cleaning and disinfection protocols. Specialist services and equipment are not required to reduce the risk of fomite transmission in community settings. Clinical rooms should be cleaned and decontaminated after each patient with suspected mpox in accordance with local policy.

Management of patients requiring hospitalisation

Whilst most patients with mpox are clinically well, a small number develop severe disease or complications such as secondary bacterial infection, sepsis, or corneal involvement. These patients require expert care and should be managed by an infection specialist familiar with the treatment of mpox.  Specialised regional infectious disease centres (SRIDCs) can provide expert clinical advice, and transfer to an SRIDC may be required for severe cases. Infection specialists may wish to discuss with the UKHSA Imported Fever Service (IFS) on 0844 778 8990 for clinical advice.

Other affected individuals requiring hospitalisation, for example those with lesions causing severe, refractory pain, constipation, urinary retention, or inability to swallow, should also be managed by an appropriately skilled infection specialist with support from an SRIDC as required. Staff from other specialties involved in the patient’s care should be alerted to the suspected or confirmed infection and wear appropriate PPE.

All hospitalised patients must be isolated in an individual room, preferably ensuite, and cared for using contact and airborne transmission-based precautions. Where possible, a negative pressure ventilated room should be used according to local availability and risk assessment. Enhanced cleaning should be conducted daily, following local protocols and the guidance in section 5.4 of the National Standards of Healthcare Cleanliness. Terminal decontamination should be undertaken once the patient has been transferred, discharged, or is no longer infectious as per the NIPCM section 2.3.  Laundry and clinical waste should be managed as per the respective Health Technical Memoranda.  

Antiviral treatment with Tecovirimat is available for patients hospitalised with severe or complicated mpox and meeting certain clinical criteria, as per the published UK interim clinical policy statement. Supply is managed via the SRIDCs.

Occupational health

Healthcare workers with suspected mpox should be excluded from work until clinical and/or virological investigations have ruled out MPXV infection. Healthcare workers with confirmed mpox should be excluded from work until all lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath.

Mpox exposures in healthcare workers should be risk assessed and managed as per the contact tracing guidelines for mpox. Occupational health services may wish to discuss with their local IPC team for assistance with this risk assessment.

Healthcare workers with high risk (category 3) exposures should be offered post-exposure vaccination as soon as possible and within 4 days of exposure. Vaccination may also be offered within 14 days of exposure to those at higher risk of complications from mpox infection. Healthcare workers with medium risk (category 2) exposures may also be eligible for post-exposure vaccination in some situations. Please see the contact tracing guidelines for mpox and Chapter 29 of the Green Book for further information. Occupational health services should discuss with their commissioner to establish regional arrangements for accessing vaccine.

Healthcare workers with high or medium risk exposures may need to be excluded from work or redeployed for 21 days following exposure. Exclusion or redeployment advice should be based on the category of exposure and the vulnerability of those with whom they would be in contact. Any exposed healthcare worker who develops symptoms should be excluded and undergo clinical assessment and testing prior to returning to work.

Onwards referral of patients to other health services 

A rapid evidence summary conducted by the UKHSA found that sexual transmission was the most commonly reported route of mpox transmission in adults, although the virus can be spread through any close physical contact. Where sexual transmission is suspected or known, clinicians should, where appropriate:

• assess patients for other sexual health needs during mpox diagnosis and follow up
• include health promotion advice on vaccines, testing for sexually transmitted infections and harm reduction
• refer patients to relevant sexual health services for ongoing follow up

Pre-exposure vaccination  

Pre-exposure mpox vaccination is recommended for certain population groups who meet specific eligibility criteria based on their risk of exposure to MPXV. Targeted pre-exposure vaccination for eligible individuals commenced in June 2022, and a routine programme is currently being implemented to build on the existing offer.

Given the low incidence of mpox infection in the UK, most health and social care workers, including those working in sexual health centres, are at very low risk of occupational exposure and do not require routine pre-exposure vaccination. All staff attending patients with suspected or confirmed mpox, or handling clinical specimens, should use the recommended PPE and safety equipment.

Staff who work in specialist roles where frequent and prolonged exposure to MPXV is anticipated should be advised of the risk and offered vaccination based on an occupational health risk assessment.

For further information on eligibility for mpox vaccine and the vaccination schedule, please see chapter 29 of the Green Book.

Appendix I

Examples of PPE recommendations for the management of patients presenting with mpox-compatible symptoms

These examples and recommendations should be used to inform the risk assessment for PPE use in conjunction with local policies and procedures.

PPE Requirements for Mpox Scenarios

Publication reference: PRN01993