Urgent public health message advising that clade I mpox no longer meets the criteria of a high consequence infectious disease (HCID).
National resources on mpox are available using the following links:
- https://www.gov.uk/guidance/monkeypox-case-definitions
- https://www.gov.uk/government/news/ukhsa-detects-first-case-of-clade-ib-mpox
- https://www.gov.uk/guidance/biological-principles-for-control-of-mpox-in-the-uk-4-nations-consensus-statement
- https://www.gov.uk/guidance/derogation-of-clade-i-mpox
- https://www.gov.uk/guidance/monkeypox#clinical-features
- https://www.gov.uk/guidance/monkeypox-diagnostic-testing
- https://assets.publishing.service.gov.uk/media/67e27f36d8e313b503358d43/UKHSA-mpox-contact-tracing-guidance.pdf
When to suspect mpox
Consider mpox where a case presents with:
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) or 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 known or suspected case of mpox
- a travel history to a country where mpox is currently common - this does not include people transiting through the affected country where they do not leave the airport
- link to an infected animal or meat
Or:
3. an mpox-compatible rash anywhere on the skin (face, limbs, extremities, torso) or 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.
Management of cases
Clinical diagnosis can be difficult, often confused with other infections like chickenpox.
Clinicians who assess a patient that meets the case definition for possible mpox should discuss ASAP with Imported Fever Service (0844 778 8990) which is a 24/7 helpline. The Imported Fever Service (IFS) will review risk assessment and advise on differentials, the next steps for investigation and management
Please discuss all suspected /possible/confirmed cases with Clinical Co-ordinator or senior member of your clinical team.
PPE Requirements for Suspected or Confirmed Cases of Monkeypox in IUC
- PPE requirements are set out in the National infection prevention and control manual (NIPCM) for England for non HCID mpox
- For suspected or confirmed cases attending ambulatory healthcare services (for example outpatients, EDs, urgent care centres, general practice, sexual health clinics), patients should be placed in a single room for assessment.
- The case should be provided with a fluid-resistant surgical mask (FRSM) to wear if possible, for example if they are clinically stable and able to tolerate a mask.
Cleaning and decontamination
- Pox viruses can survive in the environment and on different types of surfaces for up to 56 days depending on the environmental conditions. The risk can be substantially reduced by following existing cleaning methods based on standard cleaning and disinfection, and by washing clothes or domestic equipment with standard detergents and cleaning products.
- Cleaning to reduce risk from the environment in community settings can be effectively achieved without using specialist services or equipment.
- The risk of transmission in the home environment can be reduced by the case performing regular domestic cleans and washing their own clothing and bed linen in a domestic washing machine.
- Clinical rooms should be cleaned per standard cleaning and decontamination guidance after each patient with suspected mpox. Please visit HCID and Notifiable disease SOP for further information on cleaning