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 104KB)
Does the patient have clinical signs and symptoms of being a possible or probable case?
- Febrile prodrome (fever>38, chills, headache, exhaustion, myalgia, arthralgia and lymphadenopathy)
- Suspicion of mpox (e.g. new characteristic rash, unexplained lesions, ulcers)
If yes, there are clinical signs:
Isolate as per local pathways and clinically assess in line with guidance using high consequence infectious disease (HCID) personal protective equipment (PPE).
If there are no clinical signs:
- Consider alternative diagnosis, seeking advice as required as part of normal clinical pathways.
Does the patient meet the operational case definition?
- Confirmed case of Clade 1 mpox
- Travel history to Democratic Republic of Congo (DRC) or specified countries, with a risk of mpox exposure within 21 days of symptom onset
- Contact with a confirmed mpox case within 21 days of symptom onset
- Close or intimate in person contact/epidemiological link to a mpox case within 21 days of symptom onset
If yes, the patient meets the definition:
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.
If the patient does not meet the definition:
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.
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
- UKHSA public health messaging for NHS service providers
- Operational mpox (Clade I) case definition – including countries of risk
- Mpox case definition
- 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 Clade I mpox should be considered in any patient that meets the operational case definition.
- Providers should review current infection prevention and control (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 – this should include identifying a suitable room and access and egress arrangements.
- 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.