The following pathway provides actions when patients present to primary care and are identified as at risk of possible mpox.
Download the primary care mpox pathway and checklist in PDF format (PDF 79KB)
Does the patient have clinical signs and symptoms of being a possible or probable case?
- Febrile prodrome (fever greater than 38, chills, headache, exhaustion, myalgia, arthralgia and lymphadenopathy).
- Suspicion of mpox (eg new characteristic rash, unexplained lesions, ulcers).
If yes, there are clinical signs:
Isolate the patient in a treatment room with access to a phone and undertake a clinical assessment of the patient.
Where appropriate PPE is available this can be done in person, where appropriate PPE is not available this should be done virtually
Where suspected cases present in primary care, general practitioners should isolate the patient in a single room and contact their local infection service for advice, including immediate precautions in the setting – clinical staff should wear face fit tested FFP3 masks, eye protection, long-sleeved splash resistant gowns and gloves to provide care if immediately required.
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 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:
Contact your local infection specialist for advice. Do not test for mpox in community settings.
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
HCP referral Clade I mpox pathway checklist – probable or possible cases:
- Have you isolated the patient?
- Have you assessed the patient’s ability to self-transfer?
- Have you confirmed transfer/arrival arrangements with the receiving department?
- Have you confirmed arrangements with the patient, including a phone number to contact upon arrival?
- Seek advice from local infection prevention and control as required (including cleaning).
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) 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.