Health care providers should be aware that patients with Mpox or patients who have been exposed to Mpox might present for care in a variety of health care settings.
Reporting Suspected Cases of Mpox
Suspected cases of Mpox must be immediately reported to public health authorities 24 hours a day, seven days a week. Report suspected cases of Mpox to the local public health authority where your facility is located.
About Mpox (formerly Monkeypox)
Mpox (formerly Monkeypox) is caused by the Mpox virus, in the genus Orthopoxvirus. This is the same genus of viruses as variola virus, which causes smallpox. Symptoms of Mpox are similar to those of smallpox, but less severe. Like smallpox, monkeypox often causes a characteristic rash. However, Mpox is rarely fatal. Mpox is not related to chickenpox.
Transmission of Mpox occurs:
- During prolonged face-to-face or intimate physical contact with someone who has Mpox.
- Through direct contact with rash, scabs, or body fluids of someone who has Mpox.
- By touching items such as clothing, towels or bedsheets after being touched by rash or body fluids of someone who has Mpox.
- Through the placenta from a pregnant woman who has Mpox to a fetus.
- By being scratched or bitten by an infected animal or by preparing or eating meat or using products from an infected animal.
Infection Prevention in Health Care Settings
Transmission in health care settings has been rarely described. As with all infectious diseases, use of adequate personal protective equipment (PPE), approved disinfectants and other infection prevention and control measures promotes safety for health care providers, staff, patients and visitors. Health care providers who might encounter patients with Mpox or patients exposed to Mpox should familiarize themselves with CDC’s recommendations for Infection Prevention and Control of Mpox in Healthcare Settings.
Recognizing Mpox
While many of the cases reported during the current outbreak have been among gay, bisexual, or other men who have sex with men, it is important to remember that anyone can get Mpox, including children.
Course of Illness — The incubation period after infection with Mpox virus is approximately 1–2 weeks but can be longer. Prodromal symptoms may occur and can include fever, malaise, headache, and other generalized symptoms. Lymphadenopathy may also occur and can be generalized or localized. Mpox virus frequently causes a characteristic rash which undergoes several stages of evolution including macular, papular, vesicular, pustular, and scab stages. People infected with Mpox virus are believed to be contagious from the onset of symptoms until all scabs have fallen off and new intact skin forms. Illness duration typically lasts between 2–4 weeks. Note that one patient might have lesions in different stages at the same time.
Pictures and more information are available at the following links:
Mpox in the Current Outbreak — Many features described in the current outbreak vary from historical accounts of Mpox infection, including that a prodromal syndrome may or may not occur before a rash appears. Lesions can appear on and or in the mouth, genitals, and perianal regions and may or may not disseminate to other parts of the body. This can make Mpox difficult to distinguish from other infections that are more commonly seen clinical practice, such as secondary syphilis, herpes, molluscum contagiosum, and varicella zoster.
Although Mpox is not considered a sexually transmitted infection (STI), it can spread during intimate physical contact between individuals. Patients with Mpox may present to sexual health clinics for care. Mpox infection does not preclude coinfection with STIs, varicella, or other pathogens. A patient that has been diagnosed with or is suspected to have Mpox may be at risk for sexually transmitted infections. Evaluation and treatment of STIs should be performed in accordance with CDC’s 2021 STI Treatment Guidelines.
A health care visit for evaluation of a rash concerning for Mpox can present an opportunity to connect a patient with other important health services. Need for and interest in receiving HIV pre-exposure prophylaxis (PrEP), COVID-19 vaccination, or other services should be assessed.
Conduct a Thorough Physical Examination to Identify Lesions — A thorough physical exam should include careful inspection of mucosal tissues, including an oral, genital, and anal exam. Patients may not be aware of lesions in these or other areas (e.g., the ears). Anal lesions may be internal.
Take a Thorough History to Determine Level of Suspicion for — Epidemiologic criteria can help inform evaluation of a rash that might be Mpox. A complete sexual and travel history during the past 21 days should be obtained for all patients presenting with symptoms concerning for Mpox.
As soon as Mpox is suspected, clinicians should isolate the patient in a single person room and immediately notify the facility’s Infection Prevention staff and the local public health authority.
Testing and Specimen Collection
Patients with a new characteristic rash or who meet one or more of the epidemiologic criteria and in which there is a high suspicion should be tested for Mpox.
Diagnostic Process for Mpox Virus Testing
Partnerships with commercial laboratories have increased testing capacity and access. Commercial labs offering Orthopoxvirus tests include:
- Aegis Science (order code 06575)
- Labcorp (order code 140230)
- Mayo Clinic Laboratories
- Quest Diagnostics (test code 12084)
- Sonic Healthcare
Coordination with local public health authorities is not required when ordering a Mpox test from a commercial laboratory. However, all suspected cases, including anyone for whom a test is ordered, must be reported to public health authorities. Coordination with public health authorities is required when sending a specimen to the Nevada State Public Health Laboratory or the Southern Nevada Public Health Laboratory.
Note that specimen collection must occur at a health care facility and is not offered at commercial laboratory collection centers. Staff performing specimen collection should wear PPE and are strongly encouraged to thoroughly review guidance from CDC and the laboratory performing the test prior to collection. Local public health authorities can provide additional guidance if needed.
Considerations for Clinical Management
Though Mpox is rarely fatal, symptoms are often severe and may present a risk of long-term sequelae. Pain and pruritis may be disproportionate to rash appearance. Supportive care and symptom management should be initiated for all patients with Mpox infection. Referral to, or consultation with, specialists (e.g., ENT, urology, etc.) should be considered for patients with lesions in areas presenting with special concerns. Patients with severe illness, complications, or risk factors for severe disease might benefit from treatment with medical countermeasures (see "Smallpox Treatments for Patients with Mpox" section below).
If a patient who has been exposed to Mpox or may have been exposed to Mpox presents for care, notify local public health authorities immediately. Refer to CDC’s Monitoring People Who Have Been Exposed for more information.
Visit CDC’s website for the most up-to-date information regarding clinical care of patients with Mpox infection: Information For Healthcare Professionals | Mpox | Poxvirus | CDC
Special Populations
Patient Education
Educate patients with Mpox:
- About the expected course of illness (up to 4 weeks) and possible complications.
- To keep lesions clean and dry after bathing.
- To isolate and avoid contact with other people and animals, including pets until the rash has healed and a new layer of skin has formed.
- To wear a well-fitting mask and cover any areas of the skin where lesions are present if the patient must be around others who do not have Mpox.
- To take steps to prevent spread to household members.
- Discourage patients from using contact lenses to prevent inadvertent ocular infection.
Consider providing informational fliers to patients or stocking them in waiting rooms.
Vaccination
Refer to the page linked here for information about Mpox vaccination.
Smallpox Treatments for Patients with Mpox
Currently, there are no pharmaceuticals specifically approved for the treatment of Mpox. Medical countermeasures developed for use in patients with smallpox may prove beneficial and can be used for patients with Mpox under CDC-held Expanded Access Investigational New Drug Protocols (EA-IND).
Several medical countermeasures are available from the Strategic National Stockpile (SNS) for consideration in the treatment of patients with Mpox. Information regarding these products can be found here: Treatment Information for Healthcare Professionals | Mpox | Poxvirus | CDC
Tecovirimat (TPOXX) is one medical countermeasure that has been used frequently during the current outbreak. Because tecovirimat use for Mpox is under an EA-IND, certain documentation and return of information are required. Tecovirimat has been ordered from the SNS and is available for use at designated treatment sites throughout the state. Contact the local public health authority to connect patients with treatment.
Guidance for Tecovirimat Use Under Expanded Access Investigational New Drug Protocol during 2022 U.S. Mpox Cases | Mpox | Poxvirus | CDC
For urgent clinical situations after hours, providers may contact the CDC Emergency Operations Center (770-488-7100) for clinical consultation on patient cases.