When to suspect mpox
One or more of:
- Unexplained recent onset rash (single or multiple lesions)
- Mucosal lesions (single or multiple lesions which may be oral, conjunctival, urethral, penile, vaginal or anorectal)
- Proctitis (tenesmus; rectal pain or bleeding)
- Acute illness with fever (38.5C or greater), headache, myalgia, back pain, arthralgia, lymphadenopathy, asthenia, fatigue
AND EITHER
1. Travel history to countries where clade I mpox is endemic [country list here]
OR
2. Close contact with a confirmed or suspected case of clade I mpox
When mpox is suspected, the immediate actions required include:
- Try to manage the case over the phone if possible – advise the person to confine themselves to one room, ideally with an ensuite bathroom, pending further instruction
- For face-to-face consultations with suspected mpox, don PPE (including a gown, FFP2/3 mask, gloves and if there is a risk of splashing fluids to the face, a visor/goggles)
- The patient should be moved away from other staff and patients and occupy a room alone. It may be possible to be assessed in a car
- Assess the clinical status of the person (by phone or face-to-face)
- Contact the local infectious disease (ID) physician or clinical microbiologist for advice about transfer to the hospital for testing. ID or microbiology can arrange scheduled ambulance transport to the hospital. Whilst GPs can’t arrange scheduled transfers, GPs can request an emergency ambulance if there is clinical urgency. In these circumstances, pre-notify the National Ambulance Service and the receiving hospital of possible mpox clade I status
Subsequent steps
- Collect names of the people present in the building and the nature of their contact with the suspected case for future contact tracing (proximity, duration of contact)
- The rooms in which the patient was present in the practice should not be used until they have had environmental cleaning and disinfection
Scott Walkin.
AMRIC Lead, Irish College of GPs.