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Mpox

What's new

The World Health Organization (WHO) has released a living guideline for the prevention and management of mpox. Preventive measures include standard infection prevention and control practices, as well as contact and droplet precautions for patients with mpox in the community until all lesions have healed. Patients with mild, uncomplicated mpox who are being cared for at home do not need to isolate, provided their lesions are fully covered and they wear a well-fitting medical mask when in close contact with others until healing is complete. Mothers with mpox may continue breastfeeding while minimizing direct contact with their uninfected infant. .

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of mpox are prepared by our editorial team based on guidelines from the World Health Organization (WHO 2025,2022) and the Center for Disease Control (CDC 2022,2021,2019).
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Screening and diagnosis

Epidemiology: as per WHO 2022 guidelines, view one case of monkeypox virus infection as an outbreak.
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  • Case definition

  • Indications for testing

  • Differential diagnosis

Diagnostic investigations

Initial evaluation: as per WHO 2022 guidelines, obtain the following in patients with monkeypox virus infection:
clinical examination using appropriate infection prevention and control measures
asking about possible sources of infection and the presence of similar illnesses in the patient's community and contacts (both backward to identify the source and forward contact tracing to reduce onward transmission)
collecting and dispatching specimens for mpox laboratory examination.
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  • Specimen collection

  • Specimen handling

  • Laboratory testing (safety measures)

  • Laboratory testing (NAAT)

  • Laboratory testing (serology)

  • Laboratory testing (electron microscopy)

  • Laboratory testing (viral culture)

  • Laboratory testing (interpretation)

Medical management

Specific treatment: as per CDC 2021 guidelines, recognize that at this time there are no specific treatments available for mpox, but mpox outbreaks can be controlled using the smallpox vaccine, cidofovir, tecovirimat, and vaccinia immune globulin.
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  • Antiretroviral therapy

Specific circumstances

Breastfeeding patients
As per WHO 2025 guidelines:
Consider continuing breastfeeding for mothers with mpox while limiting direct contact with their non-infected infant.
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Consider resuming breastfeeding and direct contact with the infant for mothers who have recovered from mpox infection and had previously withheld breastfeeding and direct contact, once lesions are healed.
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Preventative measures

Infection prevention and control: as per WHO 2025 guidelines, implement infection prevention and control measures, including hand hygiene, dedicated personal items, appropriate handling of linens and laundry, cleaning and disinfection of the environment, and waste management for patients with mpox in the community until all lesions are healed.
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  • Vaccination in high-risk groups

  • Post-exposure vaccination

Follow-up and surveillance

Contact tracing: as per WHO 2022 guidelines, initiate contact tracing to control the spread of the monkeypox virus to allow the interruption of transmission and help people at a higher risk of developing severe disease to more quickly identify their exposure. Interview case-patients to elicit the names and contact information of all such persons. Notify contacts within 24 hours of identification.
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Quality improvement

Networking and reporting
As per CDC 2022 guidelines:
Report possible human cases of mpox to the local hospital epidemiologist and/or infection control personnel, the state health department, and the national center for disease control and prevention.
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Consult with the state epidemiologist, state health laboratory, and the national center for disease control and prevention before sending specimens to the center for disease control and prevention.
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