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Mpox (monkeypox) is an infectious disease caused by the Monkeypox virus of the Orthopoxvirus genus. It is endemic in West and Central Africa. In 2022, mpox spread to nonendemic regions and was declared a public health emergency of international concern by the WHO. In the wake of the 2022 epidemic, the WHO changed the name of the disease from monkeypox to mpox because of concerns about stigmatizing language. Mpox is primarily transmitted via skin-to-skin contact with lesions from an infected individual or from a bite or scratch from an infected animal. Clinical features include flu-like symptoms, lymphadenopathy, and a painful, vesicular rash that typically develops 1–4 days after the onset of fever. Diagnosis is confirmed by PCR from a sample of the lesion. Affected individuals generally recover within 2–4 weeks with supportive treatment. Individuals with severe disease may be treated with antivirals. Two vaccines are currently available for use against mpox.
- Endemic in West and Central Africa 
- Travel-associated outbreak in the UK in May 2022, with subsequent cases in continental Europe, North America, South America, and Australia 
- On July 23, 2022, the WHO declared the mpox outbreak a public health emergency of international concern. 
Epidemiological data refers to the US, unless otherwise specified.
- Pathogen: Monkeypox virus (dsDNA virus of the Orthopoxvirus genus in the family Poxviridae) 
- Reservoir: rodents and primates 
- Incubation period: 5–21 days 
- High risk for mpox infection (risk factors and groups at risk)
- Typically lasts 1–4 days
- Characteristic mpox rash 
- Upper respiratory
Perform a thorough clinical evaluation and obtain PCR testing if indicated.
While PCR testing alone is required to diagnose mpox, additional laboratory studies (e.g., CBC, CMP) can identify individuals with severe disease who have indications for inpatient management and/or antiviral therapy.
PCR testing 
- Characteristic mpox rash
- OR clinical suspicion and the presence of one or more of the following within 21 days of symptom onset:
- Close or intimate contact with someone who has:
- A similar rash
- Confirmed or probable mpox
- Travel to a country with mpox cases or to an endemic region
- Contact with animals, or products derived from animals, known to carry mpox
- Close or intimate contact with someone who has:
Contact the local or state health department for further guidance on testing.
- Isolate patients during evaluation.
- Obtain two separate swabs from multiple lesions (if present).
- Do not unroof lesions prior to swabbing.
- Send samples for nonvariola Orthopoxvirus PCR test.
Advise patients to remain isolated while awaiting test results, which may take 2–3 days.
Severe mpox (or risk factors for severe mpox)
- Consult infectious diseases.
- Consider antiviral treatment.
- Monitor and treat in an inpatient setting.
- Mild or uncomplicated disease: outpatient management
- Provide supportive care.
- Educate about infection prevention and control measures.
- Report cases to the local department of health.
Severity assessment 
- Severe mpox 
- Risk factors for severe mpox 
Isolation recommendations may vary regionally and may change as the mechanisms of the spread of mpox infection are better understood.
- Outpatient: Isolate at home until the illness has resolved.
- Hospitalized individuals: Isolate in a single-person room with a dedicated bathroom with:
- during aerosol-generating procedures
- Sexual abstinence until all crusted lesions have healed
- Consistent use of condoms for at least 12 weeks after recovery
Advise patients to avoid the following until all lesions have healed: close contact with people and animals, using contact lenses, shaving skin with lesions, and sharing household or personal items.
Patients are contagious until crusts have fallen off and new skin has formed.
- Antiviral therapy
- Intravenous vaccinia immune globulin: unknown effectiveness but can be considered in severe cases
Supportive care for mpox 
- Skin lesions
- Oral lesions
- Additional considerations
- Sepsis or septic shock
- Bacterial superinfection (e.g., cellulitis, abscess, necrotizing soft tissue infection)
- Blindness (following corneal infection)
- Acute respiratory distress syndrome
- Hemorrhagic disease
We list the most important complications. The selection is not exhaustive.
- Affected individuals typically recover within 2–4 weeks. 
- Mortality: 1–10% (esp. children and immunocompromised individuals)
Primary prevention 
- Occupational exposure
- Exposure to animal reservoirs
- Sexual exposure
- Bisexual, gay, or other , and transgender or nonbinary individuals with an STI and/or ≥ 1 sex partner within the past 6 months
- Individuals who have had sex at a commercial sex venue and/or sex in association with a large public event in an area with a known mpox outbreak within the past 6 months
- Sexual partners of any of the above individuals
- Immunosuppression and recent or anticipated potential exposure to mpox
Secondary prevention 
Mpox postexposure prophylaxis
- : used in the 2022 mpox outbreaks in different parts of the world
- Vaccinia immune globulin: for individuals with severe T-cell immunodeficiency in whom vaccination is contraindicated
- Indication: all patients with any known mpox exposure
- Duration: 21 days
- Activity restrictions are not required during monitoring.
- If symptoms develop, individuals should isolate until evaluation by a health care provider.