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Mpox — Clinical Guidelines

Overview

Mpox, formerly known as monkeypox, is a zoonotic viral disease caused by the monkeypox virus (MPXV), which has seen significant outbreaks outside of Africa since 2022, primarily due to clade IIb MPXV. The disease presents with fever, rash, and lymphadenopathy, and has led to multiple public health emergencies globally 2 3.

Diagnosis

Clinical Presentation: Fever, rash, lymphadenopathy, and systemic symptoms 13.

Laboratory Tests: PCR testing of lesion samples for MPXV confirmation 2.

Genomic Sequencing: Essential for tracking viral clades and transmission dynamics 2 3.

Differential Diagnosis: Consider other vesiculotropic viruses and conditions mimicking mpox rash 13.

Management

Vaccination: Use of third-generation vaccines like MVA-BN (JYNNEOS) for post-exposure prophylaxis and pre-exposure protection 5 6.

Supportive Care: Management of symptoms including pain relief, hydration, and monitoring for complications like secondary infections 4.

Isolation: Implement strict isolation protocols to prevent human-to-human transmission 4.

Monitoring: Regular follow-up for complications, especially in high-risk groups 4.

Special Populations

Children: Vulnerable to severe disease; vaccination efforts face regulatory and liability hurdles 7.

Immunocompromised: Higher risk of severe disease; close monitoring and prompt vaccination recommended 4.

Key Recommendations

Strategic Vaccine Deployment: Utilize available vaccine doses strategically to target high-risk populations effectively (Evidence: Moderate 1).

Enhanced Surveillance Systems: Implement robust surveillance systems for timely detection and reporting of mpox cases (Evidence: Moderate 9).

Genomic Surveillance: Conduct rapid viral genome sequencing to track transmission dynamics and emerging clades (Evidence: Strong 2 3).

Patient Education and Support: Provide comprehensive support and education to patients, especially during outbreaks, to improve care experiences (Evidence: Expert opinion 4).

Address Vulnerable Groups: Prioritize vaccination and clinical care for children and immunocompromised individuals despite logistical challenges (Evidence: Expert opinion 7).

References

1 Cohen J. Scattershot vaccination fails to slow mpox spread in Congo. Science (New York, N.Y.) 2025. link 2 Kinganda-Lusamaki E, Ayouba A, Mbala-Kingebeni P, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Delaporte E et al.. [From the emergence of mpox in the Democratic Republic of the Congo to global health emergencies]. Medecine sciences : M/S 2025. link 3 Liu BM, Yang Z. An urgent need for diagnostic tools to address global mpox public health emergencies. Journal of clinical microbiology 2025. link 4 Brick M, Rudolph D, Dashler G, Varnauskas A, Qiao L, Hamill MM et al.. When public health emergencies hit the front line: a qualitative study of the patient experience in the emergency department and outpatient infectious disease clinic during the 2022 Mpox clade IIb outbreak. BMC infectious diseases 2025. link 5 Pischel L, Martini BA, Yu N, Cacesse D, Tracy M, Kharbanda K et al.. Vaccine effectiveness of 3rd generation mpox vaccines against mpox and disease severity: A systematic review and meta-analysis. Vaccine 2024. link 6 Berry MT, Khan SR, Schlub TE, Notaras A, Kunasekaran M, Grulich AE et al.. Predicting vaccine effectiveness for mpox. Nature communications 2024. link 7 Cohen J. Children are left behind in Congo's mpox vaccination drive. Science (New York, N.Y.) 2024. link 8 Rahim FO, Fallah M, Jain U, Richardson ET, Ndembi N, Ngongo N et al.. Challenges and Ongoing Actions to Address the Mpox Emergency in Africa. Annals of global health 2024. link 9 Rainey JJ, Lin XM, Murphy S, Velazquez-Kronen R, Do T, Hughes C et al.. Deployment of the National Notifiable Diseases Surveillance System during the 2022-23 mpox outbreak in the United States-Opportunities and challenges with case notifications during public health emergencies. PloS one 2024. link 10 de Araújo LP, de Melo Santos NC, Corsetti PP, de Almeida LA. Immunoinformatic Approach for Rational Identification of Immunogenic Peptides Against Host Entry and/or Exit Mpox Proteins and Potential Multiepitope Vaccine Construction. The Journal of infectious diseases 2024. link 11 Weidenthaler H, Vidojkovic S, Martin BK, De Moerlooze L. Real-world safety data for MVA-BN: Increased frequency of syncope following intradermal administration for immunization against mpox disease. Vaccine 2024. link 12 Duffy J, Myers TR, Marquez P, Rouse D, Brown H, Zhang B et al.. JYNNEOS Vaccine Safety Surveillance During the 2022 Mpox Outbreak Using the Vaccine Adverse Event Reporting System and V-safe, United States, 2022 to 2023. Sexually transmitted diseases 2024. link 13 Long B, Liang SY, Carius BM, Chavez S, Gottlieb M, Koyfman A et al.. Mimics of Monkeypox: Considerations for the emergency medicine clinician. The American journal of emergency medicine 2023. link 14 Shah J, Saak TM, Desai AN, Gudis DA, Cheema HA, Abuelazm M et al.. Otolaryngologic manifestations among MPOX patients: A systematic review and meta-analysis. American journal of otolaryngology 2023. link 15 Studemeister L, Pai S, Walsh K, Cooper J. Acute Tonsillitis Due To Monkeypox. The Journal of emergency medicine 2023. link

Mpox