Mpox — Evaluation — Clinical Pathway: Emergency Department, Outpatient Specialty Care and Primary Care

Mpox (Monkeypox) Clinical Pathway — Emergency Department, Outpatient Specialty Care and Primary Care

Evaluation of Child with Possible Mpox

This pathway guides the care of adolescents and children with possible mpox in the ambulatory, ED or Inpatient setting.

Patients at Risk for Mpox

Patients presenting with mpox may have varied presentation of symptoms.

Assessment of travel history   close contact exposures, sexual activity, prodromal symptoms, and presence of rash are important to determine the need for diagnostic testing, isolation, and treatment.

For Health Departments: Please see CDC’s Case Reporting Recommendations   for Health Departments for more information about data collection for case reporting and specimen collection.

Case Definitions

Suspected Case
  • New characteristic rash
  • or
  • Meets one of the epidemiologic criteria and has a high clinical suspicion for mpox
    • Clinical suspicion may exist with rashes that mimic mpox
      • Secondary syphilis
      • Herpes
      • Varicella zoster
Probable Case
  • No suspicion of other recent Orthopoxvirus exposure (e.g., smallpox vaccination) and demonstration of:
    • Orthopoxvirus DNA by polymerase chain reaction of a clinical specimen
    • or
    • Orthopoxvirus using immunohistochemical or electron microscopy testing methods
    • or
    • Demonstration of detectable levels of anti-orthopoxvirus IgM antibody during the period of 4 to 56 days after rash onset
Confirmed Case
  • Demonstration of the presence of mpox virus DNA by polymerase chain reaction testing or Next-Generation sequencing of a clinical specimen
  • or
  • Isolation of mpox virus in culture from a clinical specimen

CDC: Clinical Considerations for Mpox in Children and Adolescents  
CDC: Signs and Symptoms  

Exposure, Epidemiologic Criteria, Rash Characteristics and Prodrome

Exposure and Epidemiologic Risk
  • Within 21 Days of Illness Onset
    • Contact with a person/people with a similar appearing rash or with a diagnosis of confirmed or probable mpox
    • or
    • Individual within a network experiencing mpox activity such as sexually active adolescents and young adults, especially those with prior or concurrent STIs, multiple partners, or anonymous partners
    • or
    • Individual with travel to high risk countries  
Rash Characteristics
  • May be located on or near the genitals
    • Penis, testicles, labia, and vagina or anus
  • May also be on other areas
    • Hands, feet (including palms and soles), chest, face, or mouth
  • Rash goes through several phases which may be present at the same time
    • Maculopapular to vesicles, pustules then scabs
    • May be painful or itchy
    • Patients may have isolated rash without prodromal symptoms
Prodrome
  • Fever
  • Headache
  • Muscle aches and backache
  • Lymphadenopathy
  • Chills
  • Malaise
  • Respiratory symptoms
    • Sore throat, nasal congestion or cough