Emergency Department, Outpatient Specialty Care, and Primary Care
Clinical Pathway for the Evaluation and Management of Orthopox (Monkeypox)
- Travel Exposure Screen
- Close contact (sexual, household) with person with suspected or confirmed case in preceding 21 days
- AND
- Rash, fever/rash
- Suspected case: exposure + rash
or new onset characteristic rash- Exposure, Epidemiologic Criteria
- Sexual contact (e.g., oral, anal, vaginal) in the preceding 21 days
- Household, sexual, or close physical contact w/suspected or confirmed case
- Rash
- Solely anogenital or may appear on other areas like the hands, feet, chest, face, or mouth
- Appears as pustules, papules,
or vesicles - Evolves into scabs
- May be painful or pruritic
- Prodrome
- Fever, chills, headache, malaise, myalgia, lymphadenopathy
- CDC – Signs and Symptoms
- Exposure, Epidemiologic Criteria
- History
- Assess:
- Symptoms, prodrome, rash
- Exposure, Epidemiologic Criteria
- Sexual contact (e.g., oral, anal, vaginal) in the preceding 21 days
- Household, sexual, or close physical contact with suspected or confirmed case
- Risk Factors for severe disease
- Physical
- Gloves should be used for skin exam for all patients with rash
- Don expanded precautions for physical exam, specimen collection
- Perform thorough skin and mucosal (e.g., anal, vaginal, oral) examination for the characteristic rash visual diagnosis
- Use of Chaperones During Sensitive Area Physical Examinations
Exposure + Prodrome without Rash
Standard Precautions
Standard Precautions
Rash Present (+/- Prodrome)
Expanded Precautions
Expanded Precautions
- Indications for Vaccination
- Vaccine supplies currently limited
- Contact county health department for vaccination of close contacts of confirmed cases
- Disposition
- Patient Counseling
- Discuss anticipatory symptom monitoring for rash, isolation
- Indications for Vaccination
- Patient Counseling
- Diagnostic Testing
- Orthopoxvirus Testing
- Specimen Collection, Ordering
- Additional Testing, as indicated
- HSV, syphilis, GC/CT, VZV, enterovirus
- Review Differential Diagnosis
- Rash Visual Diagnosis
- Orthopoxvirus Testing
- Discharge
- Patient Counseling
- Discharge Instructions — English
- Discharge Instructions — Spanish
- Isolation not indicated
- Discharge
- Patient Counseling
- Discharge Instructions — English
- Discharge Instructions — Spanish
- Isolation not indicated
- Follow-up
- Positive Test
- Patients and families should be informed of positive results
- Immediately and provided Isolation Guidance
- Patient Counseling
- Indications for Vaccination
- Patients, Close Contacts
- Consult and Admission Considerations
- ID Consult Considerations
- Admission Considerations
- Negative pressure room
- Expanded Precautions
- ED Referral Considerations
Posted: August 2022
Revised: August 19, 2022; August 23, 2022; August 25, 2022, September 1, 2022, September 12, 2022, September 16, 2022
Authors: S. Wood MD; C. Kerman, MD; S. Jelinek, MD; J. Lavelle, MD; M. Russo, MD; L. Karel, PharmD;
H. Yoon, MPH; S. Townsend, MS-HQS; M. Langer, MD
Evidence
- Clinical Considerations for Orthopox (Monkeypox) in Children and Adolescents — CDC
- Orthopox (Monkeypox) Health Alerts — Philadelphia Department of Public Health (PDPH)
- Updated Recommendations for Orthopox (Monkeypox) Case Identification and Testing — Pennsylvania Department of Health
Related Links
