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
Triage/Clinician Intake
Expedite to room, close door as able
Standard Precautions
  • 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, Asymptomatic with
Normal Physical Exam

Standard Precautions
Exposure + Prodrome without Rash
Standard Precautions
Rash Present (+/- Prodrome)
Expanded Precautions
  • Indications for Vaccination
    • Vaccine supplies currently limited
    • Contact county health department for vaccination of close contacts of confirmed cases

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

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