Mpox (monkeypox) outbreak 2022 - guidance

Background

Epidemiology

Mpox (monkeypox) virus is endemic in Western and Central Africa. A global outbreak is currently (from May 2022) occurring in non-endemic countries. On 23 July 2022, the WHO declared this a Public Health Emergency of International Concern, its highest level of alert. Cases in this outbreak have mostly, but not exclusively, occurred in individuals who identify as gay, bisexual and other men who have sex with men. Since 5 July 2022, Mpox cases that are not associated with travel or epidemiological links to endemic areas are no longer considered a High Consequence Infectious Disease (HCID) in the UK. From 23 January 2023, only Mpox cases known to be Clade I, or linked to travel to Central Africa are considered HCID, as they may be expected to cause more severe disease. Mpox cases due to Clade II (such as the current UK outbreak), or linked to travel to West Africa, are no longer considered HCID.

The current outbreak of Mpox is being transmitted by close physical contact with lesions or contaminated fomites (including shed skin cells in e.g. bed linen).

There are relatively little published data on Mpox in children. In outbreaks in West and Central Africa, younger children had a higher mortality rate than adolescents and adults. It is currently thought that this risk is greatest in infants and the immunocompromised.

Further background information is available on the GOV.UK website

Case definitions

These are defined nationally by UKHSA. Please note these may change as the situation evolves - see latest definitions.

Possible case

A person with a febrile prodrome compatible with Mpox infection where there is known prior contact with a confirmed case in the 21 days before symptom onset. A febrile prodrome may consist of fever ≥ 38°C, chills, headache, exhaustion, muscle aches (myalgia), joint pain (arthralgia), backache, and swollen lymph nodes (lymphadenopathy).

Or, a person with an illness where the clinician has a high suspicion of Mpox (for example, this may include prodrome or atypical presentations with exposure histories deemed high risk by the clinician, or classical rash without risk factors).

Probable case

A person with an unexplained rash on any part of their body plus one or more classical symptom or symptoms of Mpox infection. Acute illness with fever (>38.5°C), intense headaches, myalgia, arthralgia, back pain, lymphadenopathy. since 15 March 2022 and either:

• has an epidemiological link to a confirmed or probable case of Mpox in the 21 days before symptom onset, or
• reported a travel history to West or Central Africa in the 21 days before symptom onset, or
• is a gay, bisexual or other man who has sex with men

Currently, it would appear to be highly unlikely that a CYP has Mpox in the absence of one of these three epidemiological risk factors.

Clinical features

The incubation period for Mpox is between 5 and 21 days. Mpox infection is usually a self-limiting illness and most people recover within several weeks. However, severe illness can occur in some individuals, with children, pregnant women and the immunosuppressed thought to be most at risk.

Classically, Mpox begins with a prodrome with fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. Within 1 to 5 days, a rash develops, often beginning on the face then spreading to other parts of the body, often the palms and soles before spreading elsewhere centrally (see pictures here and here). The rash changes and goes through different stages (macule -> papule -> vesicle -> pustule) before finally forming a scab which later falls off.

Whilst Mpox rash often demonstrates the 4 “Ps”; Pustules, Peripheral, Palms/soles, lymPhadenopathy, not all cases will have these features. An individual is contagious until all the scabs have fallen off and there is intact skin underneath. The scabs may also contain infectious virus material.

Differential diagnoses

Common differentials for a vesicular and similar rashes in children include chickenpox, HSV, enteroviral infection and molloscum contagiosum. Classically, Mpox lesions are all at a similar stage of maturation, unlike chickenpox where they appear over several days leading to lesions at different stages at any time. Note that this is not always the case, and Mpox lesions can appear in crops over several days in some individuals, making this distinction unreliable. Chickenpox rash typically begins centrally on the trunk and spreads peripherally. Mpox is classically described as beginning peripherally (face, extremities including palms and soles) and spreading centrally. Again, in the current outbreak, rashes have been atypical - sometimes more localised and often present in the genital area. Vesicular rashes of enterovirus can also be primarily peripheral such as in hand, foot and mouth disease.

In the absence of an identified epidemiological risk factor, Mpox is exceptionally unlikely at the present time in the UK. However, in the presence of an epidemiological risk factor, any CYP with a compatible clinical picture should undergo PCR testing to rule out Mpox.

Risks to the newborn

There is little known about Mpox in pregnancy and risks of transmission prior to, during and following delivery. It is possible for Mpox virus to be transmitted in utero from mother to fetus. Where this has been described in the first half of pregnancy, it has been associated with severe disease and fetal loss (Mbala, J Infect Dis 2017). The frequency with which this occurs is not known, and it is possible that the baby is born uninfected. There is also a possible risk of perinatal infection. Close contact with lesions is a recognised route of transmission (UKHSA, Monkeypox: Guidance), making vaginal delivery with Mpox lesions a significant additional exposure risk. It is important to note that the neonate is considered to be at very high risk of severe disease if infected with Mpox.

In an outbreak of Mpox in the USA in 2003, paediatric patients were hospitalised in intensive care units at significantly higher rates than adults (Huhn, Clin Infect Dis 2005). The most critically ill patients in that outbreak were two young school-aged children with complications that included encephalopathy and retropharyngeal abscess. Several reports from outbreaks in countries in Africa note the higher incidence of mortality amongst younger children (Meyer, J Clin Microbiol 2002; Jezek & Fenner, Monogr Virol 1988) including the death in a child at one month of age (Yinka-Ogunleye, Lancet Infect Dis 2019). The high level of concern around protecting children from infection is reflected in UKHSA guidance around isolation of confirmed cases of Mpox (UKHSA, Monkeypox: Guidance). Confirmed cases who are unable to isolate away from children in the household, are admitted to hospital to protect the child at home. 

There are to our knowledge no published reports of the outcomes of perinatal or neonatal exposure. As it is probable that newborns are at the highest level of vulnerability, it seems prudent to minimise infection risk to the new born baby. This would include exposure risk during delivery (e.g. exposure to genital lesions) and following delivery (exposure of potentially vulnerable newborn to infectious mother or other potentially exposed/infectious members of the household). Such precautions would not be needed if there is evidence the baby is already infected (e.g. from amniocentesis or a postnatal PCR test).

There are no current data regarding risk from breast milk transmission of Mpox. Several other viruses are transmitted to infants through breast milk (Lawrence, Breastfeeding 2011). In addition to the possible risk of the breast milk itself, there is the known additional risk from close physical contact. A case has been reported of transmission of the virus in smallpox vaccine (vaccinia, closely related to Mpox) during breastfeeding leading to contact vaccinia in the baby (Garde, JAMA 2004). Contacts of confirmed Mpox cases may be incubating the virus or asymptomatically infected. Their breast milk may also potentially transmit Mpox virus. WHO advises that women in this situation do not donate breast milk.

Guidance Part A: CYP with suspected Mpox (monkeypox)

Please see pathway flowchart in Appendix A

1. Arrangements for clinical assessment

Staff assessing CYP with suspected Mpox should wear personal protective equipment (PPE) in accordance with national and local guidance. Follow local guidance to isolate the child in a dedicated cubicle as soon as the risk is identified, ideally on entering the building, if not possible in advance of arrival. If such isolation is not possible, provide patients with a fluid resistant surgical mask and cover any visible lesions (using an appropriate combination of gown, gloves and surgical cap), and remain at least 1 metre away from other people.

In some cases, home assessment may be appropriate, with consideration given to planning PPE and waste disposal arrangements. Take advice from your local IPC and infection teams.

For young people over 13 years of age where sexual contact is the identified risk factor for suspected Mpox, consider referral to a sexual health centre. This may provide opportunity for comprehensive sexual health assessment and advice, alongside testing for Mpox. For any presentation based on sexual contact, consider whether this raises any safeguarding concerns.

Staff should ensure they are wearing appropriate PPE. For possible/probable cases this includes gloves, a fluid repellent surgical facemask, and an apron. The facemask should be replaced with an FFP3 respirator and eye protection if the case presents with a lower respiratory tract infection with a cough and / or changes on their chest x-ray indicating lower respiratory tract infection. Eye protection is also required if there is a risk of splash to the face and eyes (for example when taking diagnostic tests). Follow national and local guidance around waste disposal and cleaning afterwards.

Clinical assessment of a CYP with suspected Mpox should be performed with the least physical contact and with the fewest people that is required for safe assessment. It should be done by the most appropriately senior professionals available in appropriate PPE. Consider the use of digital photography with consent and appropriate governance to enable more specialist staff to consult about the lesions without additional exposure.

If following assessment Mpox is suspected and you are proceeding with testing, consider maintaining a log of staff who enter the cubicle or have contact with the patient, in case subsequent contact tracing is required.

Further advice is available from regional paediatric infectious diseases teams.

2. How to clinically assess and test for Mpox (monkeypox) in a child

Download a PDF of these questions below

Useful questions to ask

Questions for all:

• When did the rash start?
• Where did the rash begin?  Palms and soles or centrally?
• How large are the lesions?
• Total number of lesions? 1-10 / 10-100 / 100 +
• Status of lesions – vesicles? scabbing over? When did last new lesion appear?
• Any eye/mouth/genital/rectal lesions? [ask with appropriate relevance and sensitivity if young person is sexually active]
• Any lesions causing particular concern? e.g. pain/bleeding.
• Fever?
• Headache?
• Vomiting? Able to keep down fluids?
• Diarrhoea?
• Fatigue or lethargy?
• Breathing difficulties?
• Any other symptoms?
• Do they feel they are getting better? Same? Worse?
• Any comorbidities, and specifically immunodeficiency/immune suppression
• Confirm address and contact details

Questions for those with a contact with a confirmed Mpox case:

• Note details of the exposure including time and nature

Questions for those with a travel history:

• Countries visited with dates of arrival and departure

Questions for young people:

• Complete psychosocial history using HEADSS tool
• Are they sexually active?
• If so ask about last sexual contact, ask if they are sexually active and consider asking if relevant
• Last sexual contact?
• High risk factors for the current outbreak are individuals who identify as MSM.

3. How to test for Mpox (monkeypox) in a child

Two viral swabs of skin lesions should be taken. If the lesions are not yet vesicular/pustular and just dry macular/papular lesions, a throat swab should be taken in addition. If there is only prodromal symptoms without rash, take a throat swab.

Follow local guidance from your local virology/infection team as to how these samples should be labelled and transported. Ensure 24/7 contact details for the referring team are on the request to allow prompt communication of the result.

At the same time, further tests may be required considering alternate diagnoses, such as a further viral swab of vesicles for HSV/VZV/enterovirus PCR. Consider the need to take a bacterial culture if lesions appear secondarily infected. It is recommended that all swabs are taken at the same time to minimise risk of exposure to staff.

The optimal way to swab a vesicle/pustule is shown in the diagram below.

4. Child with suspected Mpox (monkeypox) who is well enough to return home

It is important to minimise the risk of onward transmission whilst awaiting test results. Consider how well a child can isolate whilst at home, particularly from others who may be at higher risk. This includes young children, pregnant women and the immunocompromised. Consider asking about whether they share a bedroom, and whether there is a separate bathroom/toilet they can use.

If the clinical presentation is strongly suggestive of Mpox, and other alternative diagnoses seem highly unlikely, consider applying a more stringent level of isolation even prior to confirmation. In such cases, consider taking advice from paediatric HCID centres.

Exposed contacts who do not have symptoms do not need to isolate.

All these situations require careful planning, with consideration of the care and emotional needs of the child and other children in the household, alongside the need to protect those at high risk.

Provide families with a copy of Appendix B: How to isolate if you are suspected of having Mpox and contact details for your team.

It is the responsibility of the assessing team to maintain daily virtual contact with the child to monitor wellbeing and clinical progression until the result of the PCR test is available.

• If the PCR result is positive and Mpox confirmed, you will be notified of the result. Please contact a paediatric HCID centre to discuss planning of further care - see NHS England guidance, Management of laboratory confirmed Mpox infections (PDF) and details of use of the antiviral tecovirimat. The local Health Protection Team will commence contact tracing and provide further guidance. The team who sent the test is required to inform the patient/carer of the positive test result, and advise regarding ongoing isolation pending the decision of the HCID network meeting.
• If the result is negative, it is the responsibility of the team who sent the test to inform the family of the result and assuming there are no other infection control concerns, advise them to end isolation.

5. Child with suspected Mpox (monkeypox) who requires hospital admission

Following local assessment, an unwell child who is still deemed to have suspected Mpox may require hospital admission. In such a situation, continue to follow guidance regarding enhanced PPE, minimising staff contact with the child, and care with waste disposal. In these circumstances, local teams are advised to discuss patients with the paediatric infectious diseases teams at their nearest airborne HCID centre (see list at end of document).

Use the checklist in Appendix C to ensure you have done all that is required.

In the event that the patient is confirmed to have Mpox, please discuss with a paediatric HCID centre and follow instructions in the NHS England guidance, Management of laboratory confirmed Mpox infections (PDF), and see details around eligibility for the antiviral tecovirimat.

6. Management of a child with confirmed Mpox (monkeypox)

The team who sent the sample will be notified by the laboratory. Unless there is an epidemiological link to endemic countries, or other reason to suspect it is not linked to the current outbreak, the case will not be considered an HCID case.

Any confirmed case in a child under 16 years should be notified to the closest paediatric HCID centre, even if not considered an HCID case. The network of paediatric infectious diseases specialists who work in HCID centres have developed collective experience through discussion of Mpox cases in national network meetings. The paediatric HICD unit will provide initial advice on management and referral into the national NDT.

All children under 12 years of age should be discussed in the national NHSE/I Network MDT meeting within 24 hours to determine ongoing management. This will be arranged by the paediatric HCID unit. Outcomes may include remaining at home with active daily monitoring, admission locally or to a regional PID unit or admission to a paediatric HCID unit, depending on the specific circumstances.

The clinical team who sent the test on the child are required to inform the patient/carer of the positive test result, and advise regarding ongoing isolation and care plans on the basis of the above discussions. The local Health Protection Team will commence contact tracing and provide further guidance.

Guidance Part B: Child contacts of confirmed case of Mpox (monkeypox)

How to risk assess an exposed child

To assess the risk of an exposure to a child, the infectivity of the index case, the nature and duration of the exposure and the vulnerability of the exposed child all need to be taken into account. Transmission is primarily dependent on direct contact with lesions or contaminated fomites. A person with an isolated covered lesion poses significantly less risk than a person with exposed lesions. Newborns, children under five and the immunocompromised are likely to be most at risk of more severe disease if infected. However, there is no evidence to date that they are more vulnerable to becoming infected than others following a similar exposure.

There is a national framework for risk assessing both the exposure and the vulnerability of the contact. This was revised on 19 July 2022 as it had become clear that transmission was hardly ever occurring in the current outbreak outside of close physical contact with a symptomatic case. The majority of household or school classroom exposures would therefore not be expected to lead to transmission. This has led to a reduction in isolation advice for contacts. In the absence of any symptoms, exposed children do not need to isolate and should continue to attend school and other activities as normal.

If an adult with confirmed Mpox is unable to isolate away from a child in the household, precautions should be taken to minimise exposure, especially for children aged under five years of age. Aim to minimise direct physical contact. Sharing of towels and bed linen is discouraged.

Communication with contacts

Most exposures are likely to occur either in the home or in a classroom, healthcare or leisure setting. In adolescents exposure via sexual contact must also be considered. The identity of the index case should not be explicitly disclosed.

However, there is a public health responsibility to inform and provide advice to exposed children and the adults responsible for their care. In some cases, this may lead to identification of the confirmed index case by the child or other adult. Ideally, index cases should be counselled by their care team that public health authorities are obliged to and will need to contact those exposed. The care team should aim to provide support to the index case if they wish to disclose their diagnosis themselves rather than it becoming apparent from a communication by a public health professional.

Parents/carers of exposed children should be given information about symptoms of Mpox, and informed who to contact if they arise. This includes headache, fever, chills, sore throat, malaise, fatigue, rash, and lymphadenopathy.

Health Protection Teams (HPTs) are currently advising to call 111 in the first instance and to inform 111 of the Mpox exposure. In addition, if following this Mpox is suspected contacts are asked to inform the HPT, health professionals and HPT practitioners may request further input from paediatricians in assessing the patient. Further support and advice is available from regional PID teams and HCID paediatric clinicians.

Contacts being monitored who develop any symptom consistent with Mpox should be considered a suspected case and be managed according to Part A of this guideline. They will require face to face assessment and in some cases it may be appropriate to arrange home assessment and testing. Given the extreme paucity in paediatric cases to date and possibility of severe disease in young children, it is recommended to involve HCID paediatric infectious diseases teams early in such discussions even prior to the diagnosis being confirmed.

It is sensible to avoid things that could lead to symptoms that may mimic Mpox and lead to unnecessary testing and isolation. As a result, it is advisable to defer routine childhood vaccines for 21 days following exposure to eliminate the possibility that a vaccine-induced adverse event (eg fever or rash).

Post-exposure vaccination of children

Modified vaccinia Ankara (MVA-BN; Invanex in Europe; JYNNEOS in the United States) is a third generation smallpox vaccine which contains a modified form of the vaccinia virus called vaccinia Ankara, which does not cause disease in humans and cannot replicate in human cells. Although not specifically licensed for the prevention of Mpox in Europe, MVA-BN has been used in the UK for both pre- and post-exposure prophylaxis in previous Mpox outbreaks (Vaughan, EuroSurv 2018).

The vaccine is safe and immunogenic in adults, although adults with atopic dermatitis have reported increased site-associated reactions after MVA-BN vaccination and exacerbation of the dermatitis in some. As MVA-BN is replication incompetent, MVA-BN is considered safe even in immunosuppressed individuals including people with HIV, although immunogenicity and protection may be lower in these populations.

There are currently no paediatric studies of MVA-BN immunogenicity or efficacy against either smallpox or Mpox, and the vaccine is not licensed in children. Other vaccines using MVA, such as vaccines against tuberculosis (Ota Science Translational Med 2011) and malaria (Afolabi Molecular Therapy 2016) with higher MVA doses than MVA-BN, have reported a reassuring side-effect profile in children. Although there is no specific reason for greater adverse effects in infants under three months of age, there are no reports of studies of MVA-based vaccines in that age group, and appropriate counselling should be provided to ensure informed consent.

Several countries, including the US and the UK recommend offering MVA-BN, ideally within four days of exposure, to prevent disease. Vaccination can be offered up to 14 days after exposure, which may not prevent disease but may reduce disease symptoms and severity. MVA-BN has been used in 2018 and 2019 UK Mpox outbreaks, where some young children were also vaccinated as part of post-exposure prophylaxis (ref Green Book).

For the current outbreak, MVA-BN is available in some countries, including the UK and the USA. MVA-BN should be offered to children within 14 days of contact with a case. If exposure has been intermittent or continuous, post-exposure vaccination should ideally be given within four days of the last exposure. MVA-BN administration should not be delayed even if the child has recently received another vaccination.

The same dose is recommended for adults and children. A single dose is recommended for post-exposure prophylaxis, but a second dose may be administered at least 28 days later in rare circumstance where a child may be at ongoing risk of further exposure. MVA-BN is a replication defective virus and can be given to immunocompromised children and those living with HIV. Children with atopic dermatitis should be closely monitored after vaccination.

Paediatric Airborne High Consequence Infectious Disease Units

Call switchboard and ask for Paediatric Infectious Disease doctor on-call.

Guidance Part C: Newborn baby of mother with suspected or confirmed Mpox (monkeypox)

Scope

This guidance pertains to the care of a newborn when the mother has suspected or proven Mpox on the basis of a known epidemiological link and a compatible clinical syndrome; or a highly suggestive clinical syndrome without an epidemiological link.

It does not cover the more common situation of a baby born to a woman with isolated genital lesions in the absence of a known epidemiological link.

Introduction

There is a relative lack of evidence to guide decision making, with concern that newborns may be at high risk of severe disease if infected. Where possible it is advised that clinical teams contact the airborne (Airborne) Network by calling the UKHSA Imported Fever Service on 0844 778 8990 to convene an urgent multidisciplinary meeting. If this has not been possible prior to delivery, this discussion should take place as soon as possible following delivery. This will allow clinicians to access the most up to date information and expert opinion to guide the mother’s decision making around these risks and how to minimise them.

The aim of this guidance is to reach an appropriate balance between the potential risk to the newborn of perinatal infection and the risks inherent in mother/baby separation. These guidelines will be regularly reviewed to reflect new information on the balance of risk, in order to normalise bonding and feeding to the maximum degree possible.

Specialist advice is available 24/7 from Paediatric Infectious Diseases teams at HCID centres.

1. Isolation of mother and baby until maternal Mpox status is known

A baby born to a mother with suspected or confirmed Mpox at any stage of pregnancy or at the time of delivery, should be assumed to be infected until testing excludes infection. PPE, including protection against airborne transmission, should be worn and visitors should be appropriately restricted. It will not initially be known if the baby is infected and how this may transmit to staff. In view of this, assuming the possibility for transmission by aerosolisation, AGP PPE is advised, in line with national and local guidance. The baby should be isolated from other babies.

The baby should be tested for Mpox virus by PCR from throat swab, blood, urine and swabs of any skin lesions.

The baby may be uninfected and at risk if exposed to its infectious mother. As the risk to the baby is potentially very significant, initially the baby should be separated from the mother. If the mother tests negative, or if both mother and infant both test positive, they should be reunited (where clinically appropriate). Mothers and partners should be counselled on the risk Mpox could pose to the baby and the rationale for separation. If this approach remains unacceptable to them, particularly if there are factors present that are considered to reduce risk, multidisciplinary discussion should take place to identify the most appropriate way to proceed.

2. Management of baby if mother is confirmed positive

If the mother tests positive and the infant tests negative, careful planning will be required regarding mother and infant contact, considering the balance of the risk of infant infection and the importance of bonding. This will depend on several factors including maternal day of symptoms and the evolution and sites of lesions. Planning should involve a multidisciplinary team including maternity, virology, neonatology, adult and paediatric infectious diseases specialists, through the HCID network. Use of MVA-BN vaccine is indicated and can be discussed with the HCID network. 

If, at any time, the baby is also confirmed to be infected, mother and baby may be reunited where otherwise clinically appropriate. The baby will be automatically referred to the HCID network for consideration of early antiviral treatment. This may require transfer of the baby to an HCID unit for further management, ideally keeping mother and baby together.

3. Breastfeeding

Close physical contact is a known risk factor for transmission. It is not currently known whether Mpox is transmissible via breast milk  Despite the well recognised benefits of breastfeeding, based on the current balance of risk and harm, women with suspected or confirmed Mpox should be advised not to breastfeed until they are known not to be infectious. Breast milk may be expressed to initiate and maintain supply until breastfeeding is considered safe. This milk is potentially infectious and should be disposed of following IPC waste disposal guidance. Where both mother and the neonate are infected, breastfeeding should be supported.

Donor breast milk can be considered in place of formula feeding, until maternal breast milk is deemed safe. Asymptomatic contacts of a confirmed case of Mpox should not donate breast milk until they are no longer considered potentially infected.

Recommendations: priorities for service provision and research

The current Mpox outbreak highlights the importance of working in a collaborative network of paediatric centres in order to manage small numbers of children with high risk pathogens. In the UK, clinicians and public health professionals have worked closely to identify (rigorous contact tracing), prevent (supporting isolation and facilitating access to and administration of vaccines) and communicate in a coordinated manner. 

These networks need to be adequately funded and sustained beyond the current outbreak in order to provide effective specialist paediatric care.

Affected children should be enrolled into disease registries in order to better understand the clinical manifestations.

Given the lack of current evidence for treatment of exposed or infected children, studies of antiviral medicines and vaccines must include children to develop an appropriate evidence base for future care.

Appendix A: Mpox (monkeypox) in children & young people - quick guide

Download a PDF of this flowchart below (Appendix A - quick guide flowchart).

Appendix B: How to isolate if you are suspected of having Mpox (monkeypox)

Download a PDF of this guidance below

Please return straight home. 

The person with suspected Mpox should wear a mask and cover all skin lesions.

• Aim to minimise close contact with others in the home, especially children under five years of age, pregnant people and the immunocompromised.
• This includes avoiding skin to skin contact if possible.
• Ideally the person suspected of having Mpox should sleep in a separate room and use separate facilities for eating, bathing and using the toilet – where not possible, these should be cleaned after use.
• Non-household members should not visit the residence where possible.
• Do not leave the residence.
• Pets should be excluded from infected person’s environment.
• If contact with other household members is unavoidable – all should wear surgical masks and skin lesions should be covered.
• Maintain good hand hygiene with soap and water.
• Linen and towels should not be shared.
• Avoid shaking used laundry to prevent dispersing of infectious particles, and keep the laundry separate from that of other people.
• Dishes and utensils can be cleaned with soap and water.
• Contaminated surfaces should be cleaned with alcohol or chlorine-based household disinfectants.
• If possible, take photographs of the rash as it evolves day by day - your doctor will advise on how to send these.

Your hospital team will maintain contact with you to check on your / your child’s progress.

Should you need to contact the hospital, please call [enter phone number] and ask for [enter name/team].

Appendix C: Actions when admitting a child with suspected Mpox (monkeypox)

Download a PDF of this checklist below

Working group members

• PID - Paediatric Infectious Diseases
• HCID - High Consequence Infectious Disease
• BPAIIG - British Paediatric Allergy, Immunology & Infection Group
• BAPM - British Association for Perinatal Medicine

CYP guidance working group

Newborn guidance working group