Information for clinicians treating patients with mpox who require hospitalisation

The approach to management of mpox patients varies according to the suspected or confirmed clade of the virus.

• Clade IIb mpox is the clade currently occurring in Australia, predominantly in gay, bisexual and other men who have sex with men. The main risk for transmission appears to be sexual contact. Transmission through non-sexual contact appears uncommon. The case fatality rate in the global Clade IIb outbreak which started in 2022 is <0.1%.
• Clade I mpox predominantly occurs in Central Africa. Cases there have been increasing, with spread to surrounding countries. There is concern of importation of Clade I, in particular Clade Ib. Transmission may occur through direct contact, respiratory droplets, as well as sexual contact, and the mortality rate has been reported to be as high as 10%.

Clade I mpox should be suspected where a patient has symptoms consistent with mpox (or they are mpox PCR positive) and:

• a patient (or a contact from their exposure period) has travelled to an area with known Clade I cases (see World Health Organization 2022-24 Mpox (Monkeypox) Outbreak for current information)
• known contact with a suspected or confirmed case of Clade I mpox during their infectious period
• mpox was acquired by a route other than sexual transmission.

The clade of virus can only be determined using specialised testing. Any cases where Clade I is suspected should be reported immediately to the Public Health Unit for assessment and request for urgent specialised testing.

When do patients with mpox require further assessment, hospital admission or treatment?

Most patients can be managed at home with a telehealth review through their GP, sexual health clinic or Public Health Unit. In most cases, mpox does not require treatment.

Clinical situations that may require further review or treatment include:

• eye problems as keratitis with mpox can impact on people’s eyesight
• secondary bacterial infection, sepsis or abscesses
• disseminated disease, particularly in those who are immunosuppressed
• severe pain not managed by simple analgesia.

Patients with Clade I mpox may be hospitalised for non-clinical reasons if there is concern the patient is unable to effectively isolate at home independently.

Patients with suspected Clade IIb requiring hospitalisation

Initial treatment should be discussed with local infectious diseases or sexual health physicians. Patients with suspected Clade IIb mpox may be admitted to their local hospital, following the principles outlined in the CEC Mpox Infection Prevention and Control Information for Clinicians guidelines. The NSW Specialist Service for High Consequence Infectious Diseases at Westmead can be contacted for expert advice.

Indications for antiviral treatment can be found in the Australian mpox treatment guidelines. Antiviral agents can be accessed through the NSW Specialist Service for High Consequence Infectious Diseases (or contact the infectious diseases physician on-call at Westmead Hospital via the switchboard on 02 8890 5555).

The mode of transport for a patient who requires admission should be dictated by the severity of illness. This decision should be made in consultation with the local Public Health Unit.

For a mild Clade IIb mpox illness, patients can be transported by a family member or carer, or by public transport provided their lesions are covered, the patient wears a mask, and the patient is diligent with hand hygiene.

For severe or disseminated disease, transport by NSW Ambulance may be required.

Patients with suspected Clade I requiring hospitalisation

Due to the suspected higher transmissibility and severity, Clade I mpox is considered a High Consequence Infectious Disease. For patients with suspected or confirmed Clade I mpox requiring further assessment, treatment, or hospital admission, the treating sexual health physician or infectious diseases physician are to contact the NSW Specialist Service for High Consequence Infectious Diseases (or contact the infectious diseases physician on-call at Westmead Hospital via the switchboard on 02 8890 5555).

The NSW Biocontainment Centre at Westmead provides purpose-built quarantine facilities that incorporate enhanced infection prevention and control strategies to manage Clade I mpox patients.

Patients with suspected or confirmed Clade I should be transported to the NSW Biocontainment Centre at Westmead Hospital by NSW Ambulance.