GPs told to set up mpox isolation procedures and check PPE stocks in light of new variant

GP practices have been told to set up isolation procedures and check PPE stocks, as concerns grow around a new more fatal version of mpox.

The Clade 1b mpox variant (MPXV) has been spreading rapidly across parts of central and East Africa since first being discovered in September last year, killing 537 people in the Democratic Republic of the Congo (DRC) alone.

The World Health Organisation declared ‘a public health emergency of international concern’ on Wednesday this week, with the UK Health Security Agency (UKHSA) classifying the new variant as a ‘high consequence infectious disease’ (HCID) and urging vigilance among UK doctors.

So far, no case of the new variant has been detected in the UK, but Sweden reported the first case in Europe yesterday in a patient who had travelled from the affected region. This is the first case to have been detected outside Africa.

In new strengthened guidance to NHS providers, the Department of Health and Social Care has now urged providers ‘to ensure there is a clinical pathway for isolation and management of suspected Clade I MPXV cases within their setting’.

The DHSC update said: ‘Where suspected cases meeting the operational case definition present in primary care, general practitioners should isolate the patient in a single room and contact their local infection service for advice, including appropriate arrangements for transfer into secondary care and immediate precautions in the setting.’

Practices are also advised to ‘ensure that they have adequate stocks of appropriate personal protective equipment (PPE)’ and that ‘relevant staff are trained in its use for the assessment and treatment of patients presenting with suspected MPXV infection’.

‘Clinicians should be alert to the possibility of Clade I MPXV infection in patients presenting with suspected mpox where there is a link to the specified countries in the African region,’ the DHSC said.

These countries are listed as DRC, Republic of Congo, Central African Republic, Burundi, Rwanda, Uganda, Kenya, Cameroon, Gabon, Angola, South Sudan, Tanzania and Zambia.

‘Healthcare professionals should remain vigilant for Clade I MPXV, including in sexually acquired mpox cases, and should obtain comprehensive travel histories from patients,’ the guidance said.

Actions for the NHS

Providers to ensure that relevant clinical services – including primary care, urgent care, sexual health services, paediatrics, obstetrics and emergency departments – are aware of the information in this public health message and that a differential diagnosis of Clade I mpox virus (MPXV) infection is considered in any patient who meets the operational case definition below.
Providers to ensure that they have adequate stocks of appropriate personal protective equipment (PPE) and relevant staff are trained in its use for the assessment and treatment of patients presenting with suspected Clade I MPXV infection.
Providers to ensure there is a clinical pathway for isolation and management of suspected Clade I MPXV cases within their setting. This should include isolation of the patient, liaison with local infection prevention and control (IPC) teams, and arrangements for discussion of the case with local infectious disease, microbiology or virology consultants if a diagnosis of Clade I MPXV is being considered so that appropriate clinical management, including testing and infection control measures, can be implemented.
All samples from all individuals testing positive for mpox must be sent to the UKHSA Rare and Imported Pathogens Laboratory (RIPL) for clade differentiating tests.
Providers to note the information below for the clinical assessment and testing of patients with potential Clade I MPXV infection.

Source: DHSC

The DHSC listed patients who should be managed as HCID cases (pending confirmation of clade type where appropriate), as those with:

confirmed mpox where Clade I MPXV has been confirmed 
confirmed or clinically suspected mpox, clade not yet known and:
- there is a travel history to the DRC or specified countries where there may be a risk of Clade I exposure
- or a link to a suspected case from those countries, within 21 days of symptom onset
- or there is an epidemiological link to a case of Clade I mpox within 21 days of symptom onset

Clinicians who have treated patients with suspected mpox ‘who may meet the operational case definition of an HCID’ should ‘discuss this with local infection specialists’.

Once cases are confirmed as the new variant, these ‘will be managed through the specialist network of HCID centres’, DHSC added.

The previous mpox outbreak in the UK in 2022 saw more than 3,700 confirmed cases. Vaccination was offered to gay, bisexual and other men who have sex with men (GBMSM) who were at the highest risk of infection.

What is mpox?

MPXV is a virus from the same family as smallpox, that presents with a rash illness which may be mild and localised, or severe and disseminated. There are 2 distinct clades of the virus: Clade I and Clade II. Clade II MPXV is responsible for the global outbreak that began in 2022. Clade I MPXV is currently considered more severe than Clade II MPXV, leading to its classification as a high consequence infectious disease (HCID).

The symptoms of mpox begin 5 to 21 days (average 6 to 16 days) after exposure with initial clinical presentation of fever, malaise, lymphadenopathy and headache. Within 1 to 5 days after the appearance of fever, a rash develops, often beginning on the face or genital area and it may then spread to other parts of the body. The rash changes and goes through different stages before finally forming a scab which later falls off. Treatment for MPXV is mainly supportive.

Source: DHSC