Mpox

Question 1

Which Mpox clade was responsible for the global 2022 outbreak

Answer 1

Clade 2b

Question 2

What is the incubation period of Mpox

Answer 2

5-21 days

Question 3

Describe the clinical features of Mpox

Answer 3

Biphasic illness with a febrile prodrome (fever >38, headache, fatiuge, myalgia, arthralgia, swollen lymph nodes) with onset of rash within 1-5 days

Question 4

How does the Clade 1 rash differ from Clade 2 rash

Answer 4

Clade 1: centrifucal distribution, monomorphic, synchronous evolution
Clade 2: most of the rash is at the site of exual contact, lesions elsewhere could progress at different rates

Question 5

How long does the rash usually last

Answer 5

2-4 weeks

Question 6

Test to diagnose Mpox

Answer 6

Viral swab: lesions/rectum (proctitis), throat (if no lesions/prodromal symptoms) And full STI screen.

Question 7

Countries with Clade 1 outbreaks

Answer 7

Central and East Africa: Democratic Republic of Congo (DRC), Burundi, Uganda, Kenya, and Rwanda

Question 8

Management of Mpox

Answer 8

Notify public health (urgent by phone)
supportive (analgesia, mx constipation)
self isolate - info sheet NHS
no sex until lesions healed back to normal skin
condoms 12w
antivirals not usually helpful

Question 9

De-escalation from self isolation

Answer 9

no new lesions 24h
no oral mucus membrane lesions
all exposed lesions back to epithelialised skin
all non exposed lesions can be covered

Question 10

how to manage contacts of Mpox

Answer 10

Passive monitoring
If High risk of infection,
* PEP imvanex vaccine within 4d (14d if at increased risk)
* avoid sex / close contact with others for 21d
* avoid international travel
* (off work if work with immunosuppressed/pregnant people, <5s)
Medium risk
As for high risk but not usually for PEP unless additional concerns eg immunosupressed.

If symptoms develop self isolate

Question 11

Mpox vaccination eligibility

Answer 11

GBMSM with a history of multiple partners, group sex, sex on premises, bacterial sti in the past year. Also trans/gender diverse people with similar risk profile.
occupational risk eg labs, health care professionals looking after Mpox patients, staff at sex on premises venues, aid workers travelling to at risk countries

Question 12

Mpox vaccine name and dose schedule

Answer 12

imvanex, modified vaccinia ankara MVA-BN
attenuated, consider inactivated
0, 28d