�ʼһ���

In contrast with clade II infection, clade I may be associated with more severe disease, especially in young children and is considered a high consequence infectious disease (HCID) though its transmissibility is not yet well understood. ��

Important distinctions are made based on the presence or absence of epidemiological risk factors. ��

• If there is concern that a patient has clade I mpox (potentially more severe, linked to central Africa) IPC precautions are stricter and the patient is managed on the suspected high consequence infectious disease (HCID) pathway.
• If no such concern exists and clade II infection is suspected they are managed as a non-HCID. ��

Background

Epidemiology & Terminology��

• Mpox (monkeypox) virus is endemic in Western and Central Africa. There are two distinct clades of the virus: clade I and clade II. Before 2022, all mpox in the UK was classed as a high consequence infectious disease (HCID).
• In 2022–2023, a global outbreak of mpox was caused by the clade II strain.
  • Clade II was downgraded to non-HCID status once it became better understood.
  • The 2022 clade II outbreak occurred mostly, but not exclusively, in individuals who identify as gay, bisexual and other men who have sex with men.
  • Some children and young people were affected, mostly via household transmission or sexual contact.(1,2)��
• Cases linked to central Africa or known to be clade I continue to be classed as HCID.
  • In Africa, clade I is associated with more severe disease, especially in young children who have the highest mortality rates.
  • Little is known about the clinical severity of rare clade I disease in high-income countries.
  • The efficacy of vaccination (using smallpox vaccines) against clade I disease is also not well understood��and there remain few data on the use of antivirals against this clade.
  • For these reasons and others,

Clinical features of mpox (all clades)

Overview

• Incubation period for mpox is between 5 and 21 days.
• Usually a self-limiting illness and most people recover within several weeks.
• Severe illness can occur in some individuals:, children, pregnant women��and the immunosuppressed most at risk.
• Often includes 4 “P��”; Pustules, Peripheral, Palms/soles, lymPhadenopathy (not all cases have all these features).

Infectiousness

• Patient contagious until all the scabs have fallen off and there is intact healed skin underneath.
• Scabs may also contain infectious virus material.
• In confirmed cases, Health Protection Team will provide advice.

1. Initial assessment of child or young person with possible mpox��

1a. When to suspect mpox��

• Mpox may be considered if there is a consistent rash.
• Alternatively, if there is a known contact, mpox may be considered without a rash because of prodromal symptoms. ��
• UKHSA provide guidance on determining whether to suspect the potentially more virulent clade I mpox (HCID) or clade II, primarily based on links to specific countries.

If you suspect mpox:

1. Inform the paediatric consultant responsible for the patient
2. Tell your local microbiology/virology consultant
3. Discuss with your regional paediatric infectious disease team

• These discussions will help risk assess and determine whether to proceed as suspected clade I (HCID) or suspected clade II (non-HCID). ��If in doubt, proceed as clade I (HCID).
• The national Imported Fever Service will arrange laboratory testing – you do not need to contact them directly – they will be contacted by the local microbiologist/virologist or paediatric infectious diseases team.

In a febrile patient returning from travel, always consider alternative diagnoses, including malaria.

1b. Preparing to assess a child with suspected mpox

Travel

• If the child is not already on site, consider how they will travel to you for assessment – private mode of transport is preferable to public transport – discuss this with your regional paediatric infectious diseases team.
• If the child is already a known contact of clade I mpox, there may already be a plan made in conjunction with UKHSA for this on how the child should attend for assessment. ��Your local Health Protection Team will be able to advise further. ��If they are a known clade I contact and no other plan has been made, the family should call 111 or 999 depending on clinical urgency and inform them they are a clade I mpox contact needing clinical assessment.
• Where there is no concern for clade I mpox (i.e. non-HCID), the above does not apply. Any lesions should still be covered for travel and a face mask worn, especially if public transport is used.

Personal protective equipment

• Staff assessing CYP with suspected mpox should wear personal protective equipment (PPE) in accordance with and local guidance.
• PPE is different if clade I mpox (HCID) is suspected reflecting a higher degree of concern.
• Assume the child has clade I mpox (HCID) unless there is very clear reason to only suspect clade II.

Where to assess the child

• Follow local guidance to isolate the child in a dedicated cubicle as soon as the risk is identified, ideally on entering the building.
• 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.
• Follow national and local guidance around waste disposal and cleaning afterwards.

Planning who should assess the child

• 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 appropriate 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.

Further advice is available from regional paediatric infectious diseases teams and your local IPC team, where possible contact them in advance of seeing the patient for appropriate advice on PPE, testing and isolation.

1c. How to assess a child with possible mpox��

Questions for all cases:

• 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 known contacts with mpox or other infections (e.g. chickenpox, hand-foot-and-mouth disease)?��
• Any comorbidities��and specifically immunodeficiency/immune suppression
• Confirm address and contact details
• Any vulnerable people in the household?

Questions for those who have had contact with a confirmed mpox case:

• Note details of timing, duration and nature of contact
• Obtain as much information as known about the source case��

Questions for those with a personal travel history or with household contact with someone with travel history in the previous 21 days:

• Countries visited with dates of arrival and departure

Questions for young people:

• Complete psychosocial history using HEADSS tool (e.g. )
• Are they sexually active?
• Last sexual contact?
• High risk factors for the current outbreak are individuals who identify as MSM.

Clinical Features of prodromal illness:

• Not in all cases.
• Fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.
• Occurs 1 to 5 days prior to onset of rash.

Characteristics of the rash:

• Often begins on the face then spreading to other parts of the body (if transmitted by respiratory route).
• Palms and soles may be affected before spreading elsewhere centrally (see pictures and ).��
• Lesions go through different stages (macule - papule - vesicle - pustule) before finally forming a scab, later falls off.
• May be localised in other areas if due to direct contact spread.

Differential diagnosis

Common differentials for vesicular and similar rashes in children include:

• Chickenpox, HSV, enterovirus, molluscum contagiosum,
• Classically, mpox lesions are all at a similar stage of maturation (though not always the case), unlike chickenpox where lesions appear over several days leading to lesions at different stages.
• Chickenpox rash typically begins centrally on the trunk and spreads peripherally; mpox classically begins on peripheries.
• Vesicular rashes of enterovirus can also be primarily peripheral (e.g. hand, foot and mouth disease).

Important differentials for febrile illness after travel include:

• Malaria
• Enteric fever
• Viral haemorrhagic fevers (very rare but important to consider if travelled to West or Central Africa)
• Non-travel specific infections

Outcome of assessment

In the absence of an identified epidemiological risk factor, mpox remains very unlikely at the present time in the UK in a child.

However, in the presence of an epidemiological risk factor, any CYP with a compatible clinical picture should undergo PCR testing to rule out mpox.

1d. How to test for mpox in a child

Do not take any swabs from a child with suspected mpox until you have completed a risk assessment together with a specialist (paediatric infectious diseases or local virology/microbiology) to determine if clade I (HCID) or clade II (non-HCID) is suspected.

If clade I mpox (HCID) is suspected, a higher level of precaution will be needed in transportation and processing of samples in the laboratory. ��The local virology/microbiology consultant must be involved and should make these arrangements before any samples are collected from the patient. ��Do not collect or send any other samples (including blood samples) to any other laboratories without discussing with the local virology/microbiology consultant first as these samples may pose an infection hazard.

If only clade II is suspected, other samples can be collected and sent using standard infection control precautions.

Samples to collect

• Two viral swabs of skin lesions should be taken, one for mpox and one for other possible viruses (usually VZV/HSV/enterovirus).
• If the lesions are not yet vesicular/pustular and just dry macular/papular lesions, a viral throat swab should be taken in addition.
• If there are only prodromal symptoms without rash, take just a viral throat swab for mpox testing.

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.

1e. Outcome of initial assessment

Following assessment, if you still suspect any type of mpox (i.e. sufficient concern to send a PCR test), involve the following in planning the next steps of care:

(1)���� ��Local paediatric consultant responsible for the patient
(2)���� ��Local microbiology/virology consultant
(3)���� ��Regional paediatric infectious disease team

If you suspect clade I mpox (HCID):

• The local virology/microbiology/infection consultant will liaise with the UKHSA laboratory via the NHSE Imported Fever Service regarding PCR testing.
• The patient will need admission to hospital pending the mpox PCR test result.
• See section 2c below.

If you are definitely only suspecting clade II mpox (non- HCID):

• Discuss further clinical management with your regional paediatric infectious diseases service.
• If the child is well enough, they may be able to return home with precautions described below (Section 2a).
• If they require admission for clinical or other indications, follow the advice (Section 2b).

In either case, it is advised to start a log of staff who enter the cubicle or have contact with the patient, in case subsequent contact tracing is required.

2. Ongoing care of child or young person with suspected mpox��

2a. Child with suspected clade II (non-HCID) mpox who is well enough to return home��

Children with suspected clade II mpox (non-HCID) (where there is no concern at all for clade I) may go home awaiting test result if clinically well enough. ��

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.
• Exposed contacts of suspected or proven clade II mpox 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 clade II 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, please contact your regional paediatric infectious diseases team for further advice on clinical management. The local Health Protection Team will arrange contact tracing and provide further guidance.��
• If aged over 13 years and sexual contact is the identified risk factor, referral to a sexual health centre is also advised after assessment and management of this illness. For any presentation based on sexual contact, consider whether this raises safeguarding concerns.
• If the PCR 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.

2b. Child with suspected clade II (non-HCID) mpox who requires hospital admission

• A child with suspected clade II mpox may require admission for clinical indications.��It may also be possible for them to return home whilst awaiting PCR test results if well enough (see above). ��
• Give consideration to any safeguarding concerns including young people who may have been infected through sexual contact. If over 13 years of age, refer to sexual health service if sexual contact is considered the route of infection. ��
• Specialist guidance on clinical care in suspected or confirmed clade II (non-HCID) mpox can be obtained from the regional paediatric ID service.
• Continue to follow guidance regarding PPE according to the suspected clade II status, minimising staff contact with the child��and care with waste disposal.��
• Use the checklist in Appendix C to ensure you have done all that is required.
• 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.

2c. Child with suspected clade I (HCID) mpox always requiring hospital admission

A child with suspected clade I mpox will require hospital admission whilst awaiting PCR confirmation, prior to subsequent transfer to an HCID centre.

• Continue to follow guidance for appropriate PPE for suspected clade I mpox, minimising staff contact with the child and following guidance about waste disposal.
• Use the checklist in Appendix C to ensure you have done all that is required.
• Confirmation of clade I (HCID) mpox will automatically trigger a notification cascade leading to an emergency HCID clinical network meeting where the local team will present the patient for discussion.
• Specialist ambulance services also attend this meeting to plan transport to a designated paediatric airborne HCID centre.
• The paediatric ID team at that centre will provide any specialist advice until transfer has taken place.
• UKHSA hold responsibility for contact trancing and management and the Health Protection Team will subsequently liaise with the local centre regarding this.

3. Child contacts of confirmed case of either clade I or clade II mpox

The risk of infection in an exposed child depends on the infectivity of the index case, the nature and duration of the exposure and the vulnerability of the exposed child.

Specific advice for children exposed to clade I mpox (HCID) will be determined on a case by case basis following guidance from the airborne HCID clinical network UKHSA through the local Health Protection Team (HPT).

Rationale

• Clade II mpox transmission is primarily through direct contact with lesions or contaminated fomites.
• Transmission of clade I mpox is less well understood.
• 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 for clade II mpox only.��It reflects the observation that transmission was hardly ever occurring outside of close physical contact with a symptomatic case.��
• The majority of household or school classroom exposures to clade II mpox are not expected to lead to transmission.��

Advice for child contacts of confirmed clade I mpox (HCID)

• Child contacts of clade I mpox will need to isolate assuming they may be infectious.
• Addition mitigation may be advised in the home to prevent infection on the basis this may not have occurred yet.
• Specific advice will be given by the UKHSA Health Protection Team with input from the NHSE HCID network.

Advice for child contacts of confirmed clade II mpox (non-HCID)

• In the absence of any symptoms, children who are contacts of clade II mpox (non-HCID) do not need to isolate and should continue to attend school and other activities as normal.
• ��If an adult with confirmed clade II mpox (non-HCID) 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.
• Further support is available from the HPT and .

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 to contacts or their carers.

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.

Safety netting��

• 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.
• Unless alternative arrangement have already been put in place, Health Protection Teams (HPTs) are currently advising parents/carers to call 111 in the first instance and to inform 111 that the child or young person has symptoms following mpox exposure. Further clinical support and advice is available to healthcare professionals from regional PID teams.
• Contacts being monitored who develop any symptom consistent with mpox should be considered a suspected case and be managed according to Section 1 of this guideline. They will require face to face assessment.��
• 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 of a vaccine-induced adverse event (eg fever or rash).

Post-exposure vaccination of children

• Modified vaccinia Ankara (MVA-BN; Imvanex in Europe; JYNNEOS in the United States) is a third generation smallpox vaccine containing a modified form of vaccinia virus (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 (3).��In children it appears immunogenic and well tolerated with relatively modest adverse effects only (4).��MVA-BN remains unlicensed for use in children. ��
• UKHSA recommend offering MVA-BN, ideally within four days of exposure but up to 14 days, to prevent or limit severity of disease in children of any age. 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.
• Further information on use of this vaccine in available in the

��4. Newborn baby of mother with suspected or confirmed mpox��

For details of maternal care see

Little is known about mpox in pregnancy and risks of transmission prior to, during and following delivery.��

It is probable that newborns are at the highest level of vulnerability, it seems prudent to minimise infection risk to the new born baby.

• In utero infection risk
  • Mpox virus may be transmitted in utero from mother to fetus.
  • Where described in the first half of pregnancy, it has been associated with severe disease and fetal loss (5).��
  • The frequency with which this occurs is not known��and it is possible that the baby is born uninfected.
• Perinatal infection risk�� �� ��
  • Close contact with lesions is a route of transmission, making vaginal delivery with mpox lesions a significant additional exposure risk.
  • A case of neonatal disease arising from perinatal transmission of clade II mpox led to intensive care admission (6).��
  • There are to our knowledge no other published reports of the outcomes of perinatal or neonatal exposure.
• Breastfeeding risk
  • There are no current data regarding risk of mpox virus transmission via breast milk. Several other viruses are transmitted to infants through breast milk.
  • 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 during breastfeeding of vaccinia virus (closely related to mpox) from smallpox vaccine leading to contact vaccinia in the baby (7).
  • Contacts of confirmed mpox cases may be incubating the virus and asymptomatically infected.��

Involve the following early in planning care:
(1)���� ��Obstetric consultant
(2)���� ��Microbiology/virology/infection consultant
(3)���� ��Paediatric/neonatal consultant
(4)���� ��Regional paediatric infectious diseases specialist��

If there is a suspicion of clade I mpox (HCID), the infection specialists will involve the national airborne HCID network.

Personal protective equipment

Staff assessing CYP with suspected mpox should wear personal protective equipment (PPE) in accordance with and local guidance.

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.
• The possibility of airborne transmission should be assumed.
• PPE should be according to risk of clade I (HCID) or clade II (non-HCID) in line with national and local guidance, determined by exposure and travel related risk factors (see assessment of child above). Involve infection specialists in making this risk assessment.
• The baby should be isolated from other babies.
• The baby should be tested for mpox virus by PCR from all of viral throat swab, blood, urine and swabs of any skin lesions.

The baby may also 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.��
• 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.

The aim 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 are regularly reviewed to reflect new information on the balance of risk, in order to normalise bonding and feeding to the maximum degree possible.

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. If the mother is infection with clade I mpox this will involve the HCID network.
• Use of MVA-BN vaccine is indicated.��

If the baby is also confirmed to be infected, mother and baby may be reunited where otherwise clinically appropriate.��

• Level of isolation and PPE required will be determined according to clade - clade I as HCID and clade II as non-HCID.
• In either case, the baby should be discussed with paediatric infectious diseases (clade II) or the the HCID (clade I) regarding use of early antiviral treatment.

Breastfeeding

• Despite the 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. ��This aligns with advice.

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 according to whether suspected or confirmed as clade I (HCID) or clade II (non-HCID).

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 recent and current mpox outbreaks highlight 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 are working closely together to identify (rigorous contact tracing), prevent (supporting isolation and facilitating access to and administration of vaccines) and manage any family cases of mpox.��
• Affected / infected children should be enrolled into disease registries whenever possible, to better understand clinical manifestations and treatment outcomes.
• Given the lack of evidence for treatment of exposed or infected children, studies of antiviral medicines and vaccines should include children and pregnant women to develop an appropriate evidence base for future care.

References

1. Hennessee I, Shelus V, McArdle CE et al. Epidemiologic and Clinical Features of Children and Adolescents Aged <18 Years with Monkeypox - United States, May 17-September 24, 2022. MMWR Morb Mortal Wkly Rep. 2022 Nov 4;71(44):1407-1411. doi: 10.15585/mmwr.mm7144a4.��
2. Sanchez Clemente N, Coles C, Paixao ES et al. ��Paediatric, maternal��and congenital mpox: a systematic review and meta-analysis. Lancet Glob Health. 2024 Apr;12(4):e572-e588. doi: 10.1016/S2214-109X(23)00607-1. Epub 2024 Feb 21.��
3. Bertran M, Andrews N, Davison C et al,. Effectiveness of one dose of MVA-BN smallpox vaccine against mpox in England using the case-coverage method: an observational study. Lancet Infect Dis. 2023 Jul;23(7):828-835. doi: 10.1016/S1473-3099(23)00057-9. Epub 2023 Mar 13.��
4. ��Ladhani SN, Dowell AC, Jones S et al. Early evaluation of the safety, reactogenicity��and immune response after a single dose of modified vaccinia Ankara-Bavaria Nordic vaccine against mpox in children: a national outbreak response. Lancet Infect Dis. 2023 Sep;23(9):1042-1050. doi: 10.1016/S1473-3099(23)00270-0. Epub 2023 Jun 16.��
5. Mbala PK, Huggins JW, Riu-Rovira T et al. Maternal and Fetal Outcomes Among Pregnant Women With Human Monkeypox Infection in the Democratic Republic of Congo. J Infect Dis. 2017 Oct 17;216(7):824-828. doi: 10.1093/infdis/jix260.��
6. Ramnarayan P, Mitting R, Whittaker E et al. Neonatal Monkeypox Virus Infection. N Engl J Med. 2022 Oct 27;387(17):1618-1620. doi: 10.1056/NEJMc2210828. Epub 2022 Oct 12.��
7. Garde V, Harper D, Fairchok MP. Tertiary contact vaccinia in a breastfeeding infant. JAMA. 2004 Feb 11;291(6):725-7. doi: 10.1001/jama.291.6.725.

Appendix A: Mpox in children and young people - quick guide

���ʱ��𲹲�����download the flowchart below��containing QR codes to print for use in emergency departments.��

Appendix B: Isolate if you are suspected of having clade II mpox

Download Appendix B below

Please return straight home ideally by private transport. ��Discuss with your medical team if this is not possible.

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 with alcohol or chlorine-based household disinfectants.
• 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 monitor progress.

Should you need to contact the hospital, please call ________________ and ask to speak with ________________________________________.
��

Appendix C: Actions when admitting a child with suspected clade I (HCID) mpox (monkeypox)

Download Appendix C below

Working group members��

CYP guidance working group��

Newborn guidance working group

PID - Paediatric Infectious Diseases, HCID - High Consequence Infectious Disease, BPAIIG - British Paediatric

Allergy, Immunology & Infection Group, BAPM - British Association for Perinatal Medicine

Paediatric Airborne High Consequence Infectious Disease Units

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