De-isolation and discharge of mpox-infected patients: interim guidance
Interim guidance to support NHS Trusts in managing the de-isolation and discharge of mpox-infected patients.
Applies to England
Scope
This interim guidance has been produced by the UK Health Security Agency (UKHSA) to support NHS Trusts in managing the de-isolation and discharge of mpox (monkeypox) infected patients. Arrangements for individual patients should be considered on a case-by-case basis. This guidance applies to all mpox cases, irrespective of HCID status, and will be updated in due course.
Hospital de-isolation criteria
Clinical criteria
The patient is judged clinically well enough for safe de-isolation as judged by the clinical team managing the patient.
Laboratory criteria
The patient is polymerase chain reaction (PCR) negative on all 3 of the following samples:
- EDTA blood*
- urine
- throat swab
*It is acceptable not to send EDTA blood if no sample was sent previously because the patient was well throughout admission.
Lesion criteria
The following criteria all apply:
- there have been no new lesions for 48 hours
- there are no mucous membrane lesions
- all lesions have crusted over, all scabs have dropped off, and intact skin remains underneath
Discharge from an isolation facility or isolation ward to another hospital ward, a different in-patient facility or a residential facility (including care homes and prisons)
Discharge from an isolation facility or ward to another hospital ward, different inpatient facility or residential facility can only be considered if the de-isolation criteria in the clinical, laboratory and lesion criteria sections above are all met.
If there is any doubt, clinicians should discuss virological testing of persistent lesions with the UKHSA Rare and Imported Pathogens Laboratory (RIPL).
Transfer of patients from an isolation unit in one hospital to an isolation unit in another hospital may be necessary in certain circumstances prior to the patient meeting all of the above criteria. Such arrangements must be made following case-by-case discussion and agreement between specialists at both institutions.
Discharge from hospital to home
Patients meeting the clinical, laboratory and lesion criteria as stated above can be discharged from hospital to home without requirement for ongoing isolation (that is, full de-isolation).
Patients meeting the clinical criteria but not meeting either laboratory or lesion criteria may be discharged from hospital to continue isolation at home where it is safe to do so after assessment by their treating clinician. They must be able to isolate away from any members of their household who are: children aged under 12, pregnant women or immunosuppressed individuals as per green book definition. They must not go to work, school or public areas and should avoid close contact with other people in their household.
Patients with any lesions should remain in regular contact with their clinician until all lesions have crusted over and all scabs have dropped off. Ongoing contact may be required after de-isolation.
Complex and severe cases, with slow clinical and virological resolution may require additional specialist guidance on risk management following discharge from hospital on a case-by-case basis.
Caring for mpox at home
Patients should be given clear safety-netting guidance, including resources detailing what expected symptoms are and how to treat these. They should also map out what the concerning symptoms to look out for are, and when, where and how to escalate and get help at all time periods. Symptom diaries and strategies for monitoring progress and recovery should also be shared, including where appropriate monitoring tools, for example thermometers, oximeters.
De-isolation in household settings
This guidance relates to patients who have been either diagnosed and managed at home throughout their illness, or who have been discharged from hospital to isolate at home.
There are 2 stages to de-isolation of patients in household settings.
Stage 1: Ending self-isolation
Patients are able to end self-isolation at home once the following clinical and lesion criteria have been met.
Clinical criteria
The patient has been assessed by telephone or video call and has been afebrile for 72 hours and is considered systemically well.
Lesion criteria
The following criteria must all be met:
- there have been no new lesions for 48 hours
- there are no oral mucous membrane lesions
- all lesions have crusted over
- all lesions on exposed skin (including the face, arms and hands) have scabbed over, the scabs have dropped off, and a fresh layer of skin has formed underneath
- lesions in other areas should remain covered throughout the patient’s time outside of their home or when in contact with other people
Patients should continue to avoid close contact with immunosuppressed people, pregnant women, and children aged under 12 until the criteria for full de-isolation are met (see stage 2 below). This means patients should continue to be excluded from work if their work requires close contact with any of these groups. They should be advised to speak to their employer before returning to work as a risk assessment may be required for people who work in vulnerable settings and consideration given to redeployment or continued exclusion until the criteria for full de-isolation are met.
Stage 2: Full de-isolation
The patient can resume full normal activities with no restrictions when they meet the household clinical criteria above, and the following lesion criteria:
- there have been no new lesions for 48 hours
- there are no mucous membrane lesions
- all lesions (for both exposed and unexposed areas) have crusted over, all scabs have dropped off, and intact skin remains underneath
Last updated 21 September 2022 + show all updates
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Added link to HCID status guidance.
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Clarified household de-isolation criteria.
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First published.