Clinical care

Supportive care for mpox patients and infection prevention and control

No therapeutics are known to be effective against MPXV so clinical management focuses on supportive care, particularly for skin manifestations.

MPXV can also affect specific tissues and organs, including the eye, requiring specialist care.

Isolation is central to control of transmission, alongside hygiene and other infection prevention and control measures.

Thematic leads

Thematic lead 1

Affiliation

Thematic lead 2

Affiliation

Contact the thematic leads

Clinical care knowledge gaps

Primary knowledge gaps identified in the Mpox R&D Roadmap 2026:

Natural history of infection

How does the course of mpox disease vary by patient type?

Wound/lesion care

What is the optimal approach to lesion care in different patient populations?

Special populations

What are the optimal care pathways for special populations, including children, pregnant women and people living with HIV?

Secondary infections

What is the best approach for preventing and treating secondary/co-infections?

Complications

What are the best approaches for managing ocular and other complications of mpox?

Infection prevention and control

What are the most effective ways to prevent mpox transmission in clinical and post-clinical settings?

More detailed research questions can be found in the Mpox R&D Roadmap 2026.

Clinical care workplan

A CORC workplan for the clinical care and infection prevention and control theme is in development.

Clinical care and infection prevention and control background

There is little evidence that existing antiviral treatments, developed for smallpox, are of benefit in mpox (see Therapeutics section). Clinical management therefore focuses primarily on supportive care and infection prevention (e.g. isolation).

The evidence base for mpox clinical care and infection prevention and control remains limited. Current WHO recommendations on isolation duration, lesion and wound management, pain control, breastfeeding, sexual-contact restrictions, use of personal protective equipment (PPE), and environmental decontamination are largely extrapolated from other orthopoxviruses (varicella-zoster, herpes simplex), general dermatological practice, or low-certainty data [1].

Uncertainties

Major uncertainties persist in key areas, including:

Duration of infectiousness and viral shedding (including pre-symptomatic, asymptomatic and prolonged shedding in immunocompromised individuals).
Transmission risk via body fluids (semen, breastmilk, eye fluid).
Optimal diagnostic/triage pathways, including community-based approaches.
Optimal wound-care strategies across lesion stages and special populations (advanced HIV and immunosuppressed, children, pregnant persons).
Prevention of secondary bacterial infections.
Pain management for mucocutaneous lesions.
Feasible approaches in homes and resource-limited settings.

Standardised lesion classification, outcome measures and patient-reported outcomes are also lacking. There is also no clear-cut guidance on minimising the risk of adverse long-term outcomes such as cutaneous sequelae, and limited data on their impacts on quality of life. Research into the mental and psychosocial wellbeing of people with infections, in convalescence or having been discharged needs to be more explicitly tailored to mpox.

The highest-priority gaps to fill are those that directly inform isolation duration, PPE effectiveness, targeted wound care, pain control and triage/severity scoring in resource-limited settings. An overarching theme for all the knowledge gaps is to ensure that recommendations characterise and differentiate by subclades, sub-populations (age, ethnicity, immunosuppression) and risk settings. Rigorously generated new evidence will feed into global recommendations and development or updating of national clinical guidelines.

[1] https://www.who.int/publications/i/item/B09434

Mpox lesions on a young child from Liberia (US CDC)