Management of mpox following removal of HCID status
July 7, 2025
In March 2025, UK public health authorities reclassified all clades of mpox as no longer meeting criteria for high consequence infectious disease (HCID), citing low fatality rates, limited local transmission, and effective vaccine availability. Despite this, public health oversight remains robust. Clinicians are advised to maintain vigilance in diagnosing and managing suspected mpox cases, particularly among vulnerable groups. Updated infection prevention, isolation, and notification protocols remain in place across hospital, community, and home settings. The strategic goal is still elimination of person-to-person transmission, supported by vaccination, clear clinical guidance, and enhanced occupational safety standards for healthcare providers.
The UK’s Advisory Committee on Dangerous Pathogens (ACDP) downgraded mpox from a high consequence infectious disease (HCID) in March 2025, following review of clade I severity, fatality rates, and the absence of community or healthcare transmission. Nonetheless, the disease remains a significant public health concern, with national guidance updated to maintain clinical vigilance and safeguard health systems.
The new framework emphasizes early detection, isolation, and risk-based management. Healthcare providers are encouraged to consider mpox in any patient with compatible symptoms, especially in the context of recent travel, sexual exposure, or contact with confirmed cases. Special attention is given to immunocompromised individuals, pregnant patients, and children under 16, who may require hospitalization.
Mpox remains a notifiable disease in the UK. Suspected or confirmed cases must be reported promptly, and all positive samples undergo clade typing at the UKHSA Rare and Imported Pathogens Laboratory. Updated protocols also include strengthened PPE and IPC (Infection Prevention and Control) guidance, ensuring clinical and community settings can safely manage suspected mpox cases.
Clinically stable patients may be managed at home, while hospital care is reserved for those with complications or requiring intensive management. Tecovirimat remains available for severe or complicated cases under defined clinical criteria. Healthcare workers exposed to mpox are subject to risk-based exclusion and vaccination policies.
Vaccination continues to play a preventive role, particularly among high-risk groups. A routine pre-exposure programme is underway, focused on select populations. While general healthcare workers do not require vaccination, staff in roles with repeated exposure are advised to undergo occupational risk assessments.
The UK’s approach underscores a balance between practical risk management and continued commitment to elimination, with clear pathways for diagnosis, treatment, reporting, and vaccination. The update reflects a matured response adapted to evolving mpox epidemiology and public health capacity.