ACEP ID:

Patient Classification/CDC Case Definitions

Suspect Case

  • New characteristic rash OR
    • deep-seated and well-circumscribed lesions, often with central umbilication; and lesion progression through specific sequential stages—macules, papules, vesicles, pustules, and scabs.
  • Meets one of the epidemiologic criteria and has a high clinical suspicion for monkeypox
    • Clinical suspicion may exist if presentation is consistent with illnesses confused with monkeypox (e.g., secondary syphilis, herpes, and varicella zoster)

Probable Case

  • No suspicion of other recent Orthopoxvirus exposure (e.g., Vaccinia virus in ACAM2000 vaccination) AND demonstration of the presence of
    • Orthopoxvirus DNA by polymerase chain reaction of a clinical specimen OR
    • Orthopoxvirus using immunohistochemical or electron microscopy testing methods OR
    • Demonstration of detectable levels of anti-orthopoxvirus IgM antibody during the period of 4 to 56 days after rash onset

Confirmed Case

  • Demonstration of the presence of Monkeypox virus DNA by polymerase chain reaction testing or Next-Generation sequencing of a clinical specimen OR isolation of Monkeypox virus in culture from a clinical specimen

Epidemiologic Criteria

Within 21 days of illness onset

  • Reports having contact with a person or people with a similar appearing rash or who received a diagnosis of confirmed or probable monkeypox OR
  • Had close or intimate in-person contact with individuals in a social network experiencing monkeypox activity, this includes men who have sex with men (MSM) who meet partners through an online website, app, or social event OR
  • Traveled outside the US to a country with confirmed cases of monkeypox or where monkeypox is endemic OR
  • Had contact with a dead or live wild animal or exotic pet that is an African endemic species or used a product derived from such animals

Exclusion Criteria:

  • An alternative diagnosis can fully explain the illness, or...
  • An individual with symptoms consistent with monkeypox but who does not develop a rash within 5 days of illness onset OR
  • A case where specimens do not demonstrate the presence of orthopoxvirus or monkeypox virus or antibodies to orthopoxvirus

Infection Prevention and Control in Healthcare Settings

The American College of Emergency Physicians Guide to Monkey Pox.

Specimens Collection, Handling and Storage

The American College of Emergency Physicians Guide to Monkey Pox.

Management (CDC Interim Guidance)

The American College of Emergency Physicians Guide to Monkey Pox.

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