Clinical Scenario

This protocol covers patients with severe mpox requiring hospitalisation, or those at high risk of severe disease — principally those who are immunocompromised — as well as paediatric patients under 8 years of age and patients with significant mpox complications. The patient is not pregnant and not breastfeeding.

Who This Applies To

Severe disease — haemorrhagic mpox, confluent lesions, sepsis, or encephalitis, or any presentation requiring hospitalisation
Immunocompromise — including AIDS with CD4 <200 cells/µL, leukaemia, lymphoma, generalised malignancy, solid organ transplant recipients, haematopoietic stem cell transplant recipients
Paediatric patients younger than 8 years of age
Complications — secondary bacterial skin infection, gastroenteritis with severe nausea, vomiting, diarrhoea, or dehydration; bronchopneumonia

Treatment Approach (Partial Overview)

Tecovirimat is the preferred antiviral for this population. The full structured regimen — including weight-based and age-stratified dosing — is available in the complete protocol.

Dosing details, administration requirements, and the full clinical algorithm are in the structured protocol below.

References

Those with severe disease (e.g., haemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalisation)
Those who are immunocompromised (e.g., acquired immune deficiency syndrome with CD4 count <200 cells/µL, leukaemia, lymphoma, generalised malignancy, solid organ transplantation, therapy with alkylating agents, antimetabolites, radiation, tumour necrosis factor inhibitors, high-dose corticosteroids, hematopoietic stem cell transplant recipient <24 months post-transplant or ≥24 months but with graft-versus-host disease or disease relapse, or having autoimmune disease with immunodeficiency as a clinical component).
Paediatric populations, particularly patients younger than 8 years of age.
Those with one or more complications (e.g., secondary bacterial skin infection; gastroenteritis with severe nausea/vomiting, diarrhoea, or dehydration; bronchopneumonia; concurrent disease or other comorbidities).
Tecovirimat is the preferred treatment for severe mpox.
If expert clinical judgement determines a patient requires specific treatment for mpox, the preferred first option for drug treatment is tecovirimat.

View source ↗

Treatment of Severe Mpox in Immunocompromised Patients and Other High-Risk Presentations

References