Treatment of Mpox in Immunocompromised Patients and Severe Disease
Severe mpox — including haemorrhagic disease, confluent lesions, sepsis, and encephalitis — and mpox in patients at high risk of severe disease due to immunocompromise or other vulnerability requires a specific clinical approach. This protocol addresses that distinct population.
Clinical scenario covered
- Severe mpox requiring hospitalisation: haemorrhagic disease, confluent lesions, sepsis, encephalitis, or other severe presentations
- Immunocompromised patients — including acquired immune deficiency syndrome (CD4 count <200 cells/µL), leukaemia, lymphoma, generalised malignancy, solid organ transplant recipients, or hematopoietic stem cell transplant recipients
- Paediatric patients younger than 8 years of age
- Patients with one or more complications: secondary bacterial skin infection; severe gastroenteritis with nausea, vomiting, diarrhoea, or dehydration; or bronchopneumonia
Applies to patients who are not pregnant and not breastfeeding.
Treatment approach
Management in this setting involves vaccinia immune globulin (VIG), which may require multiple and repeated treatments depending on clinical response.
Full dosing protocol, administration requirements, and clinical decision algorithm are available in the complete regimen 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).
- If tecovirimat is unavailable, VIG is the next preferred option.
- Dose of 6000 Units/kg intravenous.
- Consider higher doses where the patient does not respond to the initial dose. Multiple and repeated treatments may be required.
- Bring VIG vials to room temperature prior to dosing. Administer 6000 U/kg intravenously through a dedicated intravenous line with the infusion rate of no greater than 2 mL/min.