Severe mpox — or mpox in patients at high risk of severe disease — requires a specific, structured treatment approach. This protocol addresses the clinical presentations and patient groups described below.

Who This Protocol Covers

Patients with severe mpox presentations, including haemorrhagic disease, confluent lesions, sepsis, encephalitis, or any presentation requiring hospitalisation.

Patients at high risk of severe disease — particularly those who are immunocompromised, including those with acquired immune deficiency syndrome (CD4 count <200 cells/µL), leukaemia, lymphoma, generalised malignancy, solid organ transplantation, or haematopoietic stem cell transplant.

Paediatric patients younger than 8 years of age.

Patients with one or more complications such as secondary bacterial skin infection, gastroenteritis with severe nausea, vomiting, diarrhoea or dehydration, or bronchopneumonia.

This protocol applies to patients who are not pregnant and not breastfeeding.

Treatment Approach (Overview)

Management involves antiviral therapy delivered by intravenous infusion, structured across an induction phase and a subsequent maintenance phase.

The complete regimen — including agent selection, full schedule, and all associated clinical guidance — is available in the structured protocol below.

References

Conditions

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).

Treatment

5 mg/kg body weight, intravenous.
Induction treatment: Intravenous infusion at a constant rate over 1 hr administered once weekly for two consecutive weeks.
Maintenance treatment: Beginning two weeks after the completion of induction treatment, intravenous infusion at a constant rate over 1 hour administered once every two weeks.
Administration of Probenecid 2 g po 3 hours before Cidofovir, and 1 g 2–8 hours post Cidofovir is recommended for most indications to increase blood levels.

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

References