mpox

Supported case classification

Record the classification, its supporting observations and unresolved alternatives separately.

1. Which jurisdiction's dated mpox case definition applies, and which criteria are satisfied, absent or unknown? definition
2. How were varicella, herpes, syphilis and other plausible explanations assessed, including possible coinfection? boundary

Interpretable mpox test evidence

Link each interpretation to the actual assay, specimen and report rather than a standalone positive or negative label.

1. What specimen site, collection date, assay target and laboratory report support the result? provenance
2. Does the assay establish MPXV, broader orthopoxvirus detection or clade attribution, and what limitations qualify a negative or indeterminate result? boundary
3. What unresolved discrepancy warrants clinician or laboratory review for additional testing? action

Lesion and function profile

Record site-specific findings and distinguish unexamined areas from documented absence.

1. Which skin, oral, genital, anal or ocular sites are involved, and which were not assessed? measurement
2. What lesion evolution, pain and interference with eating, drinking, urination or defecation were recorded at each assessment? measurement

Dated clinical trajectory

Keep symptom onset, lesion onset, new lesion formation and healing as distinct observations.

1. When did systemic symptoms and lesions first appear, and which dates are recalled estimates? provenance
2. Does serial assessment show improvement, new lesions, persistent disease or deterioration, and what evidence supports that judgement? measurement

Individual risk modifiers

Use documented clinical context rather than group membership to qualify risk.

1. What current evidence describes immune function, pregnancy, age-related considerations and relevant skin disease? provenance
2. Which previous mpox episodes or vaccinations are documented, and what does the applicable guidance allow an assessor to infer from them? boundary

Escalation-relevant burden

Track ocular, neurological, respiratory, hydration, pain and secondary-infection concerns without automatically attributing each to mpox.

1. Which complications or functional impairments are observed, suspected or excluded, and how is their relationship to mpox assessed? measurement
2. Which findings meet the applicable criteria for urgent assessment, specialist consultation or inpatient care, and who must review them? action

Qualified exposure history

Capture relevant human, material and animal contacts with timing and evidential confidence.

1. What close contact, contaminated-material contact, animal contact or pregnancy-associated exposure is reported, and when? provenance
2. Is the proposed source confirmed, plausible or unknown, and what evidence would distinguish competing acquisition events? boundary

Contact window and precautions

Record the policy-defined assessment window separately from uncertain infectiousness at a particular moment.

1. Which dated guidance determines the contact-assessment interval, and how do uncertain onset dates affect its boundaries? boundary
2. Which household, intimate, healthcare or animal contacts fall within that interval, and what precautions or authorised follow-up require review? action

Care and prevention options

Support review of symptom care, additional therapies and vaccination without embedding permanent eligibility rules.

1. What symptom burden and complications determine supportive-care needs, and what response has been observed? action
2. For an exposed person, how do exposure timing, symptoms and vaccination history affect eligibility under current post-exposure guidance? action
3. If additional therapy is considered, what current evidence, eligibility criteria, local authorisation and clinician decision support it? provenance

Documented episode disposition

Record healing evidence, residual effects and the authority for closure; WHO describes infectiousness continuing until sores heal and new skin forms. [WHO mpox fact sheet](https://www.who.int/news-room/fact-sheets/detail/mpox)

1. What skin and mucosal healing evidence supports release under the applicable guidance, and who documented that determination? action
2. What residual pain, scarring, other sequelae or unresolved symptoms require follow-up after the acute episode? measurement
3. Which local reporting duties remain, and what minimum necessary information may an authorised actor disclose? action

Kinds and varieties

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

• Clade I (Congo Basin / Central African) mpox - historically more severe, higher case-fatality, endemic in the Congo Basin
• Clade Ia - predominantly zoonotic spillover with limited human-to-human spread in Central Africa
• Clade Ib - recently expanded human-adapted lineage with sustained person-to-person transmission, including sexual contact, first widely documented in the DRC from 2023
• Clade II (West African) mpox - typically milder disease, historically West African
• Clade IIa - zoonotic/West African lineage with limited human chains
• Clade IIb - the lineage responsible for the 2022-ongoing global outbreak, predominantly among men who have sex with men in many non-endemic countries
• Human mpox (clinical case, confirmed / probable / suspected under WHO/CDC case definitions)
• Animal / wildlife mpox (reservoir and incidental hosts: rodents, non-human primates, and other mammals)

1. Which of these kinds and varieties hold for the sense of mpox this model covers, and on what evidence? provenance

Identifiers and schemes

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

• Wikidata - Q69488 (mpox as disease); Q6906176 (Monkeypox virus) - Disease vs etiological agent are separate items
• ICD-11 - 1E71 - WHO ICD-11 MMS code for mpox (renamed from monkeypox in 2022)
• ICD-10 - B04 - Monkeypox; many systems still use this code
• ICTV / NCBI Taxonomy - species Monkeypox virus (MPXV); NCBI taxid 10244 - Virus species in genus Orthopoxvirus, family Poxviridae
• MeSH - D045908 (Mpox); D045909 (Monkeypox virus) - NLM Medical Subject Headings
• SNOMED CT - 359814004 (Mpox); 424642009 (Monkeypox virus) - Clinical terminology; local editions may still say monkeypox
• Disease Ontology - DOID:3292 - mpox (formerly monkeypox)
• MONDO - MONDO:0001969 - mpox disease

1. Which of these identifiers and schemes hold for the sense of mpox this model covers, and on what evidence? provenance

Standards and regulation

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

• WHO: International Health Regulations (2005) - mpox has been a Public Health Emergency of International Concern (2022-2023 and again 2024 for clade I)
• WHO: recommended case definitions (suspected / probable / confirmed) and laboratory confirmation by PCR targeting OPXV then MPXV-specific assays, with clade differentiation
• WHO: 2022 renaming of the disease from monkeypox to mpox (virus species name Monkeypox virus retained by ICTV)
• CDC (United States): nationally notifiable condition; vaccination (JYNNEOS / ACAM2000) and isolation guidance; Select Agent rules apply to monkeypox virus (variola is select agent; MPXV clade I is a select agent in the U.S.)
• FDA / EMA: authorization of tecovirimat (TPOXX), brincidofovir, vaccinia immune globulin, and non-replicating MVA-BN (JYNNEOS/Imvanex/Imvamune) and replicating vaccinia (ACAM2000) vaccines
• IHR / national notifiable-disease laws: mandatory reporting of confirmed mpox in many jurisdictions
• ICTV: species nomenclature Monkeypox virus within Orthopoxvirus

1. Which of these standards and regulation hold for the sense of mpox this model covers, and on what evidence? provenance

Real-world use

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

• Clinical diagnosis and isolation of febrile patients with a centrifugal vesiculopustular or anogenital rash, especially after close or sexual contact
• Public-health surveillance: case counting by clade, contact tracing, and outbreak control in endemic Central/West Africa and in global MSM sexual networks (clade IIb)
• Laboratory PCR confirmation from lesion swabs, with clade-specific assays to distinguish I vs II and Ia vs Ib
• Vaccination of contacts and high-risk groups with MVA-BN (JYNNEOS) or ACAM2000; ring vaccination and pre-exposure programmes
• Occupational biosafety: handling of lesion material and cultures under appropriate containment; clade I MPXV is a U.S. select agent
• Wildlife and One Health investigation of rodent and primate reservoirs after zoonotic spillovers
• Differential diagnosis work-ups that still start from 'smallpox-like rash illness' in emergency and dermatology settings

1. Which of these real-world use hold for the sense of mpox this model covers, and on what evidence? provenance

Typical measurements

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

• Incubation period - 3-17 (commonly 5-13) - days
• Case-fatality ratio, clade I (historical, untreated, endemic settings) - about 1-10 (often cited ~10 for classic Congo Basin; recent outbreaks lower with care) - percent of cases
• Case-fatality ratio, clade II / IIb (2022 global outbreak) - well below 1 (often ~0.1-0.2 in well-resourced settings) - percent of cases
• Fever-to-rash interval (classic presentation) - 1-5 - days
• Lesion stage duration (each of macule/papule/vesicle/pustule/crust) - about 1-2 per stage; total rash ~2-4 weeks - days
• Genome size of MPXV - approximately 197 - kilobase pairs (dsDNA)
• Reproductive number R0 in 2022 clade IIb sexual-network outbreaks (effective, setting-dependent) - often estimated around 1.5-2.5 before behaviour change and vaccination - dimensionless

1. Which of these typical measurements hold for the sense of mpox this model covers, and on what evidence? provenance

Failure modes and hazards

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

• Misdiagnosis as varicella, herpes, syphilis, or molluscum, delaying isolation and partner notification
• Sustained human-to-human transmission (clade Ib, clade IIb) via close and sexual contact, household fomites, and healthcare exposure
• Severe disease, bacterial superinfection of lesions, encephalitis, myocarditis, and death - highest risk in children, pregnant people, and the immunocompromised (notably advanced HIV)
• Ocular involvement and corneal scarring with vision loss
• Vaccine adverse events: replicating vaccinia (ACAM2000) can cause progressive vaccinia, eczema vaccinatum, myopericarditis; MVA-BN is safer but two-dose and supply-constrained
• Laboratory escape or misidentification among orthopoxviruses; clade I is a select agent
• Stigma and delayed care in MSM and in endemic African communities, undermining surveillance
• Name-related racism and misinformation around 'monkeypox', which is why WHO adopted mpox

1. Which of these failure modes and hazards hold for the sense of mpox this model covers, and on what evidence? provenance

Regional variation

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

• WHO and most public-health agencies use mpox (2022); many clinical codes, older papers, and some languages still say monkeypox / variole du singe / viruela símica
• Clade I (including emerging Ib) is concentrated in the Democratic Republic of the Congo and neighbouring Central African states; clade II historically West Africa (Nigeria, etc.)
• The 2022 global outbreak (clade IIb) was driven by sexual networks of men who have sex with men in Europe, the Americas, and other non-endemic regions, with a different rash distribution (often anogenital, fewer lesions) than classic endemic disease
• Endemic African presentations more often follow zoonotic spillover (bushmeat, rodent contact) and show the classic centrifugal rash and higher pediatric burden
• U.S. select-agent status and vaccination stockpile policy differ from African endemic-country practice, where diagnostics and MVA-BN access have been limited

1. Which of these regional variation hold for the sense of mpox this model covers, and on what evidence? provenance

Neighbouring kinds and how to tell them apart

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

• Smallpox (variola virus) - Smallpox is eradicated; MPXV is distinguished by PCR and by clinically milder disease with prominent lymphadenopathy, which variola typically lacked
• Varicella (chickenpox) - Varicella lesions are superficial, appear in crops at different stages, and are centripetal; mpox lesions are deep-seated, same-stage in a given area, centrifugal or anogenital, with lymphadenopathy; PCR or VZV vs OPXV assays separate them
• Herpes simplex / syphilis (especially anogenital clade IIb) - HSV and Treponema pallidum serology/PCR vs MPXV PCR on lesion swabs; syphilis chancre is typically painless and single, mpox lesions often painful and multiple
• Cowpox, vaccinia, and other orthopoxviruses - Species-specific PCR or sequencing; vaccinia is vaccine-related; cowpox is typically a single lesion after rodent/cat contact in Eurasia
• Molluscum contagiosum - Umbilicated but chronic, pearly, without systemic prodrome; poxvirus family but different genus; PCR/histology distinguish
• Hand-foot-and-mouth disease / other vesicular exanthems - Enterovirus PCR, distribution (oral-acral), and lack of deep umbilicated pustules and marked lymphadenopathy

1. Which of these neighbouring kinds and how to tell them apart hold for the sense of mpox this model covers, and on what evidence? provenance