The UK Health Security Agency (UKHSA) has released guidance for primary care settings including using personal protective equipment (PPE) and isolating patients with suspected mpox in a closed room.

But the Pharmacists' Defence Association (PDA) has called for additional, specific support and guidance on how community pharmacies should deal with suspected mpox cases. Meanwhile, the National Pharmacy Association (NPA) has called for pharmacies to be given 'prompt access' to PPE if necessary.

This comes as the World Health Organization (WHO) last week declared a public health emergency of international concern (PHEIC) over a new variant which has been recorded in Europe and is linked to deaths in Africa.

The new strain, Clade 1b, emerged in DRC but has not yet been recorded in the UK, the UKHSA said last week.

Dr Meera Chand, UKHSA deputy director, said that while the risk to the UK population was 'currently considered low', planning was underway 'to prepare for any cases that we might see in the UK'.

'This includes ensuring that clinicians are aware and able to recognise cases promptly, that rapid testing is available, and that protocols are developed for the safe clinical care of people who have the infection and the prevention of onward transmission,' she said.

The UKHSA also released guidance for healthcare professionals in all settings on how to identify and deal with suspected mpox.

It said providers should 'ensure that they have adequate stocks of appropriate personal protective equipment (PPE) and relevant staff are trained in its use for the assessment and treatment of patients presenting with suspected Clade I MPXV infection'.

Providers should also 'ensure there is a clinical pathway for isolation and management of suspected Clade I MPXV cases within their setting', the guidance added.

And it specified: 'Where suspected cases meeting the operational case definition present in primary care, general practitioners should isolate the patient in a single room and contact their local infection service for advice, including appropriate arrangements for transfer into secondary care and immediate precautions in the setting.'

Alastair Buxton, director of NHS services at Community Pharmacy England (CPE), told The Pharmacist that while the likelihood of somebody presenting in a pharmacy with symptoms of mpox was 'currently low', 'all community pharmacy staff should be aware of and follow the guidance from UKHSA'.

'The procedures are similar to those seen early in the Covid-19 pandemic so should be familiar to pharmacy teams,' he added.

And Professor Claire Anderson, president of the Royal Pharmaceutical Society (RPS), said that pharmacy teams should stay 'informed and prepared' amid the 'evolving' situation.

'All pharmacy staff should familiarise themselves with the UKHSA alert issued on 15 August 2024 and any subsequent updates, and carefully consider how this guidance may affect their teams and the care they provide,' she added, as well as highlighting the NHS England manual on high-consequence infectious disease (HCID) personal protective equipment (PPE).

Meanwhile, Jasmine Shah, the NPA's head of advice and support, and Jay Badenhorst, director of pharmacy at the PDA, have each called for specific support and guidance for community pharmacies.

Ms Shah commented: 'There are no identified mpox cases in the UK at present, but while the risk to the UK population is currently considered low, pharmacists do need to be vigilant in spotting symptoms.'

And she warned: 'In the event of a significant outbreak of mpox in this country, government and NHS must ensure that pharmacy staff and community pharmacy operations are properly protected, including prompt access to PPE'.

Mr Badenhorst suggested that 'given the drive to direct patients to pharmacies first', it was 'likely' that patients with mpox may present in a community pharmacy.

And he called for pharmacy employers to ensure that measures consistent with the UKHSA guidelines were in place for pharmacy teams to follow should a patient present with suspected mpox.

He added: 'Additional, specific guidance tailored to the unique environment of community pharmacies is crucial, which should include information on:

  • Urgent triage and isolation, especially considering that community pharmacies are typically not equipped with isolation facilities.
  • Pharmacists and pharmacy staff need explicit instructions on using PPE appropriately when dealing with potential mpox cases, including what to do if adequate PPE is not readily available.
  • Pharmacists should be provided with direct lines of communication to local infection services for immediate advice and assistance, similar to what is provided to GPs.
  • Pharmacists should have access to up-to-date, accurate information about mpox to share with patients and the public, including symptoms to watch for and when to seek further medical attention.
  • Community pharmacists and pharmacy staff should receive training on recognising mpox symptoms and understanding the necessary steps, ensuring they are prepared to manage such cases appropriately.'

The UKHSA has been approached for comment.

What is mpox?

'MPXV is a virus from the same family as smallpox, that presents with a rash illness which may be mild and localised, or severe and disseminated. There are 2 distinct clades of the virus: Clade I and Clade II. Clade II MPXV is responsible for the global outbreak that began in 2022. Clade I MPXV is currently considered more severe than Clade II MPXV, leading to its classification as a high consequence infectious disease (HCID).

'Historically, Clade I MPXV has been reported only in 5 Central African countries. However, recent cases in additional countries within Central and East Africa mark the first known expansion of its geographical range, heightening the risk of spread beyond the region. Evidence of sustained sexual transmission of Clade I MPXV has emerged in the Democratic Republic of Congo (DRC). Healthcare professionals should remain vigilant for Clade I MPXV, including in sexually acquired mpox cases, and should obtain comprehensive travel histories from patients.

'The symptoms of mpox begin 5 to 21 days (average 6 to 16 days) after exposure with initial clinical presentation of fever, malaise, lymphadenopathy and headache. Within 1 to 5 days after the appearance of fever, a rash develops, often beginning on the face or genital area and it may then spread to other parts of the body. The rash changes and goes through different stages before finally forming a scab which later falls off. Treatment for MPXV is mainly supportive.'

Source: UKHSA