Treating mpox (monkeypox) in older adults involves a careful approach that balances supportive care with targeted interventions, especially because older individuals may have additional health challenges or weakened immune systems that can complicate recovery. Although there is currently no treatment specifically approved for mpox virus infections, management focuses on relieving symptoms, preventing complications, and addressing any severe or high-risk conditions that may arise.
Most older adults with mpox who do not have severe disease or significant immunocompromise typically recover with supportive care alone. This includes managing pain, fever, and skin lesions, as well as maintaining hydration and nutrition. Symptom control is crucial because mpox can cause painful rashes and systemic symptoms like fever and swollen lymph nodes. Secondary bacterial infections of the skin lesions are a common complication and should be treated promptly with appropriate antibiotics if they occur.
For older adults who have severe manifestations of mpox or underlying conditions that increase their risk—such as advanced age-related immune decline, chronic illnesses, or immunosuppressive therapies—more intensive treatment may be necessary. These severe manifestations can include complications like eye infections, neurological problems, inflammation of the heart muscle (myopericarditis), and mucosal lesions in the mouth, genital, or rectal areas that can cause significant discomfort and risk of further infection.
In such cases, antiviral medications that are FDA-regulated and stockpiled for emergency use may be considered. One of the primary antiviral agents used is tecovirimat, which targets orthopoxviruses and has been authorized for use in severe mpox cases or in patients at high risk of severe disease. While tecovirimat is not specifically approved for mpox, it has shown promise in reducing viral replication and improving outcomes in complicated cases. The decision to use antivirals in older adults depends on the severity of illness, immune status, and presence of complications.
Another important aspect of treatment in older adults is the management of immunocompromised states. Many older adults may have weakened immune systems due to age or concurrent conditions like HIV, cancer, or use of immunosuppressive drugs. For those with HIV who are not on antiretroviral therapy (ART), starting ART promptly is critical to improve immune function and help control mpox infection. Close monitoring and consultation with infectious disease specialists are recommended for these patients to tailor treatment plans effectively.
Vaccination also plays a role in the prevention and mitigation of mpox severity. The JYNNEOS vaccine, a third-generation nonreplicating smallpox and mpox vaccine, is approved for adults and can be used both before exposure (pre-exposure prophylaxis) and shortly after exposure (post-exposure prophylaxis). For older adults at ongoing risk or those who have been exposed, vaccination can reduce the likelihood of severe disease. The vaccine is generally well tolerated in older populations, but individual health status should be considered.
Supportive care in older adults must also address pain management carefully, as mpox lesions can be very painful. Pain control strategies may include topical treatments, oral analgesics, and sometimes more advanced pain management approaches depending on the severity. Maintaining skin hygiene and preventing scratching or trauma to lesions is important to avoid secondary infections.
In summary, the treatment of mpox in older adults is primarily supportive but escalates to antiviral therapy and specialist care when severe disease or high-risk conditions are present. Managing underlying health issues, preventing complications, and using vaccination strategically are key components of care. Because mpox can have prolonged or life-threatening courses in immunocompromised or frail older adults, early recognition and tailored treatment plans are essential to improve outcomes.
