Additional cases are likely to be identified and disseminated to currently affected Member States and others. Countries should pay attention to signs related to patients with a rash that progresses in sequential stages (spots, papules, vesicles, pustules, scabs, at the same stage of development in all affected areas of the body) that may be associated with fever, enlarged lymph nodes, headache, back pain, muscle aches or fatigue. During this current outbreak, many people have a localized rash (oral, perigenital, and / or perianal distribution associated with painful regional lymphadenopathy), sometimes with a secondary infection. These individuals may be present in a variety of community and health care settings, such as primary care, fever clinics, sexual health services, travel health clinics, infectious disease units, emergency departments, dermatology clinics, obstetrics and gynecology and dental services. Raising awareness among potentially affected communities, as well as health care providers and laboratory workers, is essential to identifying and preventing new secondary cases and effectively managing the current outbreak.
Anyone who meets the definition of a suspicious case must be offered proof. The decision to test should be based on both clinical and epidemiological factors, linked to an assessment of the likelihood of infection. Because of the variety of conditions that cause rashes and because the clinical presentation may be more often atypical in this outbreak, it may be difficult to differentiate smallpox from the monkey only based on the clinical presentation, especially for cases with an atypical presentation. Any patient suspected of having smallpox in the monkey should be investigated and, if confirmed, isolated until their lesions have formed a crust, the crust has fallen off and a new layer of skin has formed underneath. . Isolation can occur in a health center or at home, as long as the infected person can be properly isolated and cared for. Every effort should be made to avoid unnecessary stigmatization of individuals and communities potentially affected by monkeypox.
Surveillance and reporting considerations
For more details, see; WHO Surveillance, Case Investigation, and Contact Tracking for Monkeypox: Interim Guidance, May 22, 2022.
Surveillance
The key objectives of monkeypox surveillance and investigation in the current context are to quickly identify cases and groups of infection and the sources of infection as soon as possible in order to provide clinical care and isolate cases. to prevent further transmission; and adapt effective control and prevention measures based on the most commonly identified routes of transmission. In non-endemic countries, one case is considered an outbreak. Due to the public health risks associated with a single case of monkeypox, physicians should immediately report suspicious cases to their local or national public health authorities in accordance with national information protocols. regardless of whether they are also exploring other potential diagnoses. Cases should be reported immediately, in accordance with case definitions (link shared above, under the public health response) or nationally adapted case definitions. Probable and confirmed cases should be reported immediately to WHO through the National Focal Points (NFPs) of the IHR in accordance with the International Health Regulations (IHR 2005).
Countries should be alert to signs related to patients with unusual rashes, vesicular or pustular lesions, or lymphadenopathy, often associated with fever, in a variety of community and health care settings, including, but not limited to, primary care, clinics. fever, health services, travel health clinics, infectious disease units, emergency services, obstetrics and gynecology and dermatology clinics. Surveillance of rash-like diseases should be intensified and guidance should be provided for the collection of skin lesion samples for confirmatory PCR testing. Physicians should be alert to any patients with relevant symptoms and signs who have recently traveled or been in contact with someone who has recently traveled. This includes, among other things, travel from endemic countries, and especially Nigeria at the moment, or travel from other countries where monkeypox has recently been reported. People who have recently had close personal contact with multiple sexual partners, either locally or in connection with recent travel, may be at risk. Outreach activities should be launched for communities identified as at risk as the outbreak develops. Currently, this includes disclosure on HSH’s social media and close contacts. It is important to note that the first case of monkeypox identified in any community may have acquired the infection through close personal contact at the local level. Under limited circumstances, the recent preparation or consumption of wild game or beef may also pose a risk.
Reports
Case reports must include at least the following information: date of report; report location; name, age, sex and residence of the case; date of onset of the first symptoms; recent travel history, including location and travel dates; recent exposure to a probable or confirmed case; relationship and nature of contact with probable or confirmed case (if applicable); recent history of multiple and / or anonymous sexual partners; smallpox or smallpox vaccination status; presence of eruption; presence of other clinical signs or symptoms according to the case definition; clinical diagnosis and laboratory confirmation date (where performed); confirmation method (where done); genomic characterization (if available); other relevant clinical or laboratory findings, especially to exclude common causes of eruption as defined in the case; if he is hospitalized; date of hospitalization (if applicable); and the result at the time of the report.
A global case notification form is being developed.
Considerations related to the investigation of the case
Justification
During human smallpox outbreaks, close physical contact with infected people is the most important risk factor for monkeypox virus infection. If monkeypox is suspected, the investigation should consist of (i) a clinical examination of the patient using appropriate infection prevention and control (CPI) measures, (ii) questioning the patient about possible sources of infection. local or travel-related and the presence of similar infections. disease in the community and patient contacts, and (iii) collection and sending of specimens for laboratory examination of monkeypox. The minimum data to be captured is included above in “Reports”. Exposure research should cover the period of up to 21 days prior to the onset of symptoms. Any patient with suspected monkeypox should be isolated during the presumed and known infectious periods, that is, during the prodromal stages and eruptions of the disease, respectively. Laboratory confirmation of suspected cases is important, but should not delay public health actions. The suspicion of the presence of a similar disease in the community or the patient’s contacts should be further investigated (also known as “back-contact tracking”).
Retrospective cases found by active research may no longer have the clinical symptoms of monkeypox (they have recovered from an acute illness), but may have scars and other sequelae. It is important to collect epidemiological information from retrospective cases in addition to the active ones.
Samples taken from people with suspected smallpox or from animals suspected of being infected with the smallpox virus should be handled safely by trained personnel working in properly equipped laboratories. National and international regulations on the transport of infectious substances must be strictly followed during the packaging of the sample and the transport to the testing laboratories. Careful planning is required to consider the testing capacity of the laboratory. Clinical laboratories should be informed in advance of samples to be submitted from people with suspected or confirmed smallpox, so that they can minimize the risk to laboratory workers and, where appropriate, perform safely. laboratory tests that are essential for clinical care. See more information below: Considerations for Laboratory Testing and Sample Management.
Retrospective cases cannot be confirmed in the laboratory; however, retrospective case serum can be collected and tested for anti-orthopoxvirus antibodies to aid in case classification.
Contact tracking considerations
Justification
Contact tracking is a key public health measure to control the spread of infectious disease pathogens such as monkeypox virus. It allows interruption of transmission and can also help people at higher risk of developing a serious illness to identify their exposure more quickly, so that their health can be monitored and they can seek medical attention more quickly if they become symptomatic. . In the current context, as soon as a suspicious case is identified, contact identification and tracking should begin. Patients in the case should be interviewed for the names and contact information of all of these individuals. Contacts must be notified within 24 hours of identification.
Definition of a contact
A contact is defined as a person who, in the period beginning with the onset of the first symptoms of the case of origin and ending when all the crusts have fallen, has had one or more of the following exposures with a probable case or confirmed smallpox monkey:
- direct physical or intimate personal contact, including any sexual contact
- face-to-face exposure (including healthcare workers without adequate PPE)
- contact with contaminated materials such as clothing or bedding
Contact identification
Patients may be asked to identify contacts in different contexts, including those in the home, intimate partners, and sexual contacts, as well as events and social gatherings when they extend …