Known mpox case contacts must avoid sexual contact with others for 21 days: WHO guidelines

World Health Organisation (WHO) had  suggested changing the name from monkeypox to mpox in November this year. It has recently released and updated its guidelines on the monkeypox on its website. A summary of the updates is as follows:

Changes from the earlier version:

The Case Investigation Form (CIF) and Case Reporting Form (CRF) are updated, and the name of the disease is changed from "monkeypox" to"mpox".

Investigating exposure to infected animals:

A new section has been added to the updated CIF to investigate cases exposed to infected animals. The content of the CRF is not changed.

CIF as a tool for Member States and researchers:

· To conduct an in-depth epidemiological investigation of mpox cases(suspected, probable and confirmed).

· Collection of information both prospectively or retrospectively for both cases and their contacts.

· The full form is meant to serve as a tool for in-country use, and the data are not required to be reported to WHO.

Data collection and sharing:

· A macro-enabled Microsoft Excel form has been prepared by WHO that countries have received through IHR communication channels for data collection.

· To facilitate local capture, analysis, and sharing of the relevant data, WHO has implemented the in-depth case investigation form (CIF) in the Go.Data platform39.

· Countries using Go.Data can be uploaded to the mpox CIF and directly use to collect case-based data for their mpox cases.

· The template of Go.Data mpox outbreak and associated metadata description can be obtained by emailing godata@who.int.

· Through the "visualization" feature, Go.Data allows member states, partners and institutions to visualize outbreak response activities in real-time chains of transmission.

· Data collected through the WHO CIF could be collated across multiple countries in a collaborative effort, increasing the sample size and allowing robust analyses.

· The case-based surveillance data will be used by WHO only for its products, without sharing it with external third parties.

Sexual contact, precautions and quarantine:

· The known case contacts must avoid sexual contact for 21 days.

· As long as no symptoms are developed, quarantine is not necessary.

· PPE or Personal protective equipment should be used by the providers when mpox is suspected in a clinical or hospital setting. The patients should be investigated in a well-ventilated room and be questioned for the possible sources of infection. There should be safe specimen collection sent to the laboratory.

Recommendations from SAGO:

The statement by the Scientific Advisory Group for the Origins of NovelPathogens (SAGO) outlines the following recommendations:

• To conduct studies for a better understanding of the dynamics of human-to-human transmission.

· Infectiousness studies should be conducted to identify the reproductive number, viral shedding duration and all possible transmission routes.

A better understanding of virus mutation patterns.

· Multidisciplinary and multisectoral zoonosis studies to identify animal reservoirs and a better understanding of animal-to-human transmission.

· Conduct environmental, anthropological, behavioural and social science studies around confirmed cases to better understand how mpox is transmitted between humans.

· Better understanding of animal-to-human transmission.

· To Conduct more studies (environmental, anthropological, behavioural and social science) around confirmed cases to better understand mpox transmission between humans.

To conclude, SAGO recommends more studies on the origin, re-emergence,and transmission of the mpox virus. Contact tracing should be initiated as soon as the suspected case is identified. Suspected cases should be immediately reported to public health authorities by the Clinicians.

The main objective is to identify cases, provide optimal care, and isolation, prevention of further transmission, follow-ups,  protection of healthcare workers, and identification if high-risk groups and effective control. More data must be collected to better understand the mpox virus from all aspects.

Further reading:

• Recommendationsto better understand the origins of and factors for the emergence and re-emergence of mpox.
• Case investigation form (CIF) and minimum dataset Case reporting form (CRF)