Surveillance, case investigation and contact tracing for monkeypox: interim guidance, 25 August 2022

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This is an updated version of the previous guidance published on 24 June 2022. It applies to all countries reporting monkeypox cases as part of the current outbreak and with historically documented monkeypox transmission. 

On 23 July, the Director General of WHO declared the multi-country outbreak of monkeypox to be a Public Health Emergency of International concern (PHEIC). This interim guidance has been updated with the latest information on symptomatology and epidemiological parameters, and to align with the Temporary Recommendations issued by the Director General.

The suspected case definition has been updated to include known contacts with prodromal signs or symptoms, and both suspected and probable case definitions have been updated to capture additional clinical characteristics such as mucosal lesions. New variables have been added to the minimal dataset of probable and confirmed cases to be shared with WHO. 

This version of the document contains the first definition of monkeypox related death for surveillance purposes.

The overall goal of surveillance, case investigation and contact tracing in this context remains to stop human-to-human transmission to control the outbreak. 

Clinicians should report suspected cases immediately to local and national public health authorities. Probable and confirmed cases of monkeypox should be reported as early as possible, including a minimum dataset of epidemiologically relevant information, to WHO through IHR national focal points (NFPs).

If monkeypox is suspected, case investigation should consist of clinical examination of the patient while using appropriate personal protective equipment (PPE), questioning the patient about possible sources of infection, and safe collection and dispatch of specimens for monkeypox virus laboratory examination.

As soon as a suspected case is identified, contact identification and forward contact tracing should be initiated. Contacts of probable and confirmed cases should be monitored, or should self-monitor, daily for any sign or symptom for a period of 21 days from last contact. Quarantine or exclusion from work are not necessary as long as no symptoms develop

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