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Key points
• Since 2023, the Democratic Republic of the Congo has been experiencing a steady increase in mpox cases in both endemic and newly affected areas, and in early 2024, a new monkeypox virus (MPXV) strain, subclade Ib was identified. The continuing spread of mpox in the Democratic Republic of the Congo and the detection of subclade Ib in neighbouring countries led the WHO Director-General to declare mpox a Public Health Emergency of International Concern (PHEIC) on 14 August 2024. In addition, a multi-country outbreak of mpox, caused by MPXV clade IIb, has been ongoing since May 2022 with continuing transmission reported across all WHO regions.
• The primary goals of mpox surveillance, case investigation, and contact tracing are to detect and contain outbreaks and stop ongoing transmission, as well as to monitor and orient the epidemic response. This approach aims to protect people at risk of mpox in endemic and new settings while working towards eliminating human-to-human transmission.
• The specific objectives of surveillance and case investigation for mpox are to rapidly identify cases, clusters of cases, and sources of exposure in order to: provide optimal clinical care; isolate cases to prevent further transmission; identify and monitor contacts to recognize early signs of infection; identify risk groups for infection and for severe disease; protect frontline health workers; and tailor effective control and prevention measures.
• Key actions of outbreak response are to provide accurate information to people at risk; offer pre- and postexposure vaccination to people at risk; stop further spread; and protect vulnerable individuals and frontline health workers.
• Clinicians should immediately report suspected mpox cases to relevant national public health authorities.
• Probable and confirmed cases of mpox should be reported to WHO through national IHR national focal points (NFPs) as early as possible, at least monthly, and with a minimum epidemiological dataset, in line with Article 6 of the International Health Regulations (IHR 2005) and the Standing recommendations extended by the Director General of WHO (August 2024). African countries experiences an upsurge in cases should report weekly on suspected, probable, and confirmed mpox cases according to national or WHO case definitions, in line with the mpox temporary recommendations (August 2024).
• All confirmed cases of clade Ib MPXV should be reported to WHO through IHR notification as soon as they are detected and confirmed.
• If mpox is suspected, case investigation should consist of a clinical examination of the patient in a wellventilated room while using appropriate personal protective equipment (PPE), questioning the patient about possible sources of exposure, and safe collection and dispatch of specimens for laboratory testing.
• As soon as a suspected case is identified, contact identification and 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 with an infectious case or contaminated materials.
• Contacts do not require quarantine or exclusion from work during the contact monitoring period as long as they are symptom-free. WHO encourages contacts to rigorously practice hand hygiene and respiratory etiquette, avoid contact with persons who are immunocompromised or pregnant and avoid sexual contact throughout the 21-day monitoring period. Non-essential travel is discouraged during this period.