Surveillance, case investigation and contact tracing for Monkeypox: interim guidance

Insight

This is an updated version of previous guidelines published on May 22, 2022. They apply to all countries with potential cases of monkeypox, including countries that have historically documented monkeypox transmission and those that didn’t.

The confirmed case definition has been updated to include polymerase chain reaction (PCR) positive cases, regardless of associated symptoms or lack thereof, to better characterize pre-symptomatic, pauci-symptomatic or asymptomatic. The definition of contact has been amended to include more examples of potential exposures, as well as the contact risk levels established by the monkeypox vaccination guidelines.

The overall goal of surveillance, case investigation and contact tracing in this setting is to stop human-to-human transmission to control the outbreak. The main goals of surveillance and case investigation are to rapidly identify cases and clusters in order to provide optimal clinical care; isolate cases to prevent further transmission; identify, manage and follow up contacts to recognize early signs of infection; protect frontline health workers; identify groups at risk; and to adapt effective control and prevention measures.

Clinicians should immediately report suspected cases to local and state public health authorities. Probable and confirmed cases of monkeypox should be reported as soon as possible, including a minimum data set of epidemiologically relevant information, to WHO through IHR National Focal Points (NFPs).

If monkeypox is suspected, the case investigation should consist of clinical examination of the patient using appropriate personal protective equipment (PPE), questioning the patient about possible sources of infection, and collecting and sending safely samples for laboratory examination for monkeypox virus.

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