Development and implementation of a clinical decision support system tool for the evaluation of suspected monkeypox infection

Abstract

Monkeypox virus was historically rare outside of West and Central Africa until the current 2022 global outbreak, which has required clinicians to be alert to identify individuals with possible monkeypox, institute isolation, and take appropriate next steps in evaluation and management. Clinical decision support systems (CDSS), which have been shown to improve adherence to clinical guidelines, can support frontline clinicians in applying the most current evaluation and management guidance in the setting of an emerging infectious disease outbreak when those guidelines are evolving over time. Here, we describe the rapid development and implementation of a CDSS tool embedded in the electronic health record to guide frontline clinicians in the diagnostic evaluation of monkeypox infection and triage patients with potential monkeypox infection to individualized infectious disease physician review. We also present data on the initial performance of this tool in a large integrated healthcare system.

Recent Developments in Mpox Prevention and Treatment Options

“…Moreover, the effective public health measure adoption in these endemic regions has also limited the spread of mpox infections [ 4 , 7 ]. An additional factor that should be noted is that mpox has neither a lifelong survival nature nor has purely the characteristic nature of sexually transmitted diseases such as HIV [ 4 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. The disease mostly remains self-limiting and resolves within 2–4 weeks of symptoms, as the host slowly develops immunity against it.…”

“…So far, these are limited to African countries; however, some recent outbreaks have been reported in other continents as far as America, Asia, and Europe. The situation is thus alarming for scientific and healthcare networks around the world [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Mitigation Measures to Control the Expected Mpox Outbreak in a Developing Country—Pakistani Scenario

“…Vaccine hesitancy is among the top ten challenges faced by WHO which has extended after the COVID-19 pandemic worldwide [ 18 ]. With regard to Pakistan specifically, the country has always suffered from the issue of vaccination hesitancy, such as for the polio vaccination, COVID-19 vaccination, or for the proposal of the current Mpox vaccination drive [ 57 ].…”

“…Treatment and preventive strategies are of the utmost importance in any viral outbreak, and thus the following [ 18 ] recommendations should be implemented to increase treatment and preventive practices against Mpox and related infections in developing nations, such as Pakistan [ 11 , 12 , 67 , 68 ].…”

“…Owing to its similarity with smallpox infection, the smallpox vaccine can be utilized against Mpox as directed by WHO. A few vaccine candidates, including mainly the smallpox vaccine, along with therapeutics such as tecovirimat (antiviral agent), are currently being employed for the treatment of Mpox infection in endemic regions [ 17 , 18 , 19 , 20 ].…”