Variations in national surveillance reporting for Mpox virus: A comparative analysis in 32 countries

Abstract

ObjectivesCase Reporting and Surveillance (CRS) are crucial to combat the global spread of the Monkeypox virus (Mpox). To support CRS, the World Health Organization (WHO) has released standardized case definitions for suspected, probable, confirmed, and discarded cases. However, these definitions are often subject to localized adaptations by countries leading to heterogeneity in the collected data. Herein, we compared the differences in Mpox case definitions in 32 countries that collectively reported 96% of the global Mpox caseload.MethodsWe extracted information regarding Mpox case definitions issued by the competent authorities in 32 included countries for suspected, probable, confirmed, and discarded cases. All data were gathered from online public sources.ResultsFor confirmed cases, 18 countries (56%) followed WHO guidelines and tested for Mpox using species specific PCR and/or sequencing. For probable and suspected cases, seven and eight countries, respectively were found to have not released definitions in their national documentations. Furthermore, none of the countries completely matched WHO’s criteria for probable and suspected cases. Overlapping amalgamations of the criteria were frequently noticed. Regarding discarded cases, only 13 countries (41%) reported definitions, with only two countries (6%) having definition consistent with WHO guidelines. For case reporting, 12 countries (38%) were found to report both probable and confirmed cases, in line with WHO requirements.ConclusionThe heterogeneity in case definitions and reporting highlights the pressing need for homogenization in implementation of these guidelines. Homogenization would drastically improve data quality and aid data-scientists, epidemiologists, and clinicians to better understand and model the true disease burden in the society, followed by formulation and implementation of targeted interventions to curb the virus spread.

A Review of Mpox Outbreak and Public Health Response in Spain

“…In Spain, every reported case was confirmed by PCR or sequencing samples from skin lesions, vesicular fluids, oropharyngeal, genital, or recto-anal exudates. Despite the initial use of generic PCR for orthopoxviruses in some centers, 28 a real-time quantitative PCR was specifically designed and assessed across numerous patient samples within the majority of Spanish reference centres. Surveillance is passive, nationwide, and case-based; with laboratory information integrated, information flows from the regional to the national level.…”

“…When the outbreak began, timely and accurate diagnosis became imperative, posing a significant challenge for microbiology services. In Spain, despite the initial use of generic PCR for Orthopoxviruses in some hospitals, 28 a real-time quantitative PCR was specifically designed and assessed across numerous patient samples within the majority of Spanish reference centres. The results underwent meticulous comparison with isolation outcomes, and these diagnostic tests were made accessible from June 2022.…”

Mpox (Monkeypox) in Pregnancy: Viral Clade Differences and Their Associations with Varying Obstetrical and Fetal Outcomes

“…The number of reported cases of mpox in DR Congo and other endemic African countries, including infections occurring during pregnancy, is almost certainly underestimated because of the difficulty in obtaining laboratory confirmation, social inequality, paucity of local diagnostic facilities, affected persons living in remote rural settings, and challenges from armed conflict, civil unrest, and insufficient infrastructure, including poor roads and the current health delivery system. Compounding these issues is a historical record of inconsistency in the criteria for diagnosing mpox, as the World Health Organization did not release standardized diagnostic criteria and case reporting forms until many months after the onset of the 2022–2023 global mpox outbreak [ 67 , 68 ]. Even following their release, there remain inconsistencies in what is considered to be a confirmed case versus a suspected case due to technical and logistical limitations and discrepancies in molecular pathology testing [ 68 , 69 ].…”

“…Compounding these issues is a historical record of inconsistency in the criteria for diagnosing mpox, as the World Health Organization did not release standardized diagnostic criteria and case reporting forms until many months after the onset of the 2022–2023 global mpox outbreak [ 67 , 68 ]. Even following their release, there remain inconsistencies in what is considered to be a confirmed case versus a suspected case due to technical and logistical limitations and discrepancies in molecular pathology testing [ 68 , 69 ]. In assessing the prevalence of mpox infections in obstetric and pediatric populations, these challenges are potentially exacerbated by the fact that current diagnostic criteria do not specifically address testing among pregnant women and children, where they may exist specific immunological differences.…”

Monkeypox Diagnosis in Clinical Settings: A Comprehensive Review of Best Laboratory Practices

“…Pursuant to Article 6 of the International Health Regulations (IHR) 2005, it is mandatory for WHO member countries to report probable and confirmed cases to the WHO for surveillance purposes (Panag et al 2023). In this regard, the WHO has provided the case reporting form (CRF) that acts as a template for data collection and reporting.…”