After the declaration of theInternational Public Health Emergency for Mpox (formerly known as monkeypox), the director general of theWorld Health Organization has issued a series of temporary recommendations addressed to countries experiencing a surge in cases, including the Democratic Republic of Congo, Burundi, Kenya, Rwanda, Uganda.
The recommendations
The first invitation is to collaborate to better coordinate the response to emergencies at national and local levels. But the issue of vaccines is also touched upon, and the need for strong surveillance that goes beyond borders is reiterated, for a greater commitment to research, but also for the fight against the stigma that can accompany this disease.
On the surveillance the message launched by DG Tedros Adhanom Ghebreyesus is that it must be improved by “increasing the sensitivity of the approaches adopted and ensuring complete geographical coverage”. It is also necessary to expand “access to accurate, affordable and available diagnostics to differentiate the clades of the virus” Mpox, including by strengthening arrangements for the transport of samples, the decentralization of diagnostics and the provisions to conduct genomic sequencing”. Contacts of people affected by Mpox must be identified, monitored and supported to prevent transmission, and it is necessary to “intensify efforts to thoroughly investigate cases and outbreaks of Mpox disease to clarify the modes of transmission and prevent transmission to family members and communities”, in addition to “promptly and weekly reporting to WHO of suspected, probable and confirmed cases”.
A chapter is dedicated to theassistance: it is necessary to “provide clinical, nutritional and psychosocial support to patients with Mpox, including, where justified and possible, isolation in treatment centers and guidance for home care”. A “plan is needed to expand access to optimized supportive clinical care for all patients with Mpox, including children, HIV patients and pregnant women”. And the capacity, knowledge and skills of health and care workers must be strengthened and they must be provided with personal protective equipment”. The document also speaks of “infection prevention and control measures and basic water and sanitation services in health facilities, in households” in places such as prisons, refugee and displaced person camps, schools, and in cross-border transit areas.
As for the international trafficWHO recommends “establishing or strengthening cross-border collaborative arrangements for the surveillance and management of suspected MPOX cases, the provision of information to travellers and transport operators, without resorting to general travel and trade restrictions that would have an unnecessary impact on local, regional or national economies”.
Finally the Vaccination chapter: it is necessary to “prepare for the introduction of the Mpox vaccine for emergency response by convening national technical advisory groups for immunization, informing national regulatory authorities and preparing national policy mechanisms to request”. But also “launch plans to promote Mpox vaccination activities” in the context of the response to epidemics in areas with the emergence of new cases, “targeting people at high risk of infection (e.g. contacts of cases, including sexual contacts, health workers, children). Other indications concern information, risk communication and community engagement for epidemic prevention, response and vaccination strategies, management of misinformation. And it is asked to “address stigma and discrimination of all kinds”.
National funding must then be “stimulated and increased and external opportunities for targeted funding explored”, and it is crucial to “fill gaps in research“invest in the generation of scientific evidence, during and after epidemics, regarding the dynamics of Mpox transmission, risk factors, social and behavioral factors of transmission, the natural history of the disease, through trials of new therapies and vaccines against Mpox, the effectiveness of public health interventions, with a One Health approach”.
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