（英文）行业资料 who -Multi-country outbreak of mpox,External situation report #19 - 30 March 2023

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Multi-countryoutbreakofmpox

ExternalSituationReport19,published30March2023

DataasreceivedbyWHOnationalauthoritiesby17:00CEST,27March2023

Riskassessment

Globalrisk–Moderate

Laboratoryconfirmedcases

86724

Deaths

112

Countries/areas/territories

110

WHORegionalrisk

•AfricanRegion,EasternMediterraneanRegion,EuropeanRegion,RegionoftheAmericas–Moderate

•SouthEastAsiaRegion,WesternPacificRegion–Low

Highlights

•Sincethelast

situationreport

publishedon16March2023,228newmpoxcases(0.3%increaseintotalcases)andonenewrelateddeathhavebeenreportedtoWHO.

•Globally,thenumberofmpoxcasescontinuestodecline,buttheWesternPacificregionisshowingan

increaseincases,mainlydrivenbyanoutbreakwithlocaltransmissioninJapan.

•HIVprevalenceamongmpoxcasesinthecurrentoutbreakishigherthantheestimatedHIVprevalence

intheadultpopulationoramongmenwhohavesexwithmeninallWHOregions,excepttheAfricanregion,fromwherethereisnoHIVinformationformpoxcasesavailable.

•MpoxcaseslivingwithHIVpresentadditionalsexuallytransmittedinfectionsslightlymorecomparedwith

mpoxcaseswithoutHIV.

•PreliminaryresultsfromanimalstudyinNigeriaprovideevidenceoforthopoxvirusinfections,butpresenceof

monkeypoxviruswasnotconfirmed.

•Morestudiesareneededincountrieswherempoxcasesarereportedtoidentifytheanimalreservoirof

monkeypoxvirusandlearnmoreabouttheepidemiologyofmpoxinAfrica.

EpidemiologicalUpdate

Datasource:

WHOMulti-countrympoxoutbreak-Globaltrends

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From1January2022through27March2023,acumulativetotalof86724laboratory-confirmedcasesofmpox,

including112deaths,havebeenreportedtoWHOfrom110countries/territories/areas(hereafter‘countries’)inallsixWHORegions(Table1).Sincethelast

situationreport

publishedon16March2023,228newcases(0.3%increaseintotalcases)andonenewdeathhavebeenreported.

Thenumberofweeklynewcasesreportedgloballyhasdeclinedby20%inweek12(20Marchthrough26March

2023)(n=88cases)comparedtoweek11(13Marchthrough19March2023)(n=110cases).Thenumberofreportedweeklycaseswasunder100inthelastweekforthefirsttimesinceMay2022.TheWesternPacificRegionreportedanincreaseincases(n=46)inthelastthreeweekscomparedtothethreeweeksprior,drivenbyanoutbreakofmpoxamongmeninJapan,withlocaltransmission.1Theotherregionshavereportedadeclineincasereportsorobservednoproportionalincrease(Table1).

From13Februarythrough27March2023,14countriesreportedanincreaseincaseswhencomparingthepast

threeweeks(7Marchthrough27March2023)tothethreeweeksprior(13Februarythrough6March2023),withthehighestrelativeincreasereportedinJapan(n=36vs.n=8).Asof27March2023,28ofthe110affectedcountrieshavereportednewcaseswithinthelast21days,themaximumdiseaseincubationperiod.SixteenofthemareintheAmericas,fourareinEurope,threeareintheAfricanRegion,threeareintheWesternPacificRegion,andonecountryeachareintheEasternMediterraneanRegionandtheSouth-EastAsiaRegion.From14Marchthrough27March2023,onenewdeathwasreported,fromNigeria.

Asof27March2023,the10countriesthathavereportedthehighestcumulativenumberofcasesglobally

continuetobetheUnitedStatesofAmerica(n=30063),Brazil(n=10890),Spain(n=7546),France(n=4128),Colombia(n=4089),Mexico(n=3937),Peru(n=3785),theUnitedKingdom(n=3738),Germany(n=3692),andCanada(n=1478).Together,thesecountriesaccountfor84.6%ofthecasesreportedglobally.

Table1.NumberofcumulativeconfirmedmpoxcasesanddeathsreportedtoWHO,byWHORegion,from1January2022to27March202317:00CEST

WHORegion

TotalConfirmedCases

Total

Deaths

Casesinlast3weeks1

3-weekchangein

cases(%)

RegionoftheAmericas

58991

86

270

-443

EuropeanRegion

25852

6

6

-67%

AfricanRegion

1454

18

11

-79%

WesternPacificRegion

301

0

46

820%

EasternMediterraneanRegion

83

1

1

-

South-EastAsiaRegion

43

1

3

-

Total

86724

112

337

-39%

(-)Zerocaseswerereportedinatleastoneofthethree-weekperiodsinthepastsixweeks

1Usingthethreemostrecentlycompletedinternationalstandardweeks(Monday-Sunday)

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Figure1.EpidemiologicalcurvesofweeklyaggregatedconfirmedcasesofmpoxbyWHORegion,from1January2022to26March2023,17:00CEST*

*Thisfigureshowsaggregatedweeklydata,forcompletedepidemiologicalweeksendingonSundays.Dataonthecurrentweekwillbe

presentedinthenextsituationreport.

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TheepidemiccurvesshowninFigure1suggeststhattheoutbreakcontinuestowaneintheEuropeanandthe

AmericasRegions.IntheAfricanRegion,theepidemiccurveshowsmoresustainedtransmission,whiletheWesternPacificRegionistheonlyoneshowinganriseincasereportsinthelastweeks.MostofthenewcasesinthisregionarereportedbyJapan.TheremainingtworegionsofSouth-EastAsiaandEasternMediterraneanreportsporadiccasesandclustersratherthansustainedtransmission.

Otherkeyepidemiologicalfindings:

•Asof27March2023,96.4%(74579/77359)ofcaseswithavailabledataaremen,withamedianageof

34years(interquartilerange:29-41years).Thispatternhasbeenquitestableovertime.

•Ofcaseswithagedataavailable,1.1%(930/83072)arechildrenaged0-17years,including271(0.3%)aged0-4years.ThemajorityofpediatriccaseswerereportedfromtheRegionoftheAmericas(681/930;73%).TheoverallproportionofchildcasesintheAmericasis1.2%(703/56752),similartotheproportionwhichhasbeenobservedglobally.

•Amongcaseswithinformationavailable,84.2%(25572/30388)haveidentifiedasgay,bisexualandothermenwhohavesexwithmen.Thisproportion,whileslightlyfluctuatingovertime,hasconsistentlybeenabove75%,highlightingthatmosttransmissioncontinuestooccurinthiscommunity.

•Ofallreportedmodesoftransmission,skinandmucosalcontactduringsexwasthemostreported,in15353of22293(68.9%)ofallreportedtransmissionevents.

•Whereinformationisavailable,themostreportedexposuresettingisapartysettingwithsexualcontact,comprising3806of5559(68.0%)reportedexposuresettings.Inthelastthreemonths,transmissioninahouseholdsetting,asaproportionofallsettingsreported,hasincreasedfromaround10%to22%.

•Amongthecases(n=33849)whoreportedatleastonesymptom,themostcommonsymptomisanyrash,reportedin80.7%ofcases,followedbyfever(59.1%),andgeneralizedorgenitalrash(47.3%and44.1%respectively).Thesymptomatologyofcaseshasbeenveryconsistentovertimeinthisoutbreak.

DetailedinformationontherouteoftransmissionisnotavailableformostcasesfromtheWHOAfricanRegion,andavailableinformationontransmissionmightnotfullydescribetheepidemiologicalspreadofthevirusintheregion.Countriesfromthisregionhavereportedperson-to-persontransmission,includingtransmissionthroughsexualcontact,aswellas,insomecontexts(primarilyinCentralAfrica),infectionfromknownorpresumedcontactwithinfectedanimals.

AnalysisofmpoxinpeoplelivingwithHIV

Fromglobalsurveillancedataofthecurrentoutbreak,48%(17581/36357)ofmpoxcaseswithavailableinformationwerepeoplelivingwithHIV.Atotalof98%(17317/17374)ofmpoxcaseswithHIVco-infectionaremale,and94%(16501/17581)self-identifiedasgay,bisexualandothermenwhohavesexwithmen(MSM).TheWHOregionaldistributionofHIVprevalenceamongMSMwithmpoxrangesfrom33%(2/6)intheSouth-EastAsiaRegion,to39%(3968/10205)intheEuropeanRegion,45%(9/20)intheEastern-MediterraneanRegion,50%(3/6)intheWesternPacificRegion,and56%(12519/22357)intheAmericas(Table2).NoHIVdatawereavailablefortheAfricanRegionintheglobalsurveillancedata.ThisprevalenceofHIVamongreportedmpoxcasesismuchhigherthantheHIVprevalenceestimatedamongthegeneralpopulationoramongMSMacrossallregions.2

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Figure2.AgeandsexdistributionofmpoxcasesamongpeoplelivingwithHIVfrom1January2022to26March2023.

Table2.HIVprevalenceamongconfirmedcasesofmpoxinmenwhohavesexwithmen(MSM)byWHORegion,from1January2022to26March2023

WHOregion

HIVprevalenceamongMSMmpoxcaseswithHIVinformation

HIVprevalenceamongallMSMmpoxcases

AFRO

Nodata

Nodata

EMRO

45%(9/20)

35%(9/26)

EURO

39%(3968/10205)

16%(3968/25271)

PAHO

56%(12519/22357)

24%(12519/52553)

SEARO

33%(2/6)

9%(2/22)

WPRO

50%(3/6)

2%(3/198)

•AmongreportedmpoxcasesinpeoplelivingwithHIVforwhichinformationwasavailable,65%werereportedtobeimmunocompromised(Figure3).Theimmunocompromisedstatuswasdefinedbytheclinicianwhoassessedthecase,andnodataontheCD4countofcaseswasavailable.Immunocompromisedcasesshowedbothahigherhospitalizationrateandmortalitywhencomparedtonon-immunocompromisedcases.

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Figure3.SchemashowingthedistributionofmpoxcaseswithHIVreportedtoWHOfrom1January2022to26March2023

*Around1/3ofcountriesdoesnotreportHIVstatus

**Only1%ofHIV-casesfromsurveillancedataisimmunocompromised

•AmongcasereportsforpersonswithmpoxandlivingwithHIV,318werehealthcareworkersandtwoweresexworkers.

•Atotalof19%(935/4899)ofmpoxcaseslivingwithHIVreportedatleastoneothersexuallytransmittedinfection(STI),comparedto14%(777/5594)ofthosewithoutHIV(p-value<.00001).TheslightlyhigherproportionofSTIsamongpersonswithmpoxlivingwithHIVmaysuggestriskiersexualactivitiesinthisgroup,orincreasedaccesstoSTItesting.

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Figure4.GeographicdistributionofconfirmedcasesofmpoxreportedtooridentifiedbyWHOfromofficialpublicsourcesfrom1January2022to27March202317:00CEST

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StudyoftheanimalreservoirofmonkeypoxvirusinNigeria

Thepreliminaryresultsofananimalstudytoinvestigatethereservoirofmonkeypoxvirus(MPXV)conductedinNigeriabetween2018and2019waspublishedFebruary2023.Atotalof240rodentsweresampledduringtheperiod,fromforest,urbanandperi-urbanlocationsassociatedwithrecenthumancasesinfouroftheaffectedstates.3

Molecularanalysesbyreal-timepolymerasechainreaction(PCR)identified,inarodent,anunknownorthopoxvirus(OPXV)whichtestednegativeformpoxonaMPXV-specificassay.SerologicalanalysisofsamplesfromtwoanimalsinaruralandanurbanlocationtestedpositivebyELISAforOPXVantibody(OPXVIgG).Theurbanlocationwasclosetoacorrectionalfacilitywhereampoxoutbreakhadbeenreportedin2017.4TheserologicaltestcouldnotdistinguishbetweendifferentOPXVspeciesandwasunabletoascertainwhetherthetwoanimalswereexposedtoMPXVoranotherOPXVcirculatinginsmallmammalsinNigeria.

ThestudyshowedmolecularandserologicevidenceofOPXVinfectionbutcouldnotconfirmthepresenceofMPXVinanimalsinNigeria.SimilarinvestigationsintheDemocraticRepublicoftheCongo,conductedin2012,2013,and2015,detectedOPXVIgGinsixrodents,butnonewaspositiveforMPXVbyPCR.5

NigeriahasexperiencedaresurgenceofmpoxsinceSeptember2017.Priortothis,threecasesofmpoxwerereportedintheliteraturefrom1971and1978.3Between2017andDecember2022,atotalof988confirmedmpoxcaseswererecorded,ofwhich762werein2022.6MonkeypoxviruscladeIIisthecirculatingvirusinNigeria.WhileMPXVwasthoughttobeenzooticinNigeria,thereisapaucityofevidenceofanimaltohumantransmission,withthevirusyettobeidentifiedinanimals.Epidemiologicalandmolecularstudieshavedemonstratedhumantohumantransmissionduringoutbreaks.

MorestudiesareneededincountrieswherempoxcasesarereportedtoidentifytheanimalreservoirofMPXVanddeterminetheroleofzoonosisintheepidemiologyofmpoxinAfrica.Inthemeantime,publichealthmeasuresmustbetakentoreducehuman-to-humantransmissionofmpoxandstoptheoutbreakinNigeria.Studiesarealsoneededtoidentifyotherorthopoxvirusesfoundinanimalstudiesandassesstheiranimalhealthandpublichealthimportance.

References:

1.Multinationalspreadofmonkeypox(mpox)|OsakaPrefecturalInfectiousDiseaseSurveillanceCenter.AccessedMarch29,2023.http://www.iph.pref.osaka.jp/040/20230317114302.html

2.2022-global-aids-update_en.pdf.AccessedMarch29,2023.

/sites/default/files/media_asset/2022-global-aids-update_en.pdf

3.MesekoC,AdedejiA,ShittuI,etal.OrthopoxvirusInfectionsinRodents,Nigeria,2018–2019.EmergInfectDis.2023;29(2):433-434.doi:10.3201/eid2902.221411

4.Yinka-OgunleyeA,ArunaO,DalhatM,etal.OutbreakofhumanmonkeypoxinNigeriain2017-18:aclinicalandepidemiologicalreport.LancetInfectDis.2019;19(8):872-879.doi:10.1016/S1473-3099(19)30294-4

5.LiY,OlsonVA,LaueT,LakerMT,DamonIK.Detectionofmonkeypoxviruswithreal-timePCRassays.JClinVirolOffPublPanAmSocClinVirol.2006;36(3):194-203.doi:10.1016/j.jcv.2006.03.012

6.NigeriaCentreforDiseaseControlandPrevention.AccessedMarch29,2023.

.ng/diseases/sitreps/?cat=8&name=An%20Update%20of%20Monkeypox%20Outbreak

%20in%20Nigeria

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RegionalUpdate:AfricanRegion

Mpoxsituationupdate:Africanregion

Between1January2022and27March2023,1454laboratory-confirmedcaseshavebeenreportedfrom10Africancountries,includingNigeria(822),theDemocraticRepublicoftheCongo(DRC)(439),Ghana(124),theCentralAfricaRepublic(CAR)(27),Cameroon(18),Liberia(10),Congo(5),SouthAfrica(5),Benin(3),andMozambique(1).TwocountriesintheWHOAfricaRegion(GhanaandSouthAfrica)hadnotreportedhumanmpoxbefore2022.ItshouldbenotedthatSudan,whichispartoftheWHOEasternMediterraneanregion,hasalsoreportedsporadiccasesacrossthecountryforthefirsttime,aswellassignificantCladeImpoxoutbreaksinrefugeecampsin2022,whichhadnotpreviouslybeendescribed.Therestofthisreportreferstothe

epidemiologyintheWHOAfricanregion,notincludingothercountriesonthecontinent.

Thesixcountrieswiththehighestnumberofcasesinthe

AfricanRegion

areNigeria(55.6%),DRC(29.7%),Ghana

(8.3%),CAR(1.8%),Cameroon(1.2%),andLiberia(0.7%).Threecountries,Nigeria,DRC,andGhanaaccountfor93.7%(1385)ofallmpoxcasesintheregion.Fivecountries(Benin,Cameroon,Congo,Mozambique,andSouthAfrica)havenotreportednewcasesin2023.

TheaverageageofmpoxcasesreportedintheWHOAfricanregionis19.9years,rangingfrom0-87years.Morethanhalfaremales(52.2%).Predominantsignsandsymptomsincluderash(18.3%),fever(17.4%),dysphagia(10.1%),pain(10.1%),andheadache(7.3%).

Eighteendeathshavebeenreportedintheregionsince2022,fromNigeria(9),Ghana(4),Cameroon(3),CAR(1),andMozambique(1).DeathsreportedintheDRCamongsuspectedcasesofmpoxarenotincludedinthesedata,whichcompriseconfirmedandprobablecasesreportedtoWHOglobally.WHOsupportscountriesininvestigatingoutbreaks,modesoftransmission,andcharacteristicsofmpoxintheregion,byimprovinglaboratorytestingcapacitytoperformgenomicsequencingtoidentifythemaincladesinvolvedintheoutbreak.BothcladesIandIIarecirculatinginAfricancountries;CladeIispredominantinCAR,CongoRepublicandDRC;cladeIIisdominantinBenin,Ghana,NigeriaandSouthAfrica;whileCameroonhasreportedbothclades.

WHOresponsetompoxintheAfricanregion

WHOisprovidingtechnicalassistanceandcoordinatingcollaborativeeffortsacrossvarioussectorstodeviseefficientresponseplansforcontainingandpreventingthetransmissionofmpoxintheregion.

Surveillanceandcaseinvestigation

WHOassistscountriesinupdatingtheirriskprofilesformpox,enhancingtheirabilitytodetectandreportcases,improvingtheiralertmanagementsystems,andestablishingorreinforcingtheirnationalcontacttracingsystems.WHOalsoaidscountriesinconductingcaseinvestigationsandspecimencollection,aswellasstrengtheningtheircapacityfordataanalysis.

•WHOconcludedaplantointegratempoxintotheAfricanRegionIntegratedDiseaseSurveillanceandResponse(IDSR)systemandcontinuestosupportcountriestoincludempoxasanotifiabledisease.

•GuidancenotestostrengthenmpoxsurveillanceintheWHOAfricanRegionhavebeendeveloped.

•Aregional

dashboard

hasbeendevelopedtofacilitatedatavisualization,analysis,andfollow-upofmpoxcases.Additionally,WHOhasdevelopedelectronicdatacollectionandreportingtoolsforaggregateddata,linelists,andanonlinecaseinvestigationform.

Coordinationandresourcemobilization

WHOhasdeployedthreehigh-levelsupportmissionstoGhana,Nigeria,andCARtoaugmentthemonkeypoxresponseefforts.Countrysupportmissionsworkcloselywiththecountriestoensuretheyhavetheresourcesandsupporttorespondeffectivelytotheoutbreak.

Laboratory

WHOprovideslaboratoriesacrosstheregionwithessentialreagentsandtrainingincollaborationwithAfricaCDCandtheWestAfricanHealthOrganization(WAHO).

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Riskcommunicationandcommunityengagement(RCCE)

WHOcontinuestoconductsociallisteninginvolvingmonitoringsocialmediaandotheronlineplatformstounderstandhowpeoplearetalkingaboutcontrolmeasuresandrespondingtothekeymessagesthathavebeendeveloped.Thiswillhelpidentifygapsorareaswherethemessagingmayneedtobeadjusted.

Inadditiontodevelopingkeymessagesandmonitoringsocialmedia,thereisalsoafocusoncapacitybuilding,involvingtrainingcommunityvolunteersonhowtocommunicateaboutcontrolmeasureseffectively.Volunteersaretrainedtoidentifykeyaudiences,tailormessagestodifferentgroups,anduseavarietyofrelevantcommunicationchannels.

Readiness

WHOhasdevelopedandshareda

readinessassessmenttool

todeterminecountries'readiness.Over80%(39/47)

ofcountriesintheRegionhaveevaluatedtheirresponseabilities.Threecountries(8%)reportedadequatereadinesscapacity,18(46%)reportedmoderatecapacity,and18(46%)reportedlimitedcapacity.

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Technicalguidanceandotherresources

StrategicPlanningandGlobalSupport

•WHOcommentaryonthenamingofmpoxdiseaseandmonkeypoxviruscladeshasbeenpublishedintheLancetInfectiousDiseases.

6February2023.

Newnomenclatureformpox(monkeypox)andmonkeypoxvirusclades

•WHOrecommendsnewnameformonkeypoxdisease-28November2022

/news/item/28-11-2022-who-

recommends-new-name-for-monkeypox-disease

•MonkeypoxStrategicPreparedness,ReadinessandResponsePlan(SPRP)Operationalplanningguidelines–2November2022

/publications/m/item/monkeypox-strategic-preparedness--readiness--and-response--operational-planning-

guidelines

•WHOEmergencyAppeal:Monkeypox-July2022–June2023,13October2022

/publications/m/item/who-

emergency-appeal--monkeypoxjuly-2022june-2023

•MonkeypoxStrategicPreparedness,Readiness,andResponsePlan(SPRP)-5October2022,

/publications/m/item/monkeypox-strategic-preparedness--readiness--and-response-plan-

(sprp)

InternationalHealthRegulationsEmergencycommitteeandTemporaryRecommendationsoftheDirector-General

•WHOfourthmeetingoftheInternationalHealthRegulations(2005)(IHR)EmergencyCommitteeregardingthemulti-countryoutbreakofmonkeypox,15February2023.

/news/item/15-02-2023-fourth-meeting-of-the-international-

health-regulations-(2005)-(ihr)-emergency-committee-on-the-multi-country-outbreak-of-monkeypox-(mpox

)

•WHOThirdmeetingoftheInternationalHealthRegulations(2005)(IHR)EmergencyCommitteeregardingthemulti-country

outbreakofmonkeypox,1November2022.

/news/item/01-11-2022-third-meeting-of-the-international-health-

regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox

•WHOSecondmeetingoftheInternationalHealthRegulations(2005)(IHR)EmergencyCommitteeregardingthemulti-countryoutbreakofmonkeypox,23July2022.

/news/item/23-07-2022-second-meeting-of-the-international-health-

regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox

•WHODirector-General'sstatementatthepressconferencefollowingIHREmergencyCommitteeregardingthemulti-countryoutbreakofmonkeypox,23July2022.

/director-general/speeches/detail/who-director-general-s-statement-on-

the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022

WHOInterimtechnicalguidance

•Surveillance,caseinvestigationandcontacttracingformpox(monkeypox):interimguidance,22December2022.

/publications/i/item/WHO-MPX-Surveillance-2022.4

•WHOVaccinesandimmunizationformonkeypox:Interimguidance,16November

2022.

/iris/bitstream/handle/10665/364527/WHO-MPX-Immunization-2022.3-eng.pdf

•Clinicalmanagementandinfectionpreventionandcontrolformonkeypox:Interimrapidresponseguidance,10June

2022.

/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1

•Emergencyuseofunprovenclinicalinterventionsoutsideclinicaltrials:ethicalconsiderations:/publications-detail-redirect/9789240041745

•WHOTechnicalbrief(interim)andpriorityactions:enhancingreadinessformonkeypoxinWHOSouth-EastAsiaRegion,7July

2022

./media/docs/default-source/searo/whe/monkeypox/searo-mpx-tbrief22.pdf

Surveillance

•WHOGlobalclinicaldataplatformformonkeypoxcasereportform(CRF),21July2022,

/publications/i/item/WHO-MPX-Clinical_CRF-2022.3

Datamanagement

•MonkeypoxCaseandcontactinvestigationform(CIF)andminimumdatasetCasereportingform(CRF).19August2022.

/publications/m/item/monkeypox-minimum-dataset-case-reporting-form-(crf)

•TheWHOGlobalClinicalPlatformformonkeypox,14June2022.

/tools/global-clinical-platform/monkeypox

•WHOGo.Data:Managingcomplexdatainoutbreaks

./tools/godata

RiskcommunicationandcommunityengagementandPublicHealthAdvice

•Updated(V3)Publichealthadviceforgay,bisexualandothermenwhohavesexwithmenandmpox9March2023:

/publications/m/item/monkeypox-public-health-advice-for-men-who-have-sex-with-men

•Publichealthadviceonmpoxandsex-on-premisesvenuesandevents01March2023:

/publications/m/item/public-health-advice-on-mpox-(monkeypox)-and-sex-on-premises-venues-and-events

•Infographicongettingtestedf