WHO issues temporary recommendations to check spread of Monkey Pox

Emergency Coordination

• Establish or enhance national and local emergency response coordination arrangements;
• Establish or enhance the coordination of all partners and stakeholders engaged in or supporting response activities through cooperation, including by introducing accountability mechanisms;
• Engage partner organizations for collaboration and support, including humanitarian actors in contexts with insecurity or areas with internal or refugee population displacements and hosting communities insecure areas;
Collaborative Surveillance and Laboratory Diagnostics
• Enhance surveillance, by increasing the sensitivity of the approaches adopted and ensuring comprehensive geographical coverage;
• Expand access to accurate, affordable and available diagnostics to differentiate monkeypox virus clades, including through strengthening arrangements for the transport of samples, the decentralization of diagnostics, and arrangements to conduct genomic sequencing;
• Identify, monitor and support the contacts of people with mpox to prevent onward transmission;
• Scale up efforts to thoroughly investigate cases and outbreaks of mpox disease to elucidate the modes of transmission, and prevent its onward transmission to household members and communities;
• Report to WHO suspect, probable and confirmed cases of mpox in a timely manner and on a weekly basis;

Safe and Scalable Clinical Care

• Provide clinical, nutritional and psychosocial support for patients with mpox, including, as warranted and possible, isolation in care centres and guidance for home-based care;
• Develop and implement a plan to expand access to optimised supportive clinical care for all patients with mpox, including children, patients living with HIV and pregnant women. This includes offering HIV tests to adult patients who do not know their HIV status and to children as appropriate, with linkages to HIV treatment and care services when indicated; the prompt identification and effective management of endemic co-infections, such as malaria, varicella zoster and measles viruses, and other sexually transmitted infections (STIs) among cases linked to sexual contact;
• Strengthen health and care workers’ capacity, knowledge and skills in the clinical and infection and prevention and control pathways –from diagnosis to discharge of patients with suspected and confirmed mpox –, and provide them with personal protective equipment;
• Promote and implement infection prevention and control measures and basic water and sanitation services in health care facilities, household settings, congregate settings (e.g. prisons, internally displaced persons and refugee camps, schools, etc.), and cross border transit areas;
International traffic
• Establish or strengthen cross-border collaboration arrangements for surveillance and management of suspect cases of mpox, the provision of information to travellers and conveyance operators, without resorting to general travel and trade restrictions unnecessarily impacting local, regional or national economies;
Vaccination
• Prepare for the introduction of mpox vaccine for emergency response through convening of national immunization technical advisory groups, briefing of national regulatory authorities, preparing national policy mechanisms to apply for vaccines through available mechanisms;
• Initiate plans to advance mpox vaccination activities in the context of outbreak response in areas with incident cases (i.e. with disease onset in the previous 2-4 weeks), targeting people at high risk of infection (e.g., contacts of cases, including sexual contacts, children, and health and health care workers). This entails the agile adaptation of immunization strategies and plans to concerned areas; the availability of vaccines and supplies; the proactive community engagement, to generate and sustain demand for and trust in vaccination; and the collection of data during vaccination according to implementable research protocols;

Risk communication and community engagement

• Strengthen risk communication and community engagement systems with affected communities and local workforces for outbreak prevention, response and vaccination strategies, including through training, mapping high risk and vulnerable populations, social listening and community feedback, managing misinformation. This entails, inter alia, communicating effectively the uncertainties regarding the natural history of mpox, updated information about mpox including information from ongoing clinical trials, about the efficacy of vaccines against mpox, and the uncertainties regarding duration of protection following vaccination;
• Address stigma and discrimination of any kind via meaningful community engagement, particularly in health services and during risk communication activities;
Governance and financing
• Galvanize and scale up national funding and explore external opportunities for targeted funding of prevention, readiness and response activities;
• Integrate mpox prevention and response measures in existing programmes aimed at prevention, control and treatment of other endemic diseases – especially HIV, as well as STIs, malaria, tuberculosis, and COVID-19, as well as non-communicable diseases –, striving, to the extent possible, not to negatively impact their delivery;
Addressing research gaps
• Invest in addressing knowledge gaps and in generating evidence, during and after outbreaks, regarding the dynamics of transmission of mpox, risk factors, the social and behavioural drivers of transmission, the natural history of disease, through trials for novel therapeutics and vaccines against mpox, the effectiveness of public health interventions, with a One Health approach;

Reporting on the implementation of temporary recommendations

• Report quarterly to WHO on the status of, and challenges related to the implementation of these temporary recommendations, using a standardized tool and channels that will be made available WHO.
• Standing recommendations for mpox issued by the Director-General of the World Health Organization (WHO) in accordance with the International Health Regulations (2005) (IHR)

Develop and implement national mpox plans

Incorporate lessons learned from evaluation of the response (such as through intra- or after-action reviews) into related plans and policies in order to sustain, adapt, and promote key elements of the response and inform public health policies and programmes.

1. Aim to eliminate human-to-human transmission of mpox by anticipating, detecting, preparing for and responding to mpox outbreaks and taking action to reduce zoonotic transmission, as appropriate.
2. Build and retain capacity in resource-limited settings, and among marginalized groups, where mpox transmission continues to occur, to improve understanding of modes of transmission, quantify resource needs, and detect and respond to outbreaks and community transmission.
   Critical basis for actions
3. Include mpox as a notifiable disease in the national epidemiological surveillance system.
4. Strengthen diagnostic capacity at all levels of the health care system for laboratory and point of care diagnostic confirmation of cases.
5. Ensure timely reporting of cases to WHO, as per WHO guidance and Case Reporting Form, in particular reporting of confirmed cases with a relevant recent history of international travel.
6. Collaborate with other countries so that genomic sequencing is available in, or accessible to, all countries. Share genetic sequence data and metadata through public databases.
7. Notify WHO about significant mpox-related events through IHR channels.
   Enhance community
   protection
8. Communicate risk, build awareness, and engage with affected communities and at-risk groups through health authorities and civil society.
9. Implement interventions to prevent stigma and discrimination against any individuals or groups that may be affected by mpox.
   Collaborate on research
   to generate evidence
   for mpox prevention
10. Contribute to addressing the global research agenda to generate and promptly disseminate evidence for key scientific, social, clinical, and public health aspects of mpox transmission, prevention and control.
11. Conduct clinical trials of medical countermeasures, including diagnostics, vaccines and therapeutics, in different populations, in addition to monitoring of their safety, effectiveness and duration of protection.
12. States Parties in West, Central and East Africa should make additional efforts to elucidate mpox-related risk, vulnerability and impact, including consideration of zoonotic, sexual, and other modes of transmission in different demographic groups.
    International travel
13. Encourage authorities, health care providers and community groups to provide travelers with relevant information to protect themselves and others before, during and after travel to events or gatherings where mpox may present a risk.
14. Advise individuals suspected or known to have mpox, or who may be a contact of a case, to adhere to measures to avoid exposing others, including in relation to international travel.
15. Refrain from implementing travel-related health measures specific for mpox, such as entry or exit screening, or requirements for testing or vaccination.
    Delivery of optimally
    integrated clinical care
    for mpox
16. Ensure provision of optimal clinical care with infection prevention and control measures in place for suspected and confirmed mpox in all clinical settings. Ensure training of health care providers accordingly and provide personal protective equipment.
17. Integrate mpox detection, prevention, care and research within HIV and sexually transmitted disease prevention and control programmes, and other health services as appropriate.
18. Strengthen provision of and access to diagnostics, genomic sequencing, vaccines, and therapeutics for the most affected communities, including in resource-constrained settings where mpox occurs regularly, and including for men who have sex with men and groups at risk of heterosexual transmission, with special attention to those most marginalized within those groups.
19. Make mpox vaccines available for primary prevention (pre-exposure) and post-exposure vaccination for persons and communities at risk of mpox, taking into account recommendations of the WHO Strategic Advisory Group of Experts on Immunization (SAGE).