1. How can surveillance help to detect and control the disease?
Surveillance can play a role in detecting and controlling monkeypox by providing timely and accurate information about the incidence, spread, and trends of the disease. Since monkeypox is contagious, by detecting the early signs of an outbreak, we could give medical interventions such as a quarantine to prevent a massive outbreak. Surveillance would help provide the valuable data to the demographics and geographical region of the patients.
2. Should we conduct active or passive surveillance or both for the disease, why?
I think both active and passive surveillance for diseases. Active surveillance could detect more cases as we could proactively discover cases through our efforts such as calling hospitals and doing field work, and it is important for us to identify the hidden cases in the community to effectively prevent an outbreak. Active surveillance allows for better case detection, especially when passive reporting may be incomplete or delayed. However, we may not be able to consistently implement active surveillance at all times for the entire country, for as it is very resource-intensive requiring lots of human labour and capital. Therefore, we may only be able to implement active surveillance in high-risk communities.
Passive surveillance helps complement active surveillance and it relies on the voluntary reporting of cases by healthcare providers or laboratories. This is applicable to monkeypox since in some countries monkeypox is included as a notifiable disease. All healthcare providers are advised to report monkeypox cases to disease control. The data is therefore likely to be geographically broader since facilities from many places are able to report. Passive surveillance also occur at a small cost since no active efforts need to be put in. However, data from passive surveillance may be slow and the data quality may be low. Ultimately, it is best to combine both active and passive surveillance provides a comprehensive understanding of the disease, so that the two approaches could cover the disadvantages of the other.
3. Which method should be best to identify cases, why?
a. Cases in medical facilities VS community
This is difficult because I think it depends on the ultimate goal of our surveillance. If our goal is to carry out epidemiological research, to find out the prevalence, incidence, age and gender of the disease, then it would be better to collect data from medical facilities such that the only data collected are confirmed diagnosis. This would ensure that the data we get is accurate. However, if our goal is effective disease control, then timing is key. It would be best to collect data from cases in the community since we get notified of all suspected and probable cases which are yet to be fully diagnosed and confirmed. This would allow us to act quickly and do quarantine for example.
b. Sentinel VS population-based surveillance
I think it would better to do sentinel surveillance. From what I know, monkeypox tends to have a rather localized outbreak. Therefore, it would be better to do sentinel surveillance such that we could do targeted interventions in specific places. Population-based surveillance may be too expensive and unnecessary.
c. Case-based VS aggregated surveillance
While aggregated surveillance may be more simple and convenient to carry out by only collecting the total number of cases, I think case-based surveillance would be a better choice as it offers much more detailed information at an individual level. This could offer valuable data at the individual level which is crucial for investigations and disease control.
d. Syndromic VS laboratory-confirmed surveillance
I think syndromic surveillance is better since laboratory confirmed surveillance is way too slow. For a lab-confirmed diagnosis of monkeypox, swabs have to be collected for PCR in the lab. It could take days or even up to a week for labs that are slow to officially give the results, by the time the results are out, there could be a few more cases in the community already. Therefore, lab-confirmed surveillance may be too ineffective, and it would be better that we record cases as soon as there are syndromes.
4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose these tools?
I think definitely ongoing, real-time dissemination tools should be used. With many internet channels and web apps nowadays, it is not difficult nor costly to set up a system of real-time alerts such as ProMED for quick warnings of outbreaks. With contagious diseases such as Monkeypox, it is important to warn the healthcare facilities in the community to remain vigilant for any outbreak in the disease. Any new information should be instantly made available to hospital and citizens in the region for better public health awareness. Periodic dissemination would be ineffective in this case for disease control, since any information published would not be up-to-date. This is not not beneficial to preventing a monkeypox outbreak in the community.