1. How can surveillance help to detect and control the disease?
Through the systematic collection, analysis, and dissemination of health data, the surveillance will help to identify disease outbreaks with early detection, monitor the spreading and trend of the disease, and enable rapid response. Surveillance data can be used to assess the potential risks and current burden associated with a disease outbreak, which can educate the public about disease risks and promote preventative measures.
2. Should we conduct active or passive surveillance or both for the disease, why?
I believe the integrated approach of both active and passive surveillance would be the better solution. To be more comprehensive, detecting every case with the involvement of the public health staff for specific disease control, learning the transmission pattern, and contact tracing will be needed as active surveillance. Notifiable surveillance is also required because monkeypox is also of public health importance and can be a risk to human health.
3.Which method should be best to identify cases, why?
In regards to the current Myanmar settings, my consideration for the surveillance methods to identify and control the disease will be as follows:
a. Cases in medical facilities VS community
I prefer to identify the cases in medical facilities over community-based surveillance, depending on the importance of finding a single case like monkeypox. To identify the case in hospitals, clinics, and private general practitioners, it would be more possible to identify and make the response in limited surveillance settings. This was noted as community-based surveillance is useful for surveying diseases targeted for eradication.
b. Sentinel VS population-based surveillance
I think we can consider both sentinel and population-based surveillance in this case identification. But, I would start with the small number of health facilities in the area where the case is notified through sentinel surveillance sites for gathering more data of higher quality. Population-based surveillance will be considered later in the case of the widespread spread of the disease.
c. Case-based VS aggregated surveillance
I would consider case-based surveillance because it will provide more detailed information about the case, such as who, where, and when the person was infected with the disease at an individual level. As in fewer cases like monkeypox, it might be relatively easier to investigate every single case than the endemic. But this can also transition to aggregate as the number of cases increases, like what happened during the 2009 H1N1 outbreak.
d. Syndromic VS laboratory-confirmed surveillance
I am of the opinion that syndromic surveillance would be more appropriate in this case because it allows for rapid identification of a cluster of cases that might warrant further investigation. However, laboratory testing can be performed on some of the cases identified by syndromic surveillance to determine the etiology through lab-confirmed surveillance.
As my friend mentioned, I completely agree that the selection of surveillance methods should be in line with the surveillance objectives, the resource availability, the infrastructure, and the local contexts.
4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
In the current settings, I will mainly choose social media platforms (e.g., Twitter, Facebook, Instagram) to quickly reach a wide audience, not only for disease identification but also for raising awareness to get the correct information about monkeypox because of the stigma and discrimination around the disease among the public in the nation. I won’t leave behind the health organizations for the official announcement and community outreach programs to educate the local population, which is not accessible online.