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Think about monkeypox…
- How can surveillance help to detect and control the disease?
- Should we conduct active or passive surveillance or both for the disease, why?
- Which method should be best to identify cases, why?
- Cases in medical facilities VS community
- Sentinel VS population-based surveillance
- Case-based VS aggregated surveillance
- Syndromic VS laboratory-confirmed surveillance
- What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
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1. How can surveillance help to detect and control the disease?
— After surveillance program is implemented. The index cases and high-risk cases will be identified. They will be isolated or given some treatment in the hospital. After the virus is clear, they will be back to the community.2. Should we conduct active or passive surveillance or both for the disease, why?
— We should conduct both active and passive surveillance. Passive surveillance will occur at a hospital where the index case seeds for medical service. The hospital has to send report to ministry of public health. After that, active surveillance will be launched to get some more details regarding Monkeypox infection, for example, people who have contact with the index case, places where the index case has visited.3. Which method should be best to identify cases, why?
3.1 Cases in medical facilities VS community
— Typically, the symptoms of Monkeypox can range from mild symptoms, that does not need medical treatment and is self-limited, and severe symptoms that need ICU admission. To make a surveillance, I would like to do both in medical facilities and community. We can identify the index case at the hospital and look for more details in high-risk cases in the community.
3.2 Sentinel VS population based surveillance
— Since the incidence of Monkeypox in Thailand is quite low. Sentinel-based surveillance is suitable. To make the population-based surveillance, we need a lot of money.
3.3 Case-based VS aggregated surveillance
— We need case-based surveillance because the details about what, when, where do the index case present in community are essential information.
3.4 Syndromic VS laboratory-confirmed surveillance
— I will do both of them. Syndromic surveillance is conducted in screening phase. After that, the laboratory investigation is needed to confirm diagnosis.4. What dissemination tools will you choose to disseminate Monkeypox surveillance information?
— Ongoing, real-time dissemination tools is a proper one.5. Why do you choose this/these tools?
— We need promptly response to an outbreak. Moreover, the information system developed to conduct the surveillance can integrate data input system from the peripheral hospitals. The information can be analyzed and promptly eradicate the Monkeypox.-
Thanks for sharing your thoughts and giving us a jump-start on this discussion forum!
You are going in the right direction of integrating not only the natural history of the disease but also the current disease situation in Thailand to come up with the system! In addition, I would say that you can elaborate a bit more on the dissemination tools. With the rise of information technology, there are various channels that you could keep sending the real-time updates on monkeypox. One aspect of this issue is that different tools could help direct your message to audiences with varying interest in the situation or risk of contracting the disease.
Keep up the good work!!
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1. How can surveillance help to detect and control the disease?
When there is an alert for a signal about suspected patient, surveillance system is useful to detect Monkeypox by confirming the case, identifying clusters that draw the pattern of spread, and investigating the source of infection in the patient’s community and contacts. Once the surveillance system can be able to detect Monkeypox, it will help to provide optimal care to the patients and respond to the high-risk group to prevent further transmission.2. Should we conduct active or passive surveillance or both for the disease, why?
Both active and passive approaches are important for detecting early signals of Monkeypox. These can provide information for assessing public health status indicating whether there are any potential disease threats or not.3. Which method should be best to identify cases, why?
a. Cases in medical facilities VS community
– For identifying cases, the medical facility is more appropriate where clinicians can fully recognize every suspected case definition, probable case definition, and confirmed case definition.b. Sentinel VS population-based surveillance
– I prefer to choose sentinel surveillance with a particular interest in areas where there are international points of entry. Although the coverage and ongoing activities become the strong attributes of population-based system, sentinel surveillance offers available laboratory tests so the outbreak can definitely be detected.c. Case-based VS aggregated surveillance
– As Monkeypox is an emerging disease, the health system should maintain case-based surveillance. This approach enables quick response to breaking disease chain transmission in a timely manner.d. Syndromic VS laboratory-confirmed surveillance
– Both are important and can support each other, but if I were asked to choose one, I will prioritize laboratory-confirmed surveillance to detect new emerging pathogens. Once the case is confirmed under laboratory definitive evidence, it is considered an outbreak, and public health interventions are needed to be executed.4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
Of course, ongoing tool. This is the most possible option because real-time published data will accelerate public health intervention. While we expose the recent situations of the disease to expose public view, we can also perform risk communication to call to action from the public. Indonesia is one of the countries with the largest number of online social media users, and the use of social media platforms will quickly be disseminating the surveillance result. -
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How can surveillance help to detect and control the disease?
Surveillance systems are helpful in detecting Monkeypox after an alert for a case about a suspected patient has been received by verifying the case, detecting groups which show the trend of transmission, and tracing the infection back to its source among the patient’s neighbourhood and connections. When monkeypox is identifiable by the surveillance system, better care may be given to patients, and the high-risk population can be targeted to reduce the spread of the disease.Should we conduct active or passive surveillance or both for the disease, why?
The early detection of Monkeypox requires a combination of active and passive methods. These can help determine if a public health hazard exists by revealing the presence or absence of certain diseases.Which method should be best to identify cases, why?
1.Cases in medical facilities VS community
Depending on the individual, signs of monkeypox can vary from being mild enough to resolve on their own without medical intervention to being life-threatening. We have to conduct the surveillance both in hospitals and in the general public.2.Sentinel VS population-based surveillance
Given that the prevalence of monkeypox is negligible in Myanmar. Sentinel surveillance is a viable option. We require a significant budget in order to implement the population-based surveillance.3.Case-based VS aggregated surveillance
As an emerging illness, monkeypox necessitates ongoing case-based surveillance by the medical community. With this method, we can intervene rapidly to stop the spread of a disease.4.Syndromic VS laboratory-confirmed surveillance
Both are necessary and can complement one another, but if I had to pick only one, it would be laboratory-confirmed surveillance. Once the a case is lab confirmed, we need to report it to WHO and conduct necessary public health measure to prevent an outbreak.What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
I will use Ongoing, Real-Time Dissemination Tools, because WHO regard this disease as a global health emergency and public involvement is needed. With tools like Program for Monitoring Emerging Diseases
(ProMED) we can consolidates and verifies reports from media, observers, and news and disseminates via email and website. It can be helpful to tackle monkeypox and prevent it from becoming an another pandemic. -
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1. Monkey pox is the infectious disease which could transfer between human-to-human by respiratory droplets and close contact. Infected people might not realize themselves because a few days after infection, the symptoms could be common like fever, headaches and so on which are hard to differentiate from others health condition. After fever for 1-3 days, skin eruption usually happened which is the disease transmission state. The severity of symptoms are varied. If there is no early detection, quarantine systems and education, disease could be easily spread around, followed by harm and panic to people. Moreover, international traveling will accelerate the disease spreading across the world. Real time data collection will help to investigate high infection rate areas and control the spreading on time.
Data aggregation and management could be used to predict the trend, prepare medical staff and treatment, and further analysis for treatment and control. Moreover, quality data dissemination will help educate people to understand the disease and self protection.2. I would conduct both active and passive surveillance. Waiting for people to visit hospital for passive surveillance might not be able to control the spreading on time. I would suggest to conduct active surveillance to notify the possible infected areas, then followed by active surveillance in the community among close contact people to find and control outbreaks.
3.1 Community identification is my recommendation for identifying the case because the symptoms at the initial period of infection are mild. Apart from that, people might feel shy to go to the hospital because the media had put spotlight on the homosexual transmission. To eradicate the disease, investigating as many cases as possible in the community might be beneficial.
3.2 Because of the small number of infected cases in Thailand, setting population-based surveillance might be costly. I would choose to do sentinel surveillance at the start. The surveillance site could be at the high density of population area or city with the international airport. Data quality from sentinel surveillance is higher than population-based so it suits for new outbreak disease which needs further detailed analysis.
3.3 Aggregated surveillance lacks individual case details, whereas Monkey pox needs some specific patient data to be able to investigate and control cases. Case-based surveillance could be used to get more individual data and since there haven’t been massive explosions of cases, it might be possible to investigate into the details of every case.
3.4 Syndromic surveillance should be conducted for the rapid identification to control the spreading. For example, At the airport or contacted people in community. However, syndromic surveillance could only identify suspected cases. I think Laboratory-confirmed surveillance should be performed after syndromic cases are identified to confirm the infection and precise report number.
4. I would recommend to use Web applications to report the information. Users such as the general public, media reporters and healthcare workers will be able to get data via web browser which is compatible with pc and mobile. Moreover, information could be daily updated and visualized for better understanding such as outbreak mapping. Filtered data function can be applied for people with different background knowledge. Therefore, creating single Web-applications could be adjusted and approached by many different information demands.
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1. How can surveillance help to detect and control the disease?
•Surveillance helps to explain the current epidemiology of disease, changing trends and identifying new outbreaks. All of these are important information for planning to detect and prevent disease outbreaks.2. Should we conduct active or passive surveillance or both for the disease, why?
•We should conduct both methods. We conduct active surveillance on people who come from high-risk countries and surveillance in areas where the index case has been found in order to limit the spread of monkeypox and urgently treat infected people.3. Which method should be best to identify cases, why?
3.1 Cases in medical facilities VS community
•In not infected area, surveillance should be initiated from detecting cases in medical facilities first as it saves more resources, but after identifying an index case, we must go to the area to investigate people with mild symptoms or high-risk groups to prevent the spread in the community.3.2 Sentinel VS population-based surveillance
•To answer this question. I think, we should weigh between the severity and contagiousness of monkeypox versus cost to surveillance. From my point of view, I think doing just sentinel surveillance is enough for this disease.3.3 Case-based VS aggregated surveillance
•Emerging diseases should use the case-based method in order to collect detailed information and clearly identify the epidemic area.3.4 Syndromic VS laboratory-confirmed surveillance
•Monkeypox disease has flu-like symptoms. This makes syndromic surveillance less sensitivity. If using this method, it would waste a lot of resources. So, I think I’ll go with the laboratory-confirmed surveillance as my primary method until the situation changes.4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
•Ongoing, Real-Time Dissemination Tools are my selected method because, if the infrastructure is ready, adding a disease to surveillance is less time consuming and inexpensive. This will result in excellent tracking of the new emerging disease. -
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1) How can surveillance help to detect and control the disease?
Answer: Surveillance is an ongoing process for data collection, analysis, and interpretation. It helps in detecting, responding, and preventing the disease outbreaks in timely manner. In addition, surveillance helps in monitoring disease burden, providing and interpreting data for disease control and management.2) Should we conduct active or passive surveillance or both for the disease, why?
Answer: I think we should conduct both active and passive surveillances for monkeypox. Since monkeypox had been announced as an outbreak and emerging disease in early May 2022. Monkeypox is classified as notifiable disease surveillance, which is an active surveillance.
As part of passive surveillance, medical professionals, who detected monkeypox confirmed cases, should report to public health agency to conduct disease and data management. Then we can perform active surveillance to identify cases, follow-up, and trace the probable cases. In addition, we can restrict and captured active cases finding within the area of confirmed case population, to find symptomatic patients as well as contact tracing to find those at risk for developing the disease.3) Which method should be best to identify cases, why?
(a) Cases in medical facilities VS community
Answer: For monkeypox, it fears the population particularly MSM. Patients will go and seek healthcare providers for confirmation and treatment. Therefore, hospital surveillance would be sufficient. Even though symptoms for monkeypox seems to be mild but its predominant symptoms (clinical illnesses) are quite unique and classic. Ministry of Public Health arose monkeypox to their population particularly MSM, and hospital professionals.(b) Sentinel VS population-based surveillance
Answer: To reduce incident and spreading of the disease. I will choose a sentinel-based surveillance and further define population group/area because monkeypox reported to be found among adults, vast majority identify as MSM.(c) Case-based VS aggregated surveillance
Answer: By collecting information at individual level (case-based) especially detail on person, place, and time. In Thailand, they’re a few confirmed monkeypox cases, it is easier to conduct an investigation on every single case. In addition, monkeypox is needed to ensure every case is reported and investigated, and less likely to miss cases. By knowing contacts of probable, healthcare providers could ask for self monitored for any sign or symptom. But case-based surveillance could be transited to aggregate surveillance once the number of cases becomes large.(d) Syndromic VS laboratory-confirmed surveillance
Answer: Because we need to stop spreading of monkeypox, syndromic surveillance helps in early detection of an outbreak. We can monitor cases that meet a clinical case definition then we can rapid identification of a cluster of cases. After that we can further investigate by laboratory testing in order to confirm diagnosis and etiology of disease.4) What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
Answer: I will choose an ongoing, real-time dissemination tools because this will show real-time data which monkeypox cases information needed to be updated in real-time to reduce exposure of confirmed cases and spreading of the disease. -
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1.How can surveillance help to detect and control the disease?
With a disease surveillance which including systematic data collection, data analysis, data sharing and action taken of ongoing event or disease, in case of Monkeypox, it can help us describe the current burden and epidemiology of the disease, monitor trends (number, etiology of cases) and the control of disease, also formulate the national policy. Early detection of suspected and probable cases needed further intervention either to confirm or to discard and proper treatment including isolation will eventually prevent the outbreak in clean area and timely control the disease globally.
2.Should we conduct active or passive surveillance or both for the disease, why?
In my opinion, for Monkeypox, we have to use combine approach. There are at least three groups involved; those who have symptoms of rash or fever with other symptoms as suspected cases, and some come out with positive laboratory as confirmed case, these two groups are collected from hospital-based (passive). Another group is as probable case, who had contacted the suspected and confirm case, which might be initially asymptomatic but might need further investigation, so we should set up an active approach for collect more data.
3.Which method should be best to identify cases, why?
1)Cases in medical facilities VS community
My answer is both. We can identify suspected and confirmed cases in medical facilities and contact tracing for those who contact the confirmed case via community-based method.
2)Sentinel VS population-based surveillance
Sentinel surveillance is appropriate. For Monkeypox, we collect data on cases enrolled with the case definition under global network surveillance so we could get high quality of data.
3)Case-based VS aggregated surveillance
For Monkeypox surveillance, which still small number of cases, it has a case investigation form and collect data from individual case or their contact members, their medical records including laboratory. So it is case-based surveillance. However it might transition to aggregated system if number of cases become larger.
4)Syndromic VS laboratory-confirmed surveillance
Both syndromic and laboratory-confirmed surveillance. For Monkeypox, one confirmed case is an outbreak (by WHO), so it will need both sensitivity and specificity for case definition. Syndromic surveillance allows rapid identification of cluster of case that need further investigation and monitor. However, symptoms especially rash can be mimic with those who has Herpes Simplex infection, serology testing like real-time PCR or Rapid test kits for Monkeypox will provide more specific data on the circulation strains.
4.What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
Of course, Ongoing, Real-time Dissemination tools, like Health Alert Network (HAN) at CDC that provide information for medical and public health professionals. Also, there is data dashboard online that provide number of cases, global map for public actually. (https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html) -
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1. How can surveillance help to detect and control the disease?
Surveilling is a process of continuously making an observe on a particular matter. A disease surveillance is to observe an occurrence trends, and behaviour of the disease itself, in this case, a monkeypox. It is generally accepted that the faster we know about the disease, the better chance we could timely plan, intervene and contain them.
2. Should we conduct active or passive surveillance or both for the disease, why?
In my opinion, both passive and active surveillance should be conducted as monkeypox is an emerging disease and can spread through intimate contact. The signs and symptoms for this disease can be visible after a few days after contact. A passive surveillance would help detecting a new case in health care institutions and then an active surveillance can be implemented within that area to identify significant contact cases.
3. Which method should be best to identify cases, why?
1. Cases in medical facilities VS community : For monkeypox, eradication of the disease is possible provided that we capture all cases. The symptom is mild yet very contagious, so I think community-based surveillance is suitable to find every single case in a population since the signs and symptoms are very obvious.
2. Sentinel VS population-based surveillance : In my opinion, sentinel surveillance is a way to go here, since the severity of the disease is not high (in other words, low mortality). If people who are at risk or having obvious symptoms, they will likely seek medical attention as outpatients. We can then report back to the disease control sector. It is less costly compared to population-based surveillance.
3. Case-based VS aggregated surveillance : I personally think case-based surveillance is more suitable. As the disease can be transmitted through contact and take at least a few days before the symptoms occur. The total cases are still small and detailed information about their locations and contact are all important in a monkeypox control.
4. Syndromic VS laboratory-confirmed surveillance : In this case, monkeypox symptoms are quite more of a flu-like symptoms. There may be some specific features such as rash over the body. We can screen for potential contact from patients with a non-specific symptoms as it is faster and less costly. So, I will choose a syndromic surveillance.
4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?I will likely choose an ongoing, real-time dissemination tools as this disease can be rapidly spread. We are in a data-driven era, and possessing advanced informational technology. This can be done quite easily.
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1. How can surveillance help to detect and control the disease?
In Thailand, monkeypox is not widely spread. Therefore, it is crucial to early detect and limit the spreading of monkeypox in Thailand. The surveillance could help in disease monitoring, and case tracking. Once the data was obtained from the surveillance process, it could be disseminated to all stakeholders to respond to the change of situation.
If there is no surveillance of monkeypox. The case reporting might not be in a timely manner. The infection might get easily out of control.2. Should we conduct active or passive surveillance or both for the disease, why?
The monkeypox infection in Thailand is mostly due to person-person contact from arriving foreigners. Since these foreign groups are in all areas of Thailand. Passive surveillance is used because the scale of surveillance is national wide. It would be time and resource-consuming to conduct active surveillance.3. Which method should be best to identify cases, why?
1. Cases in medical facilities VS community
The cases from the community are used to ensure that we could track all possible cases since it is crucial to track case and their travel route.2. Sentinel VS population-based surveillance
The population-based surveillance is used as the reason mentioned in question 2).3. Case-based VS aggregated surveillance
The Case-based surveillance is used to ensure that all details from each case were gathered. After gathering information, the exposed person must be sent for a test to prevent further spreading.4. Syndromic VS laboratory-confirmed surveillance
I personally preferred syndromic surveillance to facilitate early detection and ensure that we could intervene the outbreak as soon as possible. The sign and symptoms of monkey is quite distinct compared to other local diseases. Combining signs and symptoms with the travel/exposure history. I’m pretty sure the specificity would be quite high.4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
Since this disease impacted all Thai people. I think it’s essential to disseminate the information to all levels of stakeholders.Thai people: The official announcement social network of case reporting would be used to raise disease awareness. Once people are aware of the risk, they would implement the measure to prevent themselves more. This would indirectly benefit to disease control.
Thai Healthcare professionals: The case alert should be sent to each hospital, especially hospitals near the case area. The email/messaging using SMS to responsible staff might be used
Thai MOPH: The official report would be provided on daily basis to ensure that Thailand healthcare authority is aware of the situation. Therefore, they could change their plan properly.
International party: The ProMed is used for disseminating the data to the international parties since this platform is popular and open access for all. -
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1. How can surveillance help to detect and control the disease? According to the key facts from WHO, Monkeypox is caused by monkeypox virus, and is usually a self-limited disease with symptoms lasting from 2 to 4 weeks. Severe cases can occur. In recent times, the case fatality ratio has been around 3–6%. Monkeypox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus via lesions, body fluids, respiratory droplets, and contaminated materials such as bedding. Therefore, health surveillance system is very crucial to detect, monitor, and control disease urgently. The surveillance data will help to see the burden and distribution of disease from data collection and analysis. Finally, the action is taken to prevent the disease outbreak.
2. Should we conduct active or passive surveillance or both for the disease, why? In this situation, we should conduct both passive and active surveillance. As there are many symptoms, such as skin eruptions with fever happen within 1-3 days, the infected person will go to the hospital, and the passive surveillance should be conducted. Once we received the case and since the disease could spread rapidly, we need to detect the disease early and collect the cases with active surveillance.
3. Which method should be best to identify cases, why?
3.1. Cases in medical facilities VS community – Community: Since the disease begins with common symptoms like fever, headache, back pain, etc., such that the infected person may not visit medical facilities. Community would be a better option to identify the cases in other areas not only the medical facilities.
3.2. Sentinel VS population-based surveillance – I would start to identify with population-based to see an overview of the geographical data for the whole country. It is appropriate to see the generalized data and the rate of disease. Later on, we may switch to sentinel-based once the pattern and trend are stable, to reduce the cost and get a higher quality of data.
3.3. Case-based VS aggregated surveillance – I would begin with aggregated surveillance to identify the epidemiology of the disease and later toward case-based surveillance to understand cases in more detail.
3.4. Syndromic VS laboratory-confirmed surveillance – In my opinion, the syndromic surveillance could be used in this situation, since the monkeypox could be identified and monitored rapidly. The symptom of particular rash and lymphadenopathy during the prodromal stage of illness could be distinguished from chickenpox or smallpox, while the accurate laboratory test is PCR, which takes time and the quality/type of specimen is important.4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
I would choose an ongoing, real-time dissemination tool because the information could disseminate rapidly with current technology such as the internet and social media. This allows the audience to see real-time outbreaks and raise awareness among the population.
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