Monkeypox Surveillance Tool

Greg Scott

Greg Scott

Conrad Fivaz

Conrad Fivaz

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On July 23, 2022, the World Health Organization (WHO) declared monkeypox a global health emergency. On August 4, the Biden administration declared it a national health emergency in the United States. Other countries, states, and regions followed with similar public health pronouncements. 

Monkeypox belongs to the same family of viruses that causes smallpox. Although the symptoms of monkeypox are similar to those of smallpox, it is a much milder disease and is rarely fatal. The disease is usually self-limited and lasts between two to four weeks.1 

An antiviral treatment (developed for smallpox) has also been licensed for the treatment of monkeypox, and there are currently two vaccines approved in the United States for the prevention of both smallpox and monkeypox.2,3

Given the continued existence of the coronavirus pandemic and the ongoing surveillance of COVID-19 in emergency dispatch agencies, the monkeypox outbreak presented a unique challenge to the International Academies of Emergency Dispatch® (IAED). The IAED and Priority Dispatch Corp. (PDC) have spent a considerable amount of time and resources over the past 2½ years developing and refining the Emerging Infectious Disease Surveillance (EIDS) Tool, within the ProQA® software system, to query callers for signs and symptoms of COVID-19. As a result, the existing version of the EIDS Tool became widely used worldwide. With the monkeypox outbreak, the challenge was to create a second surveillance screening protocol specific for signs and symptoms of monkeypox, while maintaining the integrity and functionality of the existing COVID-19 caller screening tool.

The solution was to develop an expanded EIDS Tool within the ProQA software that allows the emergency dispatcher to select a specific disease surveillance tool on demand—either COVID-19 or monkeypox. This new design required close coordination between several IAED standards groups, the PDC software development team, and the translation and logic groups. 

First, the clinical content of the new Monkeypox Surveillance Tool needed to be developed. The IAED’s CBRN (Chemical, Biological, Radiological, and Nuclear) Fast Track Subcommittee is responsible for creating and recommending changes for the protocols to the IAED Rules Group, in the case of new emerging diseases. The Committee membership includes clinicians and tactical experts in public health, disease surveillance technology, emergency dispatch, and emergency response. 

The Monkeypox Surveillance Tool was developed to identify patients most likely to be exposed to or infected with monkeypox so field responders can be alerted, in advance, to protect themselves and others from possible infection, as well as to assist with the subsequent face-to-face patient assessment done by field responders upon arrival at the patient’s side. The new Monkeypox Surveillance Tool directs emergency dispatchers through monkeypox patient screening information and allows for agency-specific, medical director-approved questions and instructions. The Tool attempts to identify infected patients through the presence of disease symptoms as well as potential exposure. 

According to the Centers for Disease Control and Prevention (CDC), common symptoms of monkeypox are:4 

• A new rash, including pimples, blisters, or  crusts/scabs (may be painful or itchy) on or near the genitals or anus but could also be on other areas such as the face, limbs, palms, soles, or inside the mouth

• Swollen lymph nodes
• Fever
• Chills
• Headache
• Muscle aches and backache
• Fatigue or exhaustion
• Upper respiratory symptoms (e.g., coughing, nasal congestion, or sore throat)

The disease can spread in several ways including:5
• Direct contact with monkeypox rash, scabs, or body fluids from a person with monkeypox
• Touching objects, fabrics, and surfaces that have been used by someone with monkeypox
• Contact with respiratory secretions from a person with monkeypox

Symptoms usually start within three weeks of exposure to the virus. Monkeypox can be spread from when symptoms first start until the rash has healed (all scabs have fallen off and new skin has formed).6 

Scientists are still researching if the virus can be spread when someone has no symptoms.7

Once the clinical content for this new Monkeypox Surveillance Tool was created by the CBRN group, it was submitted to and approved by the IAED Rules Committee. For production in ProQA, the final content was provided to the PDC Software Development and Quality Assurance Group, as well as the PDC Logic and Translation Division.  As notable as its new design to accommodate multiple disease surveillance choices is, also noteworthy is that the entire creation, production, and release was completed in record time—the first release was on August 10, 2022. The rapid deployment of the new Monkeypox Surveillance Tool will help emergency agencies around the globe manage and contain the growing monkeypox outbreak at both the 911 and EMS level. 

Current CDC case counts (as of Sept. 29, 2022) are reporting over 25,613 U.S. cases (and 1 death in the U.S. so far) with 67,602 cases reported worldwide.8

Again, the contributions of this specialized Tool, with its rapid development and widespread availability, 911 continues to lead as an essential first, first responder. 

1. “Monkeypox.” World Health Organization. 2022; May 19. who.int/news-room/fact-sheets/detail/monkeypox (accessed Sept. 29, 2022).
2. “Patient’s Guide to Monkeypox Treatment with TPOXX.” Centers for Disease Control and Prevention. 2022; Sept. 19. cdc.gov/poxvirus/monkeypox/if-sick/treatment.html (accessed Oct. 12, 2022).
3. “Vaccines.” Centers for Disease Control and Prevention. 2022; Aug. 30. cdc.gov/poxvirus/monkeypox/vaccines/index.html (accessed Sept. 29, 2022).
4. “Clinical Recognition.” Centers for Disease Control and Prevention. 2022; Aug. 23. cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html (accessed Oct. 12, 2022).
5. “Signs and Symptoms.” Centers for Disease Control and Prevention. 2022; Aug. 5. cdc.gov/poxvirus/monkeypox/symptoms/index.html (accessed Sept. 29, 2022).
6. “How It Spreads.” Centers for Disease Control and Prevention. 2022; July 29. cdc.gov/poxvirus/monkeypox/if-sick/transmission.html (accessed Sept. 29, 2022).
7. See note 6.
8. “2022 Outbreak Cases and Data.” Centers for Disease Control and Prevention. 2022; Sept. 29. cdc.gov/poxvirus/monkeypox/response/2022/index.html (accessed Sept. 29, 2022).