Sounding the alarm: Defining thresholds to trigger a public health response to monkeypox.
Endemic to the Democratic Republic of the Congo (DRC), monkeypox is a zoonotic disease that causes smallpox-like illness in humans. Observed fluctuations in reported cases over time raises questions about when it is appropriate to mount a public health response, and what specific actions should be t...
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ftdoajarticles:oai:doaj.org/article:450214d16eeb4650a8f04ed27773043c 2023-05-15T15:13:28+02:00 Sounding the alarm: Defining thresholds to trigger a public health response to monkeypox. Sarah Anne J Guagliardo Mary G Reynolds Joelle Kabamba Beata Nguete Robert Shongo Lushima Okito E Wemakoy Andrea M McCollum 2018-12-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0007034 https://doaj.org/article/450214d16eeb4650a8f04ed27773043c EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC6319745?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007034 https://doaj.org/article/450214d16eeb4650a8f04ed27773043c PLoS Neglected Tropical Diseases, Vol 12, Iss 12, p e0007034 (2018) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2018 ftdoajarticles https://doi.org/10.1371/journal.pntd.0007034 2022-12-31T00:22:00Z Endemic to the Democratic Republic of the Congo (DRC), monkeypox is a zoonotic disease that causes smallpox-like illness in humans. Observed fluctuations in reported cases over time raises questions about when it is appropriate to mount a public health response, and what specific actions should be taken. We evaluated three different thresholds to differentiate between baseline and heightened disease incidence, and propose a novel, tiered algorithm for public health action. Monkeypox surveillance data from Tshuapa Province, 2011-2013, were used to calculate three different statistical thresholds: Cullen, c-sum, and a World Health Organization (WHO) method based on monthly incidence. When the observed cases exceeded the threshold for a given month, that month was considered to be 'aberrant'. For each approach, the number of aberrant months detected was summed by year-each method produced vastly different results. The Cullen approach generated a number of aberrant signals over the period of consideration (9/36 months). The c-sum method was the most sensitive (30/36 months), followed by the WHO method (12/24 months). We conclude that triggering public health action based on signals detected by a single method may be inefficient and overly simplistic for monkeypox. We propose instead a response algorithm that integrates an objective threshold (WHO method) with contextual information about epidemiological and spatiotemporal links between suspected cases to determine whether a response should be operating under i) routine surveillance ii) alert status, or iii) outbreak status. This framework could be modified and adopted by national and zone level health workers in monkeypox-endemic countries. Lastly, we discuss considerations for selecting thresholds for monkeypox outbreaks across gradients of endemicity and public health resources. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 12 12 e0007034 |
institution |
Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Sarah Anne J Guagliardo Mary G Reynolds Joelle Kabamba Beata Nguete Robert Shongo Lushima Okito E Wemakoy Andrea M McCollum Sounding the alarm: Defining thresholds to trigger a public health response to monkeypox. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Endemic to the Democratic Republic of the Congo (DRC), monkeypox is a zoonotic disease that causes smallpox-like illness in humans. Observed fluctuations in reported cases over time raises questions about when it is appropriate to mount a public health response, and what specific actions should be taken. We evaluated three different thresholds to differentiate between baseline and heightened disease incidence, and propose a novel, tiered algorithm for public health action. Monkeypox surveillance data from Tshuapa Province, 2011-2013, were used to calculate three different statistical thresholds: Cullen, c-sum, and a World Health Organization (WHO) method based on monthly incidence. When the observed cases exceeded the threshold for a given month, that month was considered to be 'aberrant'. For each approach, the number of aberrant months detected was summed by year-each method produced vastly different results. The Cullen approach generated a number of aberrant signals over the period of consideration (9/36 months). The c-sum method was the most sensitive (30/36 months), followed by the WHO method (12/24 months). We conclude that triggering public health action based on signals detected by a single method may be inefficient and overly simplistic for monkeypox. We propose instead a response algorithm that integrates an objective threshold (WHO method) with contextual information about epidemiological and spatiotemporal links between suspected cases to determine whether a response should be operating under i) routine surveillance ii) alert status, or iii) outbreak status. This framework could be modified and adopted by national and zone level health workers in monkeypox-endemic countries. Lastly, we discuss considerations for selecting thresholds for monkeypox outbreaks across gradients of endemicity and public health resources. |
format |
Article in Journal/Newspaper |
author |
Sarah Anne J Guagliardo Mary G Reynolds Joelle Kabamba Beata Nguete Robert Shongo Lushima Okito E Wemakoy Andrea M McCollum |
author_facet |
Sarah Anne J Guagliardo Mary G Reynolds Joelle Kabamba Beata Nguete Robert Shongo Lushima Okito E Wemakoy Andrea M McCollum |
author_sort |
Sarah Anne J Guagliardo |
title |
Sounding the alarm: Defining thresholds to trigger a public health response to monkeypox. |
title_short |
Sounding the alarm: Defining thresholds to trigger a public health response to monkeypox. |
title_full |
Sounding the alarm: Defining thresholds to trigger a public health response to monkeypox. |
title_fullStr |
Sounding the alarm: Defining thresholds to trigger a public health response to monkeypox. |
title_full_unstemmed |
Sounding the alarm: Defining thresholds to trigger a public health response to monkeypox. |
title_sort |
sounding the alarm: defining thresholds to trigger a public health response to monkeypox. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2018 |
url |
https://doi.org/10.1371/journal.pntd.0007034 https://doaj.org/article/450214d16eeb4650a8f04ed27773043c |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 12, Iss 12, p e0007034 (2018) |
op_relation |
http://europepmc.org/articles/PMC6319745?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007034 https://doaj.org/article/450214d16eeb4650a8f04ed27773043c |
op_doi |
https://doi.org/10.1371/journal.pntd.0007034 |
container_title |
PLOS Neglected Tropical Diseases |
container_volume |
12 |
container_issue |
12 |
container_start_page |
e0007034 |
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1766344023165894656 |