These proposed Temporary Recommendations continue to support the goal of the Strategic Preparedness, Readiness and Response Plan for Monkeypox 2022–2023 with the aim of stopping the ongoing mpox outbreak and its objectives to interrupt human-to-human transmission, protect the vulnerable, and minimize zoonotic transmission of the virus.
Significant progress has been achieved in ending the ongoing multi-country mpox outbreak with a decline in cases globally. While the previously issued Temporary Recommendations continue to hold, recommendations for areas that continue to represent challenges and emerging areas of work due to lessons learned are emphasized in this document.
These Temporary Recommendations apply to States Parties according to their epidemiological situation, patterns of transmission, and capacities with respect to mpox; they refer to the reality that any State Party may experience importation or local transmission of mpox and some States Parties may also be experiencing zoonotic transmission.
Thus, each State Party should develop a strategy to maintain surveillance and response capacity in the medium to long term while States Parties in a position to support scaling up access to medical countermeasures, including through technology transfer, should continue efforts. With cases in some countries increasingly occurring within communities/individuals experiencing racism and other stigma and discrimination, strategies to reach these groups through risk communication, prevention and treatment are critical. In implementing these Temporary recommendations, States Parties should ensure full respect for the dignity, human rights and fundamental freedoms of persons, in line with the principles set out in Article 3 of the IHR.
The WHO advises States Parties to prepare short and medium to long-term plans for the control of mpox, and to maintain vigilance and response capacity as well as engagement with local communities and key stakeholders, following the WHO relevant guidelines.
States Parties should strengthen action in the following key areas:
- Develop and implement operational plans, including monitoring and evaluation, to set clear targets for stopping human-to-human transmission of mpox in countries currently affected by the outbreak, or mpox control in countries with known animal-to-human transmission. In that regard, State Parties should also consider developing surveillance and control plans that apply to situations where intimate sexual contact is not necessarily the predominant mode of transmission.
- Maintain laboratory-based epidemiological surveillance, including reporting of the minimum dataset of variables defined in the WHO Case Reporting Form. States Parties should continue to share confirmed and probable mpox case reports with WHO through IHR communications in a timely manner. Countries should work towards the elimination of mpox (i.e. interrupting local or community transmission, and taking measures to promptly detect and contain imported outbreaks) where feasible and maintain high-quality indicator-based and event-based surveillance to underpin all such efforts.
- Integrate mpox surveillance, detection, prevention, care and research into innovative HIV and STI prevention and control programmes and services, in order to understand risks of resurgence, detect outbreaks early, reduce barriers to health services, communicate risk, strengthen detection of undiagnosed HIV infection and early and continued antiretroviral treatment, advance clinical care for HIV-mpox co-infection, and address fear, stigma and discrimination in at-risk populations.
- Continue to enhance access to diagnostics, vaccines and therapeutics, including through allocation mechanisms and technology transfer, and subsidy of regional manufacturing to advance global health equity in areas where people may experience barriers to care, including minorities and those in the global south.
- Strengthen and support capacity in resource-limited settings where mpox continues to occur, including for but not limited to One Health and animal health, to better understand and characterize all modes of transmission and respond to outbreaks wherever they occur.
- Implement a strategic and coordinated research agenda to ensure ongoing evidence generation including but not limited to a better understanding of mpox clinical virology, modes of transmission, social determinants for affected groups and clinical disease, particularly in immune-suppressed individuals, and development of countermeasures, including effective behaviour change, rapid diagnostics and next-generation therapeutics and vaccines.
The recommendations below extend or modify those issued on 1 November 2022. In line with the WHO announcement on 28 November 2022, the term monkeypox in reference to the disease has been replaced with mpox throughout this document. WHO documents referenced are current as of 7th February 2023.