In a recent study posted to the medRxiv* preprint server, researchers illustrated a rapid response strategy for managing monkeypox (MPX) outbreaks.
As the MPX outbreak beyond the endemic regions persists, healthcare institutions and public health professionals face the dilemma of quickly identifying and managing persons potentially exposed to MPX. The United Kingdom (UK), the World Health Organization (WHO), and the Centers for Disease Control and Prevention (CDC) have all produced different definitions of MPX exposure.
Yet, the issues of timely reporting of potential exposure, risk evaluation for risk classification, and symptom surveillance within the exposure window are significant. Furthermore, risk classification is crucial because people at greater risk might be offered post-exposure prophylaxis (PEP) in the form of a vaccine. Nevertheless, the best time to provide the vaccine is within four days of MPX exposure. Additionally, public health authorities suggest monitoring healthcare personnel (HCP) for symptoms upon defined MPX exposures.
About the study
In the current study, the investigators described the speedy design and implementation of mobile responsive survey systems for reporting potential MPX exposure, risk evaluation and categorization of exposure, and symptom tracking among HCPs.
The research was conducted in an academic health institution in Boston, Massachusetts, following the admission of the initial diagnosed MPX case in the United States (US) during the present global outbreak. The study's volunteers included the occupational health, infection control, emergency preparedness professionals, Research Electronic Data Capture (REDCap) design and programmers, and HCPs with suspected MPX exposure.
The study interventions were developing and deploying REDCap techniques to recognize HCP who may have been exposed to MPX, conducting an exposure risk analysis and categorization for post-exposure prophylaxis (PEP), and monitoring symptoms in the exposure window. Dashboards for HCP monitoring and short message service (SMS) text alerts for symptom surveillance were among the project's enhancements.
Overall, the present study details the quick creation of MPX-specific solutions and the initial experience with deploying the technology, which includes 1) exposure risk analysis and classification, 2) symptom monitoring, and 3) alerting of potential exposure. Additionally, the authors noted that these systems were available to others for use. Moreover, each solution was improved further by clinical support teams offering guidance and counseling for HCPs.
In detail, the study results indicated that the tools to enable contact mapping and exposure inquiry were implemented within 24 hours of the recognition of an individual with assumed MPX, with the entire suite in operation within four days of the confirmed MPX diagnosis. Moreover, clinical follow-up of the medical professional was incorporated into the design, and actual-time versioning permitted modifications, resulting in improved HCP symptom tracking compliance and monitoring.
The speedy development of MPX-specific solutions employing REDCap allowed flexibility in approach and design, and the incorporation of focused clinical assistance augmented functionality. Assigned team representatives successfully accessed a user-friendly interface to explore HCP data within the REDCap project by employing the previously constructed bespoke MGB REDCap external module.
A crucial component of the methodology was the proactive recognition of HCP who might gain from clinical assistance, either associated with technological proficiency, consisting of both email access and familiarity with survey completion, or with language hurdles or those who require PEP counseling. As the tools persist to be implemented, workflows such as clinical assistance could continue to be optimized for effectiveness.
Other organizations could use Massachusetts General Hospital (MGH) Monkeypox REDCap Toolkit and any customized external modules' code. Customization may be required if an institution or entity was adopting local public health criteria of exposure or monitoring, depending on responses. The entire solution development and design strategy were collaborative, with multiple developers concurrently working on different aspects of the solution, focusing on particular areas such as survey question layouts, automatic notifications, reporting, and allowed access.
In conclusion, the authors noted that it was critical to implement exposure reporting, risk evaluation and classification, and symptom surveillance systems within days of detection of an MPX case. The present research fulfilled this need due to the development team's knowledge in constructing similar devices before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic to assist operations and investigation efforts. Further, the modularized characteristics of REDCap, precise and clear communications from the involved parties, including occupational health services (OHS) and infection control on their functional requirements, made this possible.
The team believes that sharing the REDCap strategy and tools used might help others in similar situations and lead to developments and improvements. In addition, they mentioned that these technologies were applicable beyond the healthcare context, where several similar demands have been recognized in reaction to the spread of MPX in the community.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.