The National Bureau of Disease Control and Prevention has issued a monkeypox prevention and control plan: Close contacts must undergo 21 days of health monitoring and hygiene | prevention and control | plan
National Disease Control and Prevention [2023] No.16
Notice on Issuing the Monkeypox Prevention and Control Plan
To the disease control bureaus and health commissions of various provinces, autonomous regions, municipalities directly under the central government, and Xinjiang Production and Construction Corps:
In order to further improve the prevention and control of monkeypox, timely and effectively respond to the monkeypox epidemic, enhance the scientific, accurate and effective nature of monkeypox prevention and control work, and effectively safeguard the safety and health of the people, the National Bureau of Disease Control and Prevention, together with the National Health Commission, has formulated the "Monkeypox Prevention and Control Plan". It is now issued to you, please organize and implement it carefully.
National Bureau of Disease Control and Prevention
National Health Commission
July 26, 2023
Monkeypox prevention and control plan
Monkeypox is a zoonotic disease caused by monkeypox virus infection. In September 2022, China reported its first imported case of monkeypox. Since June 2023, multiple provinces in China have reported multiple cases of monkeypox, posing a high risk of new local outbreaks and hidden transmission. To guide various regions to scientifically and accurately carry out monkeypox prevention and control work, and effectively maintain the physical health of the people, this plan is formulated.
General 1. requirements
Adhere to the principle of "prevention first, combination of prevention and control, precise prevention and control, and rapid disposal", and implement the measures of "early detection, early reporting, early isolation, and early treatment. Carry out multi-channel monitoring of medical institutions, key groups, inbound personnel and key places. Strengthen epidemic analysis and risk analysis, and carry out targeted health education and comprehensive intervention for key populations. Implement measures such as case isolation treatment, epidemiological investigation and close contact tracing management. Insist on finding one, controlling one, and blocking the spread of the epidemic in time.
2. disease characteristics
Pathogenic characteristics.
Monkeypox virus belongs to the genus Orthopoxvirus in the family Poxvirus, and is a double stranded DNA virus with a genome length of approximately 197kb. The virus was first discovered in monkeys in 1958. In 1970, monkeypox virus was first isolated from a suspected smallpox patient's specimen in the Democratic Republic of Congo, marking the first confirmed case of human monkeypox.
The monkeypox virus is divided into two evolutionary branches: Branch I, formerly known as the Central African branch or the Congo Basin branch; Branch II, formerly known as the West African branch, is further divided into IIa and IIb branches. The strain that caused the outbreak of monkeypox in non endemic areas worldwide in 2022 is the IIb branch. At present, there are many sub branches in the IIb branch, including sub branches A.1, A.2, and B.1. Since the first imported case of monkeypox was reported in China in September 2022, the strain sequences submitted to the Institute of Virology of the Chinese Center for Disease Control and Prevention in various regions belong to the IIb branch.
The monkeypox virus is resistant to dryness and low temperatures and can survive for several months on surfaces such as scabs, soil, clothing, and bedding. The virus is heat sensitive and can be inactivated by heating to 56 ℃ for 30 minutes or 60 ℃ for 10 minutes. Commonly used disinfectants such as 75% ethanol, chlorine containing disinfectants, peroxyacetic acid, and ultraviolet radiation can effectively inactivate viruses, and are sensitive to hydrogen peroxide, sodium hypochlorite, glutaraldehyde, and ortho benzaldehyde.
Epidemiological characteristics.
1. Sources of infection. The host of monkeypox virus is not yet clear, and it is currently believed that African rodents may be its natural host. The sources of infection include monkeypox cases and infected rodents, monkeys, and primates.
2. Transmission routes. The monkeypox virus mainly invades the human body through mucous membranes and damaged skin, and is mainly transmitted through direct contact with the diseased skin or mucous membranes of the case. It can also be transmitted through contact with items contaminated by the virus, long-term close inhalation of respiratory droplets from the case, contact with respiratory secretions, diseased exudates, blood and other body fluids of infected animals, or infection through bites or scratches from infected animals.
3. Vulnerable population. The crowd is generally susceptible. Having received smallpox vaccine has a certain degree of cross protection against monkeypox virus.
4. Epidemic characteristics. The monkeypox epidemic before 2021 was mainly localized in Central and West Africa, mainly transmitted through contact with infected animals. The human to human transmission chain caused by the epidemic was relatively short, mainly sporadic cases and clustered outbreaks in children and young adults, occasionally spreading to other countries and regions through family or travel. Since May 2022, outbreaks of COVID-19 in multiple countries around the world have mainly spread through sexual contact among men who have sex with men. The majority of cases are young and middle-aged men, and have spread through large-scale gatherings and subsequent MSM in communities, spreading to multiple countries and regions around the world.
Clinical features.
1. Incubation period: 5-21 days, mostly 6-13 days.
2. Infectious period: The case becomes infectious from the onset of symptoms until the rash scabs naturally fall off and form new skin. There are investigations suggesting that some cases may be contagious 1-4 days before symptoms appear.
3. Early symptoms: Fever, headache, back pain, muscle pain, and lymph node enlargement may occur.
4. Rashes and mucosal rashes: usually appear after fever subsides, and in some cases may appear before systemic symptoms. The occurrence of rash often goes through several stages, including rash, papules, blisters, pustules, scabbing, and scab shedding. Different forms of rash can coexist and may be accompanied by obvious itching and pain. It can affect the oral and pharyngeal mucosa, anus, genitalia, conjunctiva, and cornea. After the scab peels off, it may leave erythema, pigmentation, or even scars, which can last for several years.
5. The course and severity of the disease. The course of monkeypox is about 2-4 weeks, and patients with weakened immunity may have a longer course of disease. Monkeypox is a self limiting disease, and in most cases, symptoms will disappear on their own. Severe cases and deaths may also occur, mainly in children, pregnant women, and immunocompromised populations.
Since 2022, in the global monkeypox outbreaks in many countries, most cases have mild clinical manifestations, some cases have no systemic symptoms, the rash is only limited to the genital, anorectal mucosa, and the death cases are mainly people with low immunity such as untreated AIDS virus infected people. Since 2022, the mortality rate of cases in non endemic areas worldwide has been approximately 0.1%.
3. publicity, education and intervention
Carry out publicity and education for different groups of people, such as key groups, entry-exit personnel and the general population, strengthen the self-prevention awareness and personal protection measures of different groups, and actively cooperate with the prevention and control work.
Key groups. Health and disease control departments around the country, together with relevant social organizations, fully draw on the experience of comprehensive intervention and service model of AIDS prevention and control, and carry out peer education in bars, clubs, baths and other key venues that MSM often visit. With the help of mass media, MSM social networking sites and other Internet platforms, carry out publicity and education on monkeypox prevention and control knowledge, improve the prevention awareness of key groups, reduce high-risk behaviors, guide people with suspicious contact history to consciously conduct self-health monitoring, and enhance the awareness of active medical treatment.
The requirements for key population promotion and intervention are detailed in Annex 1 "Guidelines for Key Population Promotion and Intervention".
Entry and exit personnel. Strengthen the promotion and education of monkeypox prevention and control knowledge among entry-exit personnel through the distribution of promotional materials and other forms. Remind outbound personnel to pay attention to the epidemic information of monkeypox in the destination country and region, and not to contact individuals with monkeypox like symptoms, rodents, primates, and other animals. Remind individuals from countries and regions reporting monkeypox outbreaks that if they have a suspicious history of contact overseas, they should undergo self health monitoring within 21 days of entry to avoid close contact with others. If they experience symptoms such as fever, rash, and enlarged lymph nodes, they should seek medical attention proactively and truthfully report their epidemiological history.
General population. Various regions will fully leverage the role of new media as well as traditional media such as radio, television, and newspapers, carry out publicity and education on monkeypox prevention and control knowledge, and enhance public awareness of scientific prevention.
4. epidemic surveillance and reporting
Monitoring case definitions.
Individuals with monkeypox like symptoms. Acute rash of unknown cause, accompanied by fever or lymph node enlargement.
2. Suspected cases. Individuals with monkeypox like symptoms have any of the following epidemiological histories within 21 days prior to onset: a history of travel to areas where monkeypox cases have been reported; Have a history of confirmed or suspected contact with monkeypox; Having same-sex sexual activity, or having a history of same-sex sexual activity; There is a history of suspected animal contact in endemic areas.
3. Confirmed cases. Individuals with monkeypox like symptoms, suspected cases, and close contacts who have tested positive for monkeypox virus nucleic acid or virus isolation in the laboratory.
Multi channel monitoring.
1. Medical institution monitoring. Medical institutions at all levels and of all types should carry out monitoring of monkeypox like symptoms, especially dermatology, anorectal department, AIDS voluntary counseling and testing clinics and other clinics should focus on monkeypox like symptoms. Individuals with monkeypox like symptoms should proactively inquire about their epidemiological history, record their current address and contact information, collect specimens, and send them to disease control institutions for monkeypox nucleic acid testing. Medical institutions with the ability to detect monkeypox virus and qualifications for monkeypox virus experimental activities can also carry out testing.
2. Key population monitoring. Medical institutions at all levels and types, as well as disease control institutions, should proactively inquire about the presence of monkeypox like symptoms and suspected contact history when providing diagnosis, treatment, or testing consulting services to key populations such as MSM. If monkeypox like symptoms or suspected cases are found, samples should be collected in a timely manner for monkeypox virus nucleic acid testing.
3. Monitoring of inbound personnel. Upon receiving abnormal health declarations related to monkeypox or discovering monkeypox like symptoms during quarantine, the customs shall promptly collect specimens and conduct nucleic acid testing, and issue a "Convenience Card for Medical Treatment", requiring them to seek medical treatment as soon as possible; For those who test positive for nucleic acid, relevant information shall be reported to the disease control institutions in their jurisdiction, and further investigation and disposal shall be carried out by relevant departments.
4. Monitoring of sewage in key locations. Areas with conditions can conduct sewage monitoring on key activity areas such as bars, clubs, and bathhouses that MSM frequently visit based on the local epidemic situation, after evaluation.
Case report.
Relevant medical institutions timely diagnose patients based on clinical manifestations, epidemiology, and laboratory test results.
Suspected and confirmed cases diagnosed should be directly reported through the monitoring report management module of the China Disease Prevention and Control Information System within 24 hours. If it is an imported case, please fill in the country or region of origin of the input. Medical and health institutions that do not meet the conditions for online reporting must report the information on the infectious disease report card to the local township health center, community health service center, or county-level disease control institution for online reporting within the prescribed time limit, and at the same time fax or send the infectious disease report card to the reporting unit. Medical and health institutions responsible for online reporting of cases should promptly review and correct case information based on laboratory test results and epidemiological investigations.
The first confirmed case of monkeypox or two or more confirmed cases with epidemiological associations in each county should be reported through the Public Health Emergency Reporting Management Information System within 2 hours, with the event level selected as "unrated".
Disposal of 5. epidemic situation
Case management.
Suspected and confirmed cases of monkeypox discovered in various regions should be promptly transferred to medical institutions for isolation and treatment. If clinical symptoms significantly improve and the affected area has scabbed, it can be transferred to home isolation treatment until the rash scabs naturally fall off, and home isolation is lifted. For confirmed cases with mild conditions and conditions for home isolation treatment, after joint evaluation by medical institutions and disease control institutions, home isolation treatment can be directly adopted. For confirmed cases undergoing home isolation treatment, a health notice for monkeypox cases undergoing home isolation treatment will be issued. During the period of home isolation and treatment for confirmed cases, individuals should live in a single room and avoid direct contact with their family members' skin or mucous membranes. Disinfect contaminated items and do not go out unless necessary. When going out, it is necessary to wear long clothes, pants, and medical surgical masks, avoid going to crowded places, and avoid direct contact with other people's skin or mucous membranes; Designate medical institutions to assign dedicated personnel to be responsible for on-site or telephone follow-up, providing health consultation and medical guidance.
Epidemiological investigation.
After receiving reports of suspected and confirmed cases in the jurisdiction, county-level disease control institutions shall promptly organize epidemiological investigations, identify the source of infection, grasp, track and manage close contacts, analyze the transmission chain and characteristics, timely identify potential risk groups, their scope and characteristics, and carry out targeted publicity, education, and comprehensive interventions. During the investigation process, leverage the collaborative role of multiple departments in joint prevention and control to obtain comprehensive and accurate flow investigation information as much as possible.
The investigation mainly includes basic information of the case, the incidence and treatment situation, clinical manifestations, outcomes, and laboratory testing; History, location, and mode of contact with suspected sources of infection within 21 days prior to onset of illness; Specific activity locations from onset to isolation treatment, individuals who have direct contact with their skin or mucous membranes, and individuals who have had sexual contact with them within 4 days prior to onset.
The requirements for epidemiological investigation of monkeypox epidemic are detailed in Annex 3 "Guidelines for Epidemiological Investigation of Monkeypox Epidemic".
Identification and management of close contacts.
1. Definition of close contacts. Directly contacting the affected area of the case and its contaminated substances, or infecting animals and their secretions, exudates, and other pollutants; And individuals who have been assessed to be at risk of infection due to occupational exposure or long-term close inhalation of respiratory droplets.
2. Identification of close contacts. Based on epidemiological investigations and exposure risk assessments, disease control institutions are responsible for promptly identifying close contacts.
3. Close contact management. Disease control institutions or grassroots medical and health institutions guide close contacts to conduct self health monitoring, with a health monitoring period of 21 days from the last day of close contact.
During the self health monitoring period, close contacts can live and work normally, and should avoid close contact such as sexual contact with others, and avoid donating blood; Persist in daily temperature measurement and symptom monitoring. If you experience monkeypox like symptoms, seek medical attention promptly and proactively report any suspicious contact history. Disease control institutions or grassroots medical and health institutions in the jurisdiction should visit or call close contacts for follow-up on the 7th, 14th, and 21st day of self health monitoring, provide consultation and guidance, and promptly handle any abnormal situations found.
The requirements for determining and managing close contacts are detailed in Annex 4 "Guidelines for Determining and Managing Close Contacts of Monkeypox".
Disinfection and personnel protection.
Disinfect personal items such as clothing, towels, bed sheets, tableware, as well as environments and surfaces that may be contaminated by patient secretions, exudates, body fluids, etc. Personnel engaged in case diagnosis, treatment, nursing, epidemiological investigation, environmental cleaning and disinfection, specimen collection, and laboratory testing should take personal protective measures during work.
The disinfection and personnel protection requirements are detailed in Annex 5 "Monkeypox Disinfection Technical Guidelines" and Annex 6 "Monkeypox Personal Protection Guidelines".
6. laboratory testing
Monkeypox virus nucleic acid detection is the first choice for skin or mucosal lesions, and oropharyngeal swab specimens can be collected at the same time. Specimens of the first confirmed case of monkeypox in each province should be sent to the Virus Disease Institute of the China Center for Disease Control and prevention for review. For the first or early confirmed cases in the local epidemic, key confirmed cases with epidemiological correlation with early cases, local confirmed cases with unknown source of infection, positive specimens of imported confirmed cases from abroad, etc., virus gene sequencing shall be performed when Ct value ≤ 32 detected by fluorescence quantitative PCR. All sequencing raw data, assembled sequences and sequencing sample submission forms should be submitted to the Chinese Center for Disease Control and prevention for summary and analysis within 48 hours of obtaining the sequences. The above confirmed cases should collect at least one set of specimens and send them to the virus disease institute of China CDC.
The specific requirements for laboratory testing are detailed in Annex 7 "Technical Guidelines for Laboratory Testing of Monkeypox Virus".
nosocomial infection control in 7.
Medical institutions should strictly control nosocomial infection. Suspected cases and confirmed cases should be placed in isolation wards, and suspected cases should be isolated in single rooms. Medical personnel shall implement standard prevention, take isolation and preventive measures for diseases transmitted by contact and droplets, wear disposable latex gloves, masks of KN95/N95 and above, protective face screens or goggles, disposable isolation gowns, etc., and do hand hygiene at the same time. Strictly follow the "Technical Specifications for Disinfection of Medical Institutions" to standardize the treatment of body fluids, blood, excreta, secretions, etc., and do a good job in cleaning and disinfecting the diagnosis and treatment environment, medical equipment, and items used in cases. According to the "Medical Waste Management Regulations" and "Medical Waste Management Measures for Medical and Health Institutions", the disposal and management of medical waste should be done well.
8. job requirements
Strengthen organizational coordination. Local health and disease control departments should strengthen close cooperation and information sharing with customs and other relevant departments, timely detect and deal with monkeypox outbreaks, and implement monkeypox case detection, epidemic reporting, diagnosis and treatment isolation, and close contact tracking management, so as to prevent the spread and spread of the epidemic. In the process of prevention and control of monkeypox epidemic, all localities should pay attention to the protection of personal privacy such as cases, close contacts and key groups.
Strengthen publicity and guidance. Each region should timely release information related to the monkeypox epidemic in its jurisdiction, and provide policy interpretation and public health reminders. Carry out monkeypox prevention and control knowledge promotion through various methods and channels, and strengthen the targeted and effective publicity and education of key populations. Timely respond to social concerns and guide the public to have a scientific understanding of monkeypox.
Strengthen personnel training. Various regions should strengthen the training of professionals in disease control institutions and medical institutions at all levels. Key training will be provided to medical personnel on the identification and diagnosis of monkeypox cases, case discovery and reporting, case management, and other related knowledge to strengthen their awareness of diagnosis and treatment. We will focus on conducting epidemiological investigations, identifying and managing close contacts, conducting laboratory testing, and promoting interventions for key populations for disease control personnel, in order to enhance their ability to prevent and respond to monkeypox outbreaks.
Attachment:
1. Guidelines for Key Population Promotion and Intervention
2. Health Notice for Monkeypox Cases undergoing Home Isolation and Treatment
3. Guidelines for Epidemiological Investigation of Monkeypox Epidemic
4. Guidelines for identifying and managing close contacts of monkeypox
5. Guidelines for Monkeypox Disinfection Techniques
6. Personal protective guidelines for monkeypox
7. Technical Guidelines for Laboratory Testing of Monkeypox Virus
Attachment 1
Guidelines for Key Population Promotion and Intervention
Since May 2022, monkeypox outbreaks in non endemic areas around the world have mainly occurred among men who engage in sexual activity. This guide is formulated to make full use of China's comprehensive intervention service system for AIDS prevention and control, carry out publicity and intervention for MSM and other key groups, prevent the spread of monkeypox epidemic, and form a normalized integrated response mechanism for AIDS and monkeypox prevention and control.
1. Implementation Strategy
On the basis of the existing comprehensive intervention service system for AIDS prevention and control, comprehensive use of behavioral intervention methods and means, through publicity and education, promotion of safe sex, mobilization and testing, outreach services, peer education and Internet intervention, from the individual, group and society, etc. Provide comprehensive intervention services for the target population at multiple levels.
2. organization implementation
Medical institutions and disease control institutions at all levels should strengthen the training of monkeypox knowledge for the staff of key departments and AIDS voluntary counseling and testing clinics, and provide key groups with monkeypox prevention and control knowledge publicity, testing consultation and mobilization, treatment and care services. Disease control agencies at all levels should actively promote local capable MSM volunteers or social organizations with good AIDS prevention and control experience to participate in the monkeypox prevention and control work, and pay attention to protecting the privacy of key populations during the work process.
3. situation analysis
All localities should strengthen the investigation of the monkey pox epidemic, prevention and control status, influencing factors and entry and exit situation in key populations, analyze and judge the monkey pox epidemic situation in a timely manner, and provide a basis for the formulation of local high-risk behavior intervention work plans. The specific contents include: 1. the base number of key groups, the form and characteristics of activities, the place of activities, the time and region of entry and exit, etc.; 2. the knowledge, attitude and high-risk behavior of monkeypox; 3. the epidemic level of monkeypox and its influencing factors; 4. the work carried out by the prevention and control policies and professional institutions; 5. the intervention activities carried out by relevant organizations and individuals including volunteers; 6. Difficulties and problems affecting the prevention and treatment of monkeypox.
4. advocacy intervention
Publicity and education. Disease control institutions at all levels or health education professional institutions provide technical support, social organizations participate, jointly study and formulate monkeypox prevention publicity materials suitable for local characteristics, and strengthen warning publicity and education. Through platforms such as mass media, MSM website and dating software with mobile terminals as carriers, international, domestic and local monkeypox epidemic information and prevention and control knowledge are publicized to improve the awareness of monkeypox prevention among key groups.
Peer education. Disease control institutions at all levels should strengthen the selection, recruitment, and training of peer educators, organize and support peer promotion activities, enhance the awareness of monkeypox risk prevention among the population, and promote proactive testing. Regularly organize peer educators' work meetings to understand the difficulties and problems in monkeypox intervention work, and provide targeted assistance and support.
Outreach services. Intervention staff from various levels of disease control institutions regularly conduct outreach services such as monkeypox promotion, consultation, and distribution of promotional materials at key population activity venues, to improve the awareness and knowledge level of monkeypox prevention among key populations, promote the strengthening of self health management among key populations, and actively seek testing and consultation services.
Testing consultation. Disease control institutions at all levels mobilize key populations with monkeypox like symptoms or suspicious contact history to conduct monkeypox detection through the Internet, peer education, outreach activities and other forms. The dermatology department, anorectal department and AIDS voluntary counseling and testing clinic of various medical institutions at all levels should actively inquire about their epidemiological history and sexual contact history, record the current address and contact information of the patients, collect samples and send them to disease control institutions for testing of monkeypox nucleic acid, and medical institutions with monkeypox detection capability and qualification for monkeypox virus testing activities can also carry out testing. For regions where the Internet+HIV testing platform has been established, monkeypox testing content can be added to realize online testing appointment and result query on the Internet.
5、 Intervention in key locations
Key venues include physical and virtual venues. Physical venues include bars, clubs, baths and other business venues. Virtual venues include mobile Internet and social media.
Physical venue intervention.
Disease control institutions at all levels are responsible for organizing intervention personnel to carry out monkeypox prevention and intervention propaganda in bars, clubs, bathhouses and other activity venues frequently visited by local MSM, mainly including:
1. Post prominent health education promotional images and set up health education information bulletin boards in physical places such as bars, clubs, and bathtubs that MSM frequently visits;
2. Strengthen personal health responsibility awareness, conduct monkeypox health counseling, and promote self risk assessment;
3. Provide referral service information, inform clear diagnosis and treatment procedures, as well as relevant testing, medical institution names, contacts, and other information.
Various regions should strengthen intervention and publicity for places where confirmed cases of monkeypox have been active within 21 days before the onset of the disease, as well as places with positive sewage monitoring. Attention should be paid to the personal privacy protection of the target population, and training on monkeypox prevention and control knowledge for social organization peer educators should be strengthened. A standardized behavioral intervention process should be established to improve self-protection skills.
Virtual venue intervention.
Disease control institutions at all levels are responsible for organizing and guiding the orderly online promotion of monkeypox in the local area, timely publishing and updating monkeypox promotion and education content on relevant websites and social media platforms, and forming an online promotion and intervention service system for monkeypox testing, consultation, diagnosis and treatment targeting key populations.
Disease control institutions at all levels support social organizations or peer educators to use websites, mailboxes, or social media platforms to organize online consultation and communication. Timely answer various monkeypox related questions raised by netizens. According to the characteristics of monkeypox transmission in different periods, experts, professionals and peer educators are regularly or irregularly organized to conduct online education through the Internet and social media platforms. Disease control institutions at all levels should regularly guide and update relevant professional information to ensure that the promotional content is scientific and effective.
Attachment 2
Attachment 3
Guidelines for Epidemiological Investigation of Monkeypox Epidemic
To guide disease control institutions in various regions to conduct epidemiological investigations on suspected cases, confirmed cases, and clustered outbreaks of monkeypox, timely grasp epidemiological information such as exposure history and contact history of cases, implement tracking and judgment of close contacts, and prevent the spread of the epidemic, this guideline is formulated.
1. investigation purpose
Find the source of infection, grasp, trace and manage close contacts.
Analyze the propagation chain and propagation characteristics.
Timely identify potential risk groups, their characteristics, and scope, and carry out targeted publicity, education, and comprehensive interventions.
2、 Survey subjects
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