2024 年 MPOX 爆發(fā)背景下的聚會：公共衛(wèi)生指南

worldHealthorganization

Gatheringsinthecontextofthe2024

mpoxoutbreak:Publichealthguidance

Purpose

?Thepurposeofthisdocumentistoprovidepublichealthadviceto:

?hostgovernments,publichealthauthorities,

nationalorinternationaleventorganizers,healthcareprovidersandallstaffinvolvedintheplanningandcoordinationofmassgatherings;and

?peopleattendinggatheringsofanysizeandtype.

Acknowledgment

ThisdocumentwasproducedbytheBorderHealth

andMassGathering(BHMG)UnitattheCountryReadinessStrengtheningDepartmentoftheWorldHealth

Organization(WHO)HealthEmergenciesProgramme(WHE).ThemaintextwaswrittenbyAmaiaArtazcozGlaria,MariaBorodina,NinglanWang,andManamiYanagawa.

Thedocumentbenefitedfromstaffacrossvarious

Background

Mpoxisanillnesscausedbythemonkeypoxvirus(MPXV),ofwhichtwodistinctcladesarerecognized:CladeIandII.Thediseasewasinitiallyfoundonlyincentraland

westernAfricancountries,butaglobaloutbreakoccurredin2022–2023.In2024,thereisanongoingupsurgein

casesofmpoxincentralAfrica,whichhasreached

additionalAfricancountriesthatarereportingcasesforthefirsttime.On14August2024,theDirector-General

oftheWorldHealthOrganization(WHO)determined

thattheupsurgeofmpoxintheDemocraticRepublicof

theCongoandagrowingnumberofcountriesinAfrica

constitutedapublichealthemergencyofinternationalconcern.Informationonthisoutbreakischangingrapidlyaswelearnmore(seetheWHOwebsite(1)andweekly

updates(2)).

Duringtheglobaloutbreakin2022–2023,mostcases

(duetoCladeIIb)occurredamonggaymen,bisexual

menandothermenwhohavesexwithmenwhohave

multiplesexualpartners.Duringtheupsurgeofcasesin2024ineasternandcentralAfrica(duetoCladeIb),manycasesareinsexworkers,heterosexualpartners,personsincrowdedsettings(forexample,prisons,campsfor

internallydisplacedpersonsandrefugees,andschools),andchildren.(1,3)

technicalareaswithintheIncidentManagementSupportTeam(IMST)establishedinWHOheadquartersforthe

mpoxresponse.Amongthem,theBHMGUnitextends

gratitudetoRosamundLewis,TechnicalLead,and

colleaguesincludingMegDoherty,JanelleFranklin,AnaMariaHenaoRestrepo,PonnuPadiyara,LacinaSoro,

RyokoTakahashi,NosheenUsman,VictoriaWillet,and

BosomtwiYaa.WeextendourgratitudetotheWHO

RegionalandCountryOfficecolleagues,includingAnnetNgabiranoAlenyo,FatimaArifi,ViemaLewagaluBiaukula,AmgadAbdallaElkholy,VivianaGuzman,LataHarsh,

MaungMaungHtike,OlhaIzhyk,IbrahimMamadu,

TamaraMancero,CharlesKuriaNjuguna,andTanja

Schmidtfortheirdraftreviewanduser-orientedinput.

TheBHMGUnitappreciatesexternalcontributors

includingSujeetKr.SinghfromtheMinistryofHealthandFamilyWelfare,governmentofIndia,IsaacPhirifromtheMinistryofHealthandChildCare,governmentof

Zimbabwe,andthefocalpointsfromWHOCollaboratingCentersforMassGatheringsandGlobalHealthSecurity,namelyPaulArbonfromFlindersUniversity,Australia,LuciaMullenfromJohnsHopkinsCentreforHealth

Security,theUnitedStatesofAmerica,AnasAbdulhafeezKhanfromtheMinistryofHealth,SaudiArabia,andTinaEndericksfromHealthSecurityAgency,UnitedKingdom

ofGreatBritainandNorthernIreland.

Anyonewhohasclosecontactwithsomeonewhohas

symptomsofmpoxorcontaminatedmaterialsmaybeatrisk.Inknownendemicareas,theviruscanalsospreadfrominfectedanimalsandcontaminatedmeat.

Massgatherings(4)areeventscharacterizedbythe

concentrationofpeopleataspecificlocationfora

specificpurposeoveraspecificperiodoftimeand

havethepotentialtostraintheplanningandresponse

resourcesofthecountryorcommunityregardlessof

theevent’ssize.Theabilitytomanagethesegatheringsvariesbylocation,andevensmallereventscanposerisksdependingontheactivitiesinvolved.Thesegatheringscanbepublicorprivate,plannedorspontaneous,and

mayincludeeventslikesports,religious,culturalorpoliticalactivities.

Incountrieswithmpoxoutbreaks,gatherings,where

peoplemaybeatriskofmpox,includesmallgatherings,crowdedsettingssuchascampsforrefugeesorinternallydisplacedpersons,prisons,schools,religiousfacilitiesorhealthfacilities.

Risk-basedapproachforgatherings

WHOrecommendsthatthedecisionsaboutholding,

modifying,postponingorcancellinggatheringsshouldfollowarisk-basedapproachtailoredtotheevent’slocalcontextandcharacteristicsandbereassessedregularly.Theapproachentailsthreesteps:

?riskevaluation:identificationandquantificationofthebaselinerisks,basedonthecharacteristicsoftheeventandthecontextinwhichittakesplace

?riskmitigation:implementingprecautionarymeasurestoreducethoserisks

?riskcommunication:sharinginformationaboutthemeasurestaken,therationalebehindthem,and

adviceonprotectinghealthofindividuals.

Scope

Thisdocumentexaminestherisk-basedapproachto

gatherings,mpox-associatedrisksduringthecurrent

publichealthemergencyofinternationalconcern,andpublichealthadviceforauthorities,eventorganizersandpeopleattendingeventsofanysizeandtype.

Methodology

Thisdocumentwasdevelopedthroughareviewof

theavailableWHOdocumentsandtoolsrelatedto

gatherings.Additionally,thepublichealthadviceis

derivedfromandalignswiththeexistinglatestWHO

mpox-relatedguidance.Theadviceisprimarilydirectedatthemaingroupsinvolvedingatherings:health

authorities,eventorganizers,andpeopleattending

gatherings.Thedraftemphasizesinformationfrom

thedocumentsmentionedabovethatarerelevantto

gatherings.ThedocumentunderwentmultipleroundsofreviewbytheIMSTatWHO,WHOMassGathering

CollaboratingCentres,andotherexternalcontributors

toensurethatitscontentsalignwithWHOpublications.Thereviewers,evenlygeographicallydistributed,includevariousentitiessuchaspublichealthauthoritiesand

academia.

TheWHOMassGatheringsAllHazardsRiskAssessmentTool(5)isdesignedtohelpconductofacomprehensiveriskassessmentformassgatheringsandidentify

mitigationstrategies.Forthecurrentpublichealth

emergencyofinternationalconcern,mpox-relatedriskmitigationandcommunicationmeasuresshouldbe

includedintheplanningforallmassgatheringevents.

Mpox-associatedrisksduringthecurrent

publichealthemergencyofinternational

concern

Inthecontextofmpoxoutbreaks,thelevelofriskof

transmissionatgatheringsdependsontheincreased

likelihoodofcloseandprolongedinteractions,which

canfacilitatethespreadofMPXV.Additionally,certaingatheringsmayleadtobehaviourssuchasincreased

sexualactivity,includingsexworkforlivelihood,

furtherraisingtheriskoftransmission.Effectiverisk

mitigationmeasuresmayincludemodificationofthe

eventcharacteristics(forexample,venue,duration,

facilities,equipment,modalitiesofinteractionamongattendeesandtheirrequirementsforparticipation,

andmodalitiesofinteractionbetweenattendeesand

animals)orpublichealthmeasures,suchasvaccination,riskcommunication,anddiagnostics.

Publichealthadvicefordecision-makers(healthauthoritiesandeventorganizers)

》FollowWHO’svaccinationrecommendations.

Vaccinationisonlyadvisedforthoseatrisk,

suchasclosecontactsofmpoxcasesorhigh-exposuregroups.WHOhaspublishedapositionpaperinthisregard.(10)

》Adequatelymonitorandaddressrumoursandmisinformationaboutmpox.WHOhaspublishedatoolkitonthistopic.(11)

?Conductagathering-specificriskassessment.

Identifyeventsatriskformpoxtransmission,

basedontheeventcontext,epidemiologyand

attendees’profile,includinginternationaltravellersfromaffectedareas.Strengthencross-border

collaborationarrangementsasneeded.Conduct

ariskassessmenttoidentifythebaselineriskandinformmitigationmeasuresbasedonthecountry’scapacityandcontext.WHOhaspublishedatoolinthisregard.(5)

?Planandcoordinatewitheventorganizers.Keep

eventorganizersinformedontheevolutionoftheoutbreaksothattheycanappropriatelyimplementriskmitigationandcommunicationmeasuresfor

allattendeesandstaff.Thesemeasuresshould

includelocallyrelevantsituationalupdatesandriskmitigationmeasuresthateventorganizerscanputinplace,suchasestablishinganisolationholdingareaandreferralplaninadvance(precautionary),alteringanyhigh-contactactivitiesandfrequent

high-touchsurfacedisinfection,toreduceany

risksoftransmissionattheevent.Theyshouldalsoincludepersonalprotectionmessagestoberelayedtoattendees,suchasfrequentandthoroughhandwashing.Coordinatewitheventorganizersand

implementriskmitigationmeasurestogether.

Thefollowingmeasurescanbeconsideredbyhealth

authoritiesandeventorganizersformitigatingtheriskofmpoxtransmissionassociatedwithgatherings:

Healthauthoritiesareinvitedtoconsiderthefollowingactions.

?Increasecountrycapacitytorespondtompox.It

isimperativetostrengthenthecountry’scapacitytorespondtompoxandminimizetheriskof

transmissioninallsettings,whethergatheringstakeplaceornot.Majorconsiderationsareasfollows.

》Strengthenpublichealthmeasures,guided

byWHO’sstrategicframeworkforenhancing

preventionandcontrolofmpox2024-2027

(6)andaglobalstrategicpreparednessand

responseplanfortheperiodSeptember2024toFebruary2025.(7)

》AlignentryandtravelmeasureswithWHO’s

recommendationsandtheInternationalHealth

Regulations(2005)(3)andavoidunnecessarydisruptionstotravelandtrade.Refrainfromimplementingtemperaturescreeningspecificformpoxandrequiretestingorvaccinationforentry.

》Trainclinicians,firstresponders,staffatpointsofentry,community-basedsurveillancestaffandotherswhomayprovideclinicalservicesduringthegatheringaboutmpoxsignsand

symptoms,casedefinitions,laboratorytesting,clinicalmanagement,controlmeasures

formpox,andreportingtopublichealthauthorities.WHOhaspublishedinterimguidanceonrapidresponse.(8)

》Ensurempoxisincludedinthenational

epidemiologicalsurveillancesystem.WHO

haspublishedguidanceonsurveillance,caseinvestigation,andcontacttracingformpox.(9)

》Planimprovementofaccesstodiagnostic

services,includinggenomicsequencing,andstrengthensamplecollectionandtransportarrangementsforsuspectedmpoxsamples.

》deliveringriskcommunicationmessages:crucialinformationtocommunicate(12)mayinclude:

?signsandsymptoms;

?modesoftransmission;

?infectionpreventionandcontrolmeasuressuchashandwashiwithwaterandsoap,

alcohol-basedhandrub,andrespiratoryetiquettepractices;

?adviceforsymptomaticindividuals,

namelyavoidgatheringsandclosecontact,includingsexualactivity;

?guidanceforexposedindividuals,namelymonitorsymptomsfor21daysandavoidsexualactivity;and

?howtoaccessmedicalcare.

?Provideaccesstohandhygiene.Ensurefunctionalhandwashingstationswithsoapandwaterare

availableandappropriatelyplacedaroundtheeventlocation(thatis,atentrances,exits,eatingareas,

toiletsandthelike)orprovideaccesstoalcohol-basedhandsanitizer.Implementenvironmentalmeasuressuchassurfacecleaning.

?Cooperatewithcontacttracing.Collaboratewith

healthauthoritiesoncontacttracingifapersonwithmpoxislinkedtothegathering.Promptinterviewsshouldbeconductedwithaffectedindividuals

toidentifycontactsandplacesvisited.Notifyall

participantsofpotentialexposureandprovide

informationonmpox,includingguidanceonseekingmedicalcare.

Bothhealthauthoritiesandeventorganizersareinvitedtoleveragegatheringsasopportunitiestoinform,

engage,andempowerattendeesforeffectivempoxreadinessandresponse.

Eventorganizersareinvitedtoundertakethefollowingactions.

?Planandcoordinatewithpublichealthauthorities.Ensureclearcommunicationandcoordinationwithrelevanthealthauthoritiesforinformationsharing,reportingandcasemanagement,includingisolationifapersonwithmpoxsymptomsisidentifiedatthegathering.

?Developaresponseprotocol.Workwithhealth

authoritiestocreatearesponseprotocolfor

detection,reporting,andmanagingpeople

suspectedoforconfirmedashavingmpoxduringtheeventandensurethatstaffaretrainedtofamiliarizethemselveswiththeprotocol.Theprotocolshouldincludethefollowing:

》recognizingkeysymptoms(12)(forexample,

rash,fever,sorethroat,headache,muscle

aches,backpain,lowenergyandswollenlymphnodes)

》providingon-sitecarewithappropriateinfectionpreventionandcontrolmeasures,ifnecessary,andarrangementsformedicalreferrals

》reportingpeoplesuspectedofhavingmpoxtolocalhealthauthorities

》cooperatingincaseinvestigationandcontacttracing,includingmakingattendancelists

availableandnotifyingattendeesofpotentialexposurerisks

》informingattendeesinreal-timeaboutpotentialexposure,and

》implementingprecautionarymeasuresforstaffinvolved.

?Leverageriskcommunicationandcommunity

engagement.Suchengagementshouldbe

emphasizedandadaptedthroughoutthegathering,basedontherisklevel.Keyactionsinclude:

》sensitizingstakeholders:ensurethat

participants,healthcareproviders,venuestaff,andthegeneralpopulation,includinghotel

andrestaurantworkers,arewell-informedandsensitizedtopotentialhealth-relatedrisksthatmaybeassociatedwithplannedgatherings,

includingmpox(seesectiononmpox-

associatedrisksduringthecurrentpublichealthemergencyofinternationalconcernabove);

》identifyingplatformsforinformation

dissemination:useappropriatechannels

forcommunication,suchasleaflets,

announcements,socialmedia,andlocalmassmedia/broadcasts,targetingthemostsuitablemethodsfortheaudience;

Publichealthadviceforpeopleattendinggatheringsofanysizeandtype

?Individualswithmpoxsymptoms,orbeing

consideredaspeoplewithsuspected,probableorconfirmedmpoxbyhealthauthoritiesshouldavoidgatherings,seekmedicalcareandfollowhealth

authorityadvice.

?Attendeesshouldavoidclosecontact,including

sexualcontact,withanyoneshowingmpox

symptoms(12)(forexample,rash,feverandswollenlymphnodes).

?Ifmpoxsymptomsdevelopafterattendinga

gathering,peopleshouldseekmedicalcare,if

possible,notifythehealthcarefacilitybeforetheirarrivalandinformhealthcareprovidersabout

havingattendedanevent.

?Thoseidentifiedasaclosecontactorpotentially

exposedtompoxshouldfollowhealthadviceissuedbyrelevanthealthauthorities.

?Peoplewithmpoxareadvisedtorefrainfromhavingsexualcontactwithothersandusecondomsfor

12weeksaftertheyrecover.(1)Practicepersonalprotectionmeasureslikehandhygieneand

respiratoryetiquette.

?Attendeeswhoareathighriskmaywanttoconsulthealthcareprovidersforanunderstandingoftheirindividualriskandpreventivemeasurestotake,

includingvaccination,beforeattendingtheevent.

Groupsathighriskofmpoxinclude:(11)

》peopletravellingtoanareaorcommunitywhere

ariskofmpoxexposuretopersonswithmpoxisconsideredhigh;

》healthandcareworkersatriskofexposure;

》peopleinthesamehouseholdorclosecommunityassomeonewhohasmpox,includingchildren;

and

》peoplewhohavemultiplesexpartners,includingmenwhohavesexwithmenandsexworkersof

anygenderandtheirclients.

8.Clinicalmanagementandinfectionprevention

andcontrolformonkeypox:interimrapid

responseguidance,10June2022.Geneva:World

HealthOrganization;2024(

/

handle/10665/355798,accessed18September2024).

9.Surveillance,caseinvestigationandcontacttracingformpox(monkeypox):Interimguidance,20March

2024.Geneva:WorldHealthOrganization;2024

(

/handle/10665/376306

,accessed

18September2024).

10.WorldHealthOrganization.Smallpoxandmpox

(orthopoxviruses):WHOpositionpaper,August2024.WeeklyEpidemiologicalRecord,2024;34(99):429-456(

/publications/i/item/who

-

wer-9934-429-456,accessed18September2024).

11.Riskcommunicationandcommunityengagementreadinessandresponsetoolkit:mpox.Geneva:

World