Monkeypox metadata?

Hi All -
I’m wondering if anyone is working on a metadata package for the monkeypox outbreak? I know WHO has released a case report form, (available here). My team works with at-risk populations and are interested in capturing this information, but I don’t want to duplicate efforts if this is already in the works.

Hi Kayla,
Thanks for reaching out on this important topic! We have been discussing quite a bit internally the best way to respond from a DHIS2 global goods approach. When SARS-CoV-2 emerged as a novel pathogen, we quickly responded with a COVID-specific disease surveillance suite of implementation tools & tracker packages, as you probably already know. At the time, only around ~10 countries had implemented DHIS2 for case-based surveillance of notifiable diseases (though many more had programs set up for more routine surveillance and longitudinal patient monitoring of HIV and TB). Now we feel the DHIS2 Community is in a very different position to respond, now that nearly 50 countries have implemented DHIS2 for COVID-19 surveillance have the possibility to extend and reuse their system.

The most widely used surveillance “package” was the case-based tracker package, initially based on the WHO recommended case report forms from March 2020. This tracker program was designed based on existing integrated case-based disease surveillance Tracker programs that had been field-tested & scaled in places like Uganda and Sierra Leone. Based on discussions with a number of countries, we believe the most sustainable approach will be to expand and adapt existing DHIS2 Trackers to incorporate additional notifiable diseases in an integrated way rather than to create a parallel “Monkeypox-specific” set of tools. A number of countries already have this incorporated into their electronic case-based system, such as Sierra Leone. In the meantime, we have also released an integrated case-based tracker package that incorporates all standardized elements for 9 vaccine-preventable diseases (VPDs) based on the WHO’s Technical Guidelines for Integrated Disease Surveillance & Response in the African Region V3.0 and provides a framework for how multiple notifiable diseases can be incorporated into a single Tracker program according to national policies and contextual nuance.

After reviewing the WHO’s case investigation form and case report form (V2), we have found that this largely follows the same workflows employed through other existing case-based disease surveillance trackers and would recommend:

  • If starting a tracker program from scratch, we recommend to utilize the DHIS2 Common Tracker Metadata library that contains a core ‘case profile’ and a number of standard tracker data elements and option sets (like Countries for ‘country of origin’ that are often re-used across different case report forms for various diseases, such as symptoms. We are reviewing this library now to expand with other commonly re-usable metadata like symptoms present, travel history, exposures
  • We recommend to follow the same program structure employed in both the COVID-19 and VPD case-based tracker programs to include at least these 4 program stages:
    Clinical information & exposures – to capture all the information about a suspected case when they initially present (in the WHO form these are Case Demographics, Medical history, Clinical presentation & Exposures) Note that some demographic details like date of birth, sex, gender etc are recommended to be modeled as Tracked Entity Attributes that are entered at enrollment rather than in the program stage – you will find these already modeled as part of the Core Case Profile in the metadata library above.
    Lab request – to capture information about the sample collected, ID, date of collection, etc.
    Lab results [repeatable] in order to allow multiple lab tests to be conducted & results reported (this follows Section 4: Laboratory Information of the WHO CRF)
    Final classification & Outcome – this allows information to be appended to the case record that is typically not known at the time of presenting, such as final classification and outcomes like death.

For contact tracing, countries such as Norway have moved from COVID-19 specific contact tracing programs to a more generic model that can be used for different types of diseases. In this case, we recommend a separate Tracker Program for contact tracing, as designed in the COVID-19 surveillance toolkit where each ‘contact’ registered as a TEI is linked to the index case (registered in the Case-based Surveillance tracker program) via a ‘relationship’ in DHIS2.

We will be working on guidance and re-imagining how to take the core components of the COVID-19 and WHO VPD case-based package to create a more generic set of package frameworks for countries to use and adapt for this health emergency and the next. We’d love to hear from you which countries you might be working with and what needs they have so we can build this out in the most useful way.

Warm regards,
Rebecca & the DHIS2 team