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primarily the Central African clades: · 0% (0/33 contacts) in Central African Republic. Multi-Jurisdictional Monkeypox Outbreak 2022 – What We Know So Far 9 · 0% (0/30 contacts of one case); 3% (69/2,278 contacts); 3.3% (4/123 contacts); 10.2% (4/39 contacts) in the DRC. · 0.3% (1/292 contacts) in Gabon. · Contacts of unspecified nature in areas where West African clade is assumed to circulate: · 0% (0/16 contacts) in Israel. · 0% (0/7 contacts) in Ivory Coast. · 0% (0/44 contacts; 0/23 contacts; 0/136 contacts) in Liberia. · 0% (0/30 contacts; 0/16 contacts) in Sierra Leone. · 0.3% (1/288 contacts) in the UK. · Using active surveillance data of 338 monkeypox cases and their 3,686 close, face-to-face contacts in Zaire from 1981 to 1986, the observed SAR was 3% (69/2,278 contacts):34 · SARs were significantly higher for contacts unvaccinated against smallpox compared to vaccinated contacts: 7.47% (54 cases/723 contacts) vs. 0.96% (15 cases/1,555 contacts); P < 0.001 · SARs were significantly higher for household contacts compared to non-household contacts: 3.73% vs. 1.86%; P < 0.05 · SAR for household contacts unvaccinated against smallpox was 7 times higher than that for vaccinated household members: 9.28% (40 cases/431 contacts) vs. 1.31 (13 cases/989 contacts); P < 0.01 Diagnosis · Individuals with compatible clinical and exposure history should be assessed by a health care provider and tested as indicated. Consult with PHO’s laboratory if you have any questions regarding testing eligibility.35 · Please refer to PHO’s website on monkeypox virus for details on testing indications, specimen requirements, how to collect and submit specimens, preparation prior to transport, requisition form and instructions for completion, kit ordering, turnaround time, test methods, and result reporting.35 Multi-Jurisdictional Monkeypox Outbreak 2022 – What We Know So Far 10 Case and Contact Management A jurisdictional scan of publicly available information up to May 27, 2022 was completed for select health organizations (i.e., ECDC, CDC, WHO, and UKHSA). This scan was informed by scanning of key health organization websites, as well as general Google searches for items related to case and contact management guidance surrounding monkeypox. A formal bibliographic search was not conducted due to time constraints; thus, some relevant articles may not be included. At the time of writing, there was no CCM guidance published from Ontario nor Quebec. The literature will be monitored moving forward. Approaches to contact management by selected organizations are summarized below. World Health Organization1 · Investigation of suspect case should take place as soon as possible and include: clinical examination with appropriate personal protective equipment; exploring possible sources of infection; collecting and submitting specimens for laboratory analysis in a safe manner. See also WHO’s Surveillance, Case Investigation and Contact Tracing for Monkeypox for definitions of suspected, probable and confirmed cases.36 · Contact definition: A contact is defined as a person who, in the period beginning with the onset of the source case’s first symptoms, and ending when all scabs have fallen off, has had one or more of the following exposures (face-to-face exposure direct physical contact, including sexual contact, contact with contaminated materials such as clothing or bedding) with a probable or confirmed case of monkeypox. · Contact identification: Cases can be prompted to identify contacts across a number of contexts and any recalled interactions. Attendance lists can also support identification. As soon as a suspect case is identified, contact identification and contact tracing should be initiated. Case patients should be interviewed to elicit the names and contact information of all such persons. Contacts should be notified within 24 hours of identification. · Contact monitoring: Contacts should be monitored at least daily for the onset of signs/symptoms for a period of 21 days from the last contact with a patient or their contaminated materials during the infectious period. · Passive: identified contacts provided with information on the signs/symptoms to monitor, permitted activities, and how to contact the public health department if signs/symptoms develop. · Active: public health officials are responsible for checking at least once a day to see if a person under monitoring has self-reported signs/symptoms. · Direct: variation of active monitoring that involves at least daily either physically visiting or visually examining via video for signs of illness.