Expanding mpox surveillance: a community-centric approach using discarded condoms

Sir,

Within short span of two years, the WHO has declared emergence of mpox as Public health emergency of international concern (PHEIC) in 2022 and 2024.² As Mpox challenges the global public health system, traditional surveillance emerges as inadequate in sensitizing marginalized populations and those at elevated risk in high-risk categories. The fact that this gap exists calls for innovative and community centered approaches to inclusive, equitable, and effective public health responses.

Recently, Wannigama et al studied utilization of discarded condoms as indirect surveillance tool for understanding the transmission of mpox and co-occurrence of sexually transmitted infections (STIs) in the community.³ This unique approach relies on normally found resources to collect information regarding mpox and other sexually transmitted diseases and disorders (STI/STDs). In contrast to the traditional mpox testing where samples are taken from the suspected cases, discarded condoms are easier, non-invasive, more anonymous, and easily accessible source of samples. This approach is more suitable in the population where mpox cases are missed due to cultural beliefs or stigma associated with the disease. Furthermore, the detection of concurrent STIs along with mpox gives a broader understanding of sexual health of high-risk communities and potential risk of transmission that might remain unnoticed under surveillance approaches.

The integrity of the discarded condoms could be the major concern mainly related to the contamination of collected samples from other sources. This can be addressed by collection of the condoms which are appropriately discarded in pre-designated container. In regions with high-risk populations, this approach can facilitate early detection of potential community outbreaks and enhance targeted surveillance efforts. Nonetheless, ethical concern of such surveillance studies, should be primarily considered and included in the protocol to improve sustainability and social acceptance.4 Equipping the scavangers and sanitary workers who are involved in collection with protective gear and training them on safe handling of infectious material will reduce the risk of exposure.⁵

The novel approach of indirect surveillance of mpox using discarded condoms is an affordable surveillance tool and may be implemented with certain slight changes in experimental designs. Similar innovative methods will be important for global health to collectively fight mpox and other infectious diseases of the future.

REFERENCES

1. 1. WHO. WHO Director-General declares mpox outbreak a public health emergency of international concern, 2024. Available at: https://www.who.int/news/item/outbreakpublichealth-emergency-of-international-concern. Accessed on 10 September 2024.
2. 2. Wannigama DL, Amarasiri M, Phattharapornjaroen P, Hurst C, Modchang C, Besa JJV, et al. Community-based mpox and sexually transmitted disease surveillance using discarded condoms in the global south. Lancet Infect Dis. 2024;24(10):e610-3.
3. 3. IRIS. Pan American Health Organization. Recommendations for ethical monkeypox (mpox) surveillance, 2024. Available at: https://iris.paho.org/handle/10665.2/568. Accessed on 15 September 2024.
4. 4. Santos F, Rava ZT, Bolibar RI, Casabona J, Monteiro E, Martins E, et al. Syphilis and other sexually transmitted infections among waste pickers in Brasilia, Brazil. Waste Manag. 2020;118:122-30.