Use of Surveillance Outbreak Response Management and Analysis System for Human Monkeypox Outbreak, Nigeria, 2017–2019

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H uman monkeypox is a severe and rare smallpox- like illness that occurs sporadically in remote villages in the tropical rain forest of West and Central Africa (1,2).The causative agent, monkeypox virus, is transmitted by animal-to-human and human-tohuman contact (3,4).In September 2017, an outbreak of monkeypox occurred in Nigeria after 40 years of no reported cases in the country.As of October 2017, local health departments in Nigeria had reported 89 cases and 294 contact persons (5,6).Early in the outbreak, the Nigeria Centre for Disease Control (NCDC) used a conventional surveillance system for the outbreak investigation.That system consisted of paper-based forms transferred manually to databases within the framework of the Integrated Disease Surveillance and Response System (7).As the outbreak expanded, NCDC faced challenges because of information delay and difficulties with updating and verifying case data, integrating laboratory tests, and managing contact tracing in the conventional system.In October 2017, NCDC decided to implement the Surveillance, Outbreak Response Management and Analysis System (SORMAS) on an ad hoc basis; an earlier prototype of this system had been successfully piloted in Nigeria in 2015 (8).SOR-MAS is an open-source mHealth (mobile health) system that organizes and facilitates infectious disease control and outbreak management procedures in addition to disease surveillance and epidemiologic analysis for all administrative levels of a public health system (9-11).SORMAS includes specific interfaces for 12 users (e.g., laboratorian, contact tracing officer, epidemiologist), disease-specific process modules for 12 epidemic-prone diseases, and a customizable process module for unforeseen emerging diseases; it adheres to the Integrated Disease Surveillance and Response System.Most users operate SORMAS on mobile digital devices (e.g., smartphone, tablet), bidirectionally synchronized with a central server via mobile telecommunication networks.We compared SORMAS performance with that of the conventional surveillance system.Here we describe how we adapted and deployed SORMAS, discuss challenges encountered during implementation, and provide recommendations for deployment of similar mHealth tools. The StudyIn the second week of October 2017, we held a 2-day design thinking workshop with clinicians, epidemiologists, and virologists, in which all specific procedures for surveillance and response were defined in accordance with guidelines from the World Health Organization (12).Within 10 days, we translated the findings of the workshop into process models and programmed them into the existing SORMAS.A 2-day field test guided final programming revisions, Use of Surveillance Outbreak Response Management and AnalysisSystem for Human Monkeypox

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