Fig 3. Proposed monkeypox response algorithm in Democratic Republic of Congo.

We propose a novel algorithm consisting of three tiers: routine surveillance, an alert status, and an outbreak status. Elevation from routine surveillance to an alert status occurs when the WHO threshold is crossed, defined as the second highest number of cases per month for a given health zone. At this point, health care workers must investigate further to determine whether there are spatiotemporal or epidemiological links between observed cases. If yes, an outbreak status is declared, possibly entailing contact tracing, community education and request for external assistance, in addition to routine surveillance activities.