Availability, scope and quality of monkeypox clinical management guidelines globally: a systematic review
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  • Published on:
    Guidance takes many forms and may not always be public
    • Jake Dunning, Consultant Royal Free London NHS Foundation Trust

    As an infectious diseases clinician who has managed patients with complicated monkeypox virus infections since 2018, I agree with Webb et al. that clinical management guidelines are helpful to those managing cases of monkeypox and welcome their efforts to identify potential gaps in available guidance. However, as the principal author for the original PHE guidance on monkeypox, I feel it is important to point out that the publicly available guidance for England was not intended to be detailed clinical guidance, which is likely why it was assigned such a low score in the systematic review by Webb et al.

    Prior to 2022, clinical management of sporadic cases of mostly travel-associated monkeypox cases in England was the responsibility of five NHS England-commissioned Airborne HCID treatment centres. Readers of this systematic review may be under the false impression that, in the absence of published national clinical management guidance, those caring for cases in England had no access to advice or guidance, which is simply not the case. In addition to information shared through an active specialist peer-support network, not all guidance was published, and HCID treatment centres follow their own standardised protocols for HCID infection prevention and control, which are not published under the banner of 'monkeypox clinical guidance'. The case series describing the management of patients hospitalised with monkeypox in England between 2018 and 2021 (Adler H et al...

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    Conflict of Interest:
    1. I was the principal author for the original PHE monkeypox guidance that was included in this systematic review, and although no longer responsible for UKHSA monkeypox guidance, I am an honorary consultant at UKHSA and part of its monkeypox technical advisory group.
    2. I am the Director of the NHS England (Contact) High Consequence Infectious Diseases network and a member of the NHS England Airborne HCID Network that manages hospitalised cases of monkeypox in England; I help write internal clinical guidance for my own specialist centre and the network in this context.
    3. I am a member of the WHO Guidelines Development Group for clinical management of monkeypox
    4. I am a colleague of several of the authors of the systematic review, particularly within the University of Oxford.