Get the free Monkeypox Contact Surveillance Form - dhhr wv

This form is designed for the collection of information regarding contacts of individuals diagnosed with monkeypox. It captures essential contact details, exposure dates, vaccination history, and

How to fill out monkeypox contact surveillance form

How to fill out Monkeypox Contact Surveillance Form

1. Begin by writing your full name at the top of the form.
2. Provide your date of birth in the designated section.
3. Enter your contact information including phone number and email address.
4. Fill out your current address, including city, state, and zip code.
5. Indicate the date when you first had contact with a confirmed Monkeypox case.
6. List any symptoms you are currently experiencing.
7. Add additional information or comments in the provided section if necessary.
8. Review the form for accuracy and completeness.
9. Sign and date the form at the bottom.

Who needs Monkeypox Contact Surveillance Form?

1. Individuals who have had close contact with a confirmed Monkeypox case.
2. Health care providers managing patients suspected of Monkeypox.
3. Public health officials for surveillance purposes.

People Also Ask about

How does monkeypox enter the cell?

Infection biology Once inside the body, MPXV infects cells through a series of interactions between viral and cellular proteins, for instance the viral D8L protein, which binds to the cell surface receptor chondroitin sulfate. Once bound, the virus enters the cell by fusing with the cell membrane or by endocytosis [4].

What to do if you come in contact with someone with monkeypox?

If you know you've been exposed to someone with mpox, contact your local public health authority immediately. Your local public health authority may also tell you that you've been exposed to someone with mpox.

What is the portal of entry for monkeypox?

The portal of entry of the Monkeypox virus includes mucus membranes such as the nose, mouth, and eyes, respiratory and abrasion.

What is the route of entry for the pox virus?

Entry can occur at the plasma membrane or in acidified endosomes following macropinocytosis and involves actin dynamics and cell signaling.

What is mpox pdf?

Mpox (previously named monkeypox) is caused by infection with monkeypox virus, a member of the genus Orthopoxvirus in the family Poxviridae. There are currently more than 80 poxviruses known to science and these poxviruses have been isolated from different species of birds, insects, reptiles, marsupials and mammals.

How is monkeypox most commonly transmitted?

The virus that causes mpox is known to spread through close, interpersonal contact, including direct touching (including sex), or sharing items like towels, beds, etc. The disease is not known to spread in settings where only respiratory spread is possible – for example, across rooms, in markets or classrooms, etc.

What is the mode of entry of monkeypox?

Mpox can spread through close contact of any kind, including through kissing, touching, oral and penetrative vaginal or sex with someone who is infectious. People who have sex with multiple or new partners are most at risk.

What are the contact precautions for monkeypox?

Limit exposure to others Avoid contact with unaffected individuals until the rash has resolved, the scabs have fallen off, and a fresh layer of intact skin has formed. Isolate in a room or area separate from other household members and pets when possible.

For pdfFiller’s FAQs

What is Monkeypox Contact Surveillance Form?

The Monkeypox Contact Surveillance Form is a document used to collect and monitor information about individuals who may have been in contact with a confirmed or suspected case of monkeypox.

Who is required to file Monkeypox Contact Surveillance Form?

Healthcare providers, public health officials, and individuals who have been identified as close contacts of a confirmed or suspected monkeypox case are typically required to file the form.

How to fill out Monkeypox Contact Surveillance Form?

To fill out the Monkeypox Contact Surveillance Form, gather the necessary information about the individual, including personal details, contact history, and any symptoms that may have developed, and enter it into the provided fields on the form.

What is the purpose of Monkeypox Contact Surveillance Form?

The purpose of the Monkeypox Contact Surveillance Form is to facilitate the tracking and monitoring of individuals who have been exposed to monkeypox in order to prevent further spread of the disease.

What information must be reported on Monkeypox Contact Surveillance Form?

The Monkeypox Contact Surveillance Form typically requires the reporting of personal identification information, contact details, exposure history, symptom development, and any relevant medical history.