Monkeypox will be listed as a statutory notifiable disease in Hong Kong next week, the government has said, along with a three-tier response plan targeting the infection. Officials are also preparing to purchase vaccines and medicines for the infection, and are formulating recommendations on treatment. The city has yet to record any case of monkeypox despite a growing spread of the disease globally. So far, at least 23 non-endemic countries have reported cases of the infection which used to occur primarily in central and western Africa. What is monkeypox and should we be worried about it? “In order to address the potential risk posed by monkeypox to Hong Kong, the government will include monkeypox as a statutorily notifiable infectious disease,” an official press release stated on Wednesday. “The government will publish a notice in the Gazette next week … the notice will take effect on the same day.” It is unclear which day next week the new rule will come into effect. Under the new arrangement, doctors are required to report any suspected or confirmed case of monkeypox to the Centre for Health Protection, as stipulated by the Prevention and Control of Disease Ordinance. A response plan in case of emergence or outbreak of monkeypox in Hong Kong is also being drawn up. Officials will announce details of the three-tier response plan and levels of alert next week. Earlier this week, the World Health Organization (WHO) said the public health risk posed by monkeypox at a global level was “moderate”, but warned that it could escalate to “high” if the virus spread to groups at higher risk of severe diseases such as young children and people with weak immunity. Dr Siddharth Sridhar, a clinical virologist from the University of Hong Kong (HKU), said monkeypox “definitely” needed to be listed as a statutory notifiable disease to raise alertness among doctors. “There is a risk of importation to Hong Kong,” Sridhar said, though he agreed the risk was not very high as Covid-19 quarantine rules had reduced the city’s attractiveness as a tourist destination. “If there isn’t a statutory case notification, awareness and alertness of frontline doctors might not be that high.” While some monkeypox symptoms included swollen lymph nodes and rash, Sridhar said conditions of some cases could be quite subtle and doctors could miss the diagnosis if the alertness level was not high. Sridhar argued that monkeypox, like the city’s other 51 statutory notifiable diseases, had fulfilled the criteria for it to be regarded as a disease of public health significance. “If monkeypox became endemic, it could become another smallpox,” he said, referring to a disease that was eradicated in 1980 and described by the WHO as “one of the most devastating” to humans. “We don’t want to see the re-emergence of a similar virus.” He added: “We must spare no efforts in preventing the worldwide transmission of monkeypox … part of the control efforts is an efficient surveillance mechanism.” Professor Ivan Hung Fan-ngai, a HKU infectious disease expert, also saw the need to list monkeypox as a statutory notifiable disease. “The virus is highly contagious,” Hung said. “Early notification could prevent transmission in the community, hospitals and healthcare settings.” The Department of Health on May 23 issued a letter to all doctors in Hong Kong and asked them to report any suspected monkeypox cases to authorities, though the call at that time was a voluntary one. But HKU’s top microbiologist Dr Ho Pak-leung said he saw no urgency in listing monkeypox as a statutory notifiable disease, given the risk of an outbreak was low. “Even if there is one to two cases in the community, the risk of transmission in the community is not high,” Ho said, noting overseas information that the current spread of the disease clustered mostly among men who had sex with men. WHO warns monkeypox outbreak ‘could amplify’ in festival season He argued that if the disease could be easily transmitted through social contact, an exponential growth should be seen in countries which reported cases, but that had not happened. Infectious disease specialist Dr Joseph Tsang Kay-yan said he was not against listing monkeypox as a notifiable disease, as it could provide a legal basis for putting infected patients in specific facilities for treatment. But he said what was more important now was the government’s preparedness against the disease, such as keeping stocks of relevant vaccine and antiviral medications, and having diagnostic tools on hand. He added that all incoming travellers should also be made aware of monkeypox.