Waspada Mpox: Deteksi Cepat, Respon dengan Tepat

Assalamualaikum warahmatullahi wabarakatuh. Peace and prosperity and health to all of us. Praise and gratitude to the Lord Almighty because of the mercy and grace of His mercy, we can all gather virtually today.

Ladies and gentlemen, we have here with us all, the Director of Surveillance and Health Guarantee. May we start the event, sir?

Okay, before I go to the Director, I also want to say hello to the participants who have attended the webinar of the MFOX today. Ladies and gentlemen, thank you for your time and also for having come and have attended the MFOX webinar on July 16, 2026.

Here are our amazing speakers, from BBLBK, Pak Koko, Izin Pak Koko, Dr. Listiana Aziza from the head of the work team of the health quarantine.

surveillance intervention of infectious diseases then also here Dr. Irma, Dr. Gusmi Rati from SKD then Dr. Melati, please Doc, already present from RSPI Sulianti Saroso. May I ask, Director, can we start the event now? Okay, good, thank you, Mrs. Okay, ready, may I ask, Mr. Direktur, can we start? Yes, please, please. Okay, we can start, sir.

Okay, ladies and gentlemen, let's start the event this morning. Before we start the event, please allow me to repeat the invitation of the speakers, moderators, and participants who are present at this event. Distinguished Director of Surveillance and Health Quarantine, speakers of the webinar "Quality of M-PoX",

as well as all participants from the provincial health service, city and city, hospital, then also from the UPD Health Quarantine, the Grand Hall, and the Public Health Laboratory,

and puskesmas from all over Indonesia who are present at today's webinar webinar of the M-POKS body. I wish you a welcome and thank you again to the ladies who have been present with the theme of this webinar of the M-POKS body is "Quick Detection, Correct Response".

Introduce me, Safira, as an emcee in today's event. As the opening of the event, let's listen to Kenneth's speech from the Director of Surveillance and Quarantine of Health, Ministry of Health, to Dr. Sumarjaya SKMMFFP CFA, please. Yes, thank you, Ms. Safira. Assalamualaikum warahmatullahi wabarakatuh.

Good morning, greetings and blessings for all of us. Om Swastiastu Nama Buddhaya Greetings to all of you. Of course, I would like to pay respect to our source speakers, then I would like to pay respect to friends from WHO, there is Dr. Endang, then Mr. and Mrs. Prime Minister, both in the central and regional

as well as the participants of the webinar, "Empok's Perspective with a Quick Theme, Quick Detection, and Quick Response." We are grateful to have the grace of Allah SWT, the Lord who is the Most Gracious, where today we are given health, pleasure, so that we can attend this webinar.

My dear participants, MPOC or what we used to call as monkeypox is an infectious disease that is caused by the monkeypox virus. There are two clades, the first one has heavier symptoms and the second one has milder symptoms. Since the year 2000, since 1970,

Mpoc is endemic in Africa with zoonosis. However, since 2022, Mpoc has been used as the most common country in Asia and Africa with the main transmission of humans to humans. Mpoc has been used as a public health emergency of international consent twice by WHO.

The first public emergency international concern was in 2022 because the case was reported in a non-endemic country without a history from Africa and a large part was caused by the type of Clade 2B. Then the second PHAEC in 2024, the significant increase in Africa was caused by Clade 1B.

Next, this COVID-19 virus spread to various countries. Since 2022, Indonesia reported a total of 92 cases of COVID-19, where in 2022 there was 1 case, in 2023 there were 73 cases, in 2024

there are 14 cases, in 2005 we were not found and in 2026 we reached 4 cases per day, which spread in 8 provinces, in the DKI, in Kalimantan, in South Sulawesi, sorry I mentioned East Kalimantan,

Then there are in the Riau Islands, there are in West Java, there are in East Java, and also in the IAEA. M-POK can happen to anyone. However, based on findings from confirmation cases, in Indonesia there are 97% cases of male sex. 90% of sexual intercourse.

and 60% of men are male sex, or called LSL. And 72% of cases are with HIV status. Most of the cases are cured, but one case also happened at this time because this is a death factor, because of the co-infection factor or the so-called other disease recovery factor.

Of the 5 cases of sequencing examination, 54 cases were caused by Clade 2B. However, there were 3 cases in 2025 that were caused by Clade 1B. This 1B is quite heavy, so we need to do a balance check.

My distinguished participants in this webinar, as a form of empowerment, the government has made various efforts, such as screening on the road of action, the entry door journey through All Indonesia,

then the joint response with the community and partners, HIP or AIDS. We have 168 hospitals, in the service network, PEE training, and there are also 21 Sentinel hospitals for PEE. Then we also have human resources, therapeutic empok, laboratory and examination, pedoman, and also KIE empok media.

We also socialize with the community and health workers. Then, we also conduct this fundraising by giving this fundraising to the patient cases in all of Indonesia. The success of the Empok program is not separated from collaboration and cooperation from various parties.

We hope that you will always follow the development of the situation and the information of the MVOC to strengthen detection and response. Participate actively to spread verified information and avoid information related to the MVOC. Increase access to health services and infective transmission.

without stigma and discrimination. My dear participants, through this webinar, I invite all of you to learn from the source speakers and get information from the source speakers and discuss with the source speakers in the field of prevention, identity detection, and handling of M.P.O.C. diseases.

To all the invitations, I congratulate the inauguration of this webinar. Hopefully it will be useful for all of us. Finally, by saying Bismillahirrahmanirrahim, the webinar "Empok's Perspective with the theme of "Quick Detection, Quick Response", I open it officially. Thank you. Wassalamualaikum warahmatullahi wabarakatuh.

Waalaikumsalam warahmatullahi wabarakatuh thank you very much Mr. Director for the extraordinary welcome excuse me Mr. Director before we continue to the next event we will take a photo first with the speakers and moderators as well as the participants please be pleased Mr. Director and speakers, moderators and participants are welcome to activate their cameras can be helped

The female team to take pictures. Okay, we will take a photo together. Okay, I'm Aba-Aba. Okay, we will take pictures. 3, 2, 1. Okay, once again. Okay, smile cheerfully in the morning. 3, 2, 1.

Okay, thank you very much. We allow the next event. Ladies and gentlemen, we will enter the main topic of today's webinar. Where today's webinar will consist of two panels. The first is panel 1, which will be moderated by Dr. Cita Septiawati,

Then the second panel will be continued later with the moderator Dr. Melati Hidayanti, SPPD, S-Pharm, S-Pharm. Okay, before that we will start for the first panel. The first panel we will just go to Dr. Cita Septiawati from the Surveillance and Intervention Team of Emerging Infectious Diseases. We invite you to start panel 1. Please, Dr. Cita.

Thank you, Ms. Safira. Assalamualaikum warahmatullahi wabarakatuh. Good morning, ladies and gentlemen, and my fellow members. For this morning, in panel 1, we have three great international speakers. For our three speakers. Maybe later there will be from WHO,

Then there is a specialist in internal diseases, Dr. Robert Sinto. And the most advanced one is from the Surveillance and Intervention Team of Emerging Infectious Diseases. First, we invite Dr. Endang Widuri to tell us how to update the Global M-POX case. Please, Dr. Endang.

Thank you very much, Mrs. Cita, Dr. Cita. Good morning, ladies and gentlemen. Allow me to share the screen. Ladies and gentlemen, thank you for the opportunity. So, on this occasion, I will share about the Global EMPOC update, which actually you can also access on the WHO website.

On the WHO website, there is also a dashboard that covers global updates from mpox that are updated in batches. So for mpox, it is caused by monkeypox virus, which is included in the genus Orthopoxvirus, which we also see in it,

from this mpox there are two clades, so there is a clade 1 which is a Central African clade and clade 2 which is from West African clade where for clade 1, usually the symptom is heavier, the lesion is larger and causes death with a higher CFR than clade 2 so the CFR is

between 5-10%. Whereas for the second case, the symptoms are usually lighter with CFR or less than 1%.

and this is especially for subclade 2A, which is usually from the genesis, but there are also increases in West Africa that have been reported. Meanwhile, for subclade 2B, this initial detection comes from Nigeria and has caused a global outbreak in 2022 to 2023. And for this subclade 2B,

there is an inter-human transmission that can be through direct contact or contact with contaminated objects.

And here for the Kled I, it is also mainly zoonosis and in 2023 for Kled Ib causes a fairly large outbreak in the Democratic Republic of Congo. And this is an inter-human transmission. So here we see the difference between Kled I and Kled II, Madam.

Then lately, for MPOX, there has been an increase in cases in the Democratic Republic of Congo and

There are other countries that have increased their cases, namely in Clit 1A and 1B. Then, we know that it has been said that MFOX has been a PHEIC, where the WHO, based on the recommendation of the Emergency Committee, has set MFOX as a PHEIC, namely the first on July 23,

from May 2022 to May 2023. Then after that,

the increase of MFOX in August 2024, then it was set back to PHEIC MFOX on August 14, 2024 until September 5, 2025. So for MFOX, it was first found in 1958 through research in Denmark, actually.

which happened in the Kera colony. And for the first case, it was reported to Manusia in 1970. Well, after that, there was indeed a pandemic that happened, which was lost, and finally on July 23 and until

So, if we look at

update Mpox now, which we can see and access from the Mpox WHO dashboard, we can see the total Mpox cases from the beginning reported to increase cases until now

it is indeed for countries that report quite a lot of Mpox cases, it is seen in darker colors. For example, in the United States, Africa, there are also countries that report it, including South America. And here we also see that

countries that report M-PoX in America, the completeness and accuracy are quite good, like that. America, then also Europe, it's pretty good. But there are countries that report with quite poor completeness. So, for example, there are those who do not report cases, such as Inol Kasus, this is the white one, there may not be a good report, like that, Madam.

Then we also see the death of Mpox reported, which we see from America, then also from Africa, this is in DRC in Congo, and also in South Africa.

Well, if we look at the development of this MFOX, the 12th period of the last month, there is still an increase in cases that are the same for countries that report quite a lot of cases, namely in the United States.

Europe, Africa, the West, South America, Australia, and China also reported the Mpox case. In addition, in the last 12 months, there was still a death from the Mpox reported.

And if we look at the last month of the dashboard, there are still countries that are still reporting Mpox. Where here we see there is still a report in Congo, then there is also in China, then also in Australia. And there is also a death in Madagascar, which reported the Mpox case as well.

We have seen that there are some improvement in MFOCs based on the 1A and 1B clades reported in the WHO dashboard. We have seen that for the endemic countries, for global transmission status, the 1A MFOC clade

foreign

history of travel, so there are travel stories. For example, in China, then Ireland and Turkey, they reported cases with travel stories.

Then, when we look at the case with CLAID 1B, there are quite a few countries that report community transmission from CLAID 1B. So, in some South American countries, then also in South Africa, India, then also in Australia, we see this for

countries reported a 1B case from MFOX, which indeed here there is a community transmission, then also for the USA, China, and Ireland, this is still a case that was reported, it is linked to travel, there is a history of travel. Well, besides that, if we

overlap, from clades 1A, 1B, and clade 2, we can see the distribution of clades, where there are countries with clades that

reporting clit 1A, clit 1B, or clit 2. For example, here in some African countries. Then in America itself, the majority are clit 1B and also 2.

Meanwhile, for those in Indonesia, it was reported as a second case, it can be A or B. Now, if we look at the period from January 1, 2022 to May 31, 2026,

There are still cases reported since December 8, 2025. In fact, there are reported three recombinant M.pox infections, Clade 1B and 2B. So, this is a story of travel to Southeast Asia for cases reported in the UK. While for cases reported in India, there is a story of travel to the Arab world.

While for the ones in Qatar, we do not know the source of the transmission. So if we look at it from 2022, there have been a lot of Mpox cases reported, reaching more than 187,000 cases with 510 deaths.

Meanwhile, in May of 2026, there were still many countries reporting and the cases were still 1844 with 3 deaths from 34 countries. So if we look at it based on the region for M4,

for the MFOX that reported this MFOX case, for the African countries, the detailed details of the case are very few. So we know that there is a possibility that there is also an ice mountain phenomenon, there are cases that are not reported. Likewise, in the Eastern Mediterranean region, the detailed details of the case are quite low.

So, when we look at the total confirmation of the case, many were reported from the United States, then the second from Europe, but we see that the details are quite complete for the detailed report of the case.

Maybe for other regions, we have to see it with the cases reported, but for the details of the case report, we know it's still lacking. If we look at the trend from this Mpox case,

From around April 2026, many of the European regions reported cases, including the Western Pacific region. And if we look at

only Africa for the Africa region, from June 2025 to December 2025, there are still cases that are still reported, even more than a thousand cases reported after April 2026, so it is still circulating.

And here we see from January 1, 2022 to June 28, 2026, there is still an active KLB from Mpox in Africa, including Central Africa, South Africa, and Madagascar. And here for the clade, we see that there are variations of the clade in several regions.

For example, in South Africa, it is dominated by the 1B and 2B clades. Meanwhile, in Central Africa, there are mixed clades. There are clades 1A, 1B, or clade 2. Meanwhile, in the north and the west of Africa, in this part,

We see here there is a second clit

Here we see cases in Africa for the total summary cases, the most of them are from the Democratic Republic of Congo, total cases from 2025. So there are quite a lot of cases, such as case 1A, 1B, or case 2. Meanwhile, if we look at the whole case from Africa itself,

total of the confirmation lab is about 70,383 cases. So if we look at it from

the graph, then indeed for the highest case is between around October 2024 until August or until the end of 2025, but after that we see that there are still cases reported until now.

Then, if we look at Madagascar, here, indeed in this year, there is an increase in cases, and the cases are still reported, and quite a lot as well. And for countries with a B-clade,

in Africa, there are still reports of cases, even though there are fewer reported cases in this year, in this year, compared to the previous year. Meanwhile, for other countries, which are not countries that reported 1B, the cases have indeed decreased, quite a lot have decreased compared to the cases reported in the year 2025.

Based on the development of MFOX earlier, in February 2026, WHO has also organized or updated the Global MFOX Rapid Risk Assessment based on epidemiology and also the development of MFOX cases globally and in some countries with active KLB for MFOX.

And the results of the risk assessment for public health risk globally, the risk assessment is moderate with confidence for the risk assessment that was carried out in February this month, it is moderate.

And for individuals with multiple sexual partners, it is also moderate for global public health risk on individuals with multiple sexual partners. And for other individuals who are not included in multiple sexual partners, the global public health risk is low.

Meanwhile, here for countries that historically have an endemic area, it is moderate. Because indeed, when we look at the countries that have an endemic area, there are also quite a few children, the cases that are reported.

Well, then, based on the results of risk assessment, then also based on the analysis results, then from WHO globally arranging strategic plans for the multi-country outbreak of MFOX, how can we contain MFOX

which of course requires cross-sector involvement and also this must be based on health emergency preparedness and resilient response framework where it actually covers five pillars, there must be emergency coordination for

including sector cross-sectional in mitigation and mitigation, then there is a need for safe clinical care for the implementation of the case management and must also be integrated with existing programs, for example, with the HIV program, then in addition there must also be community protection

and surveillance is still done collectively and collaboratively, and we want to detect early for signs of Mpox that exist, so that we can verify, confirm, and respond quickly to contain the case so that it does not spread further in the community.

In addition, WHO, together with other partners, promotes countermeasures and research for this research.

Then from some of the experiences that we have, we see that there are updates from the experts about this MFOX, starting from clinical management, then infection control, how to avoid clinical assessment for suspect or confirmation of the case,

And here are also guidelines about community protection and infection control and supportive care in the community. And some other guidelines for surveillance, case management, and RCCE.

Meanwhile, globally, we have progress in the field of diagnostics, there are diagnostic tools that have been included in the emergency use listing for this MFOX.

In addition, there is also a global clinical platform where countries can input data, then we can also see the analysis of the symptoms of MFOX that exist and for us to analyze together to guide or be our response guide.

Then there is also a guide for vaccines that have been issued, namely MVABN and LC16M8, as well as operational and vaccination training. And not less, there is also information and implementation about One Health, where here together with WHO, it also builds or organizes a platform for Mpox investigation on animals.

In addition, there are clinical trials for clinical procedures and infection control that are being renewed. Then joint intervention trials for priority groups, as well as vaccination strategies that focus on high-risk areas for risk communities.

In addition, globally, we have built an access and allocation mechanism to access resources for countermeasures and continue to promote research for the strengthening of scientific evidence.

In addition, the WHO and the Ministry of Health have also organized risk communication messages to be used by the indigenous communities and high risk. In addition, this can also be informed to travel agents from the affected countries so that they can protect themselves from

and know the prevention and any initial symptoms so that they can quickly report to health officials if they experience Mpox with the risk factor of Mpox. Next are references that you can see from

WHO sources including the news and also the disease outbreak news update that we can access together. Thank you very much for your attention. I will return it back to Ms. Cita.

Thank you, Ms. Endang. We have received a lot of information about how MPOCS is global and if you want to access the information that Ms. Endang mentioned earlier, there is Q&A and so on from WHO, please open the WHO website.

Remembering friends who have questions, please enter the Q&A column. Next, we invite Dr. Robert Sinto, a specialist in internal diseases, who will talk about mpox epidemiology. We invite Dr. Sinto. Good morning, Dr. Cita. I think my camera is not visible, right? Is my camera messy?

Yes, it doesn't appear. Wait, I'll try to join. But to save time, I'll try to... It's okay, Doc. If there's a camera problem, maybe we can help to share the screen from us.

Okay, I can share the screen but the photo that doesn't appear is Dr. Cita's, right? Yes. Oh, this is out, doc. Oh, it's out, okay. Please, doc. Okay, I'll share the screen first. Wait a minute.

Why didn't it appear? Because I did a little adjustment on PowerPoint so that it wouldn't be too high-pitched as what was said by other speakers. Okay, good. One more second, share doc. Can you see it, doctor?

Thank you, Dr. Cita, and I apologize for the technical difficulties. Good morning, dear professors, seniors, students, and health professionals. I am very happy to be back on this morning's discussion about MPOC.

the topic that was given to me is quite general about epidemiology and pox, a bit detailed with other speakers, but hopefully what I say can be an overview, a recap of what has been said by Dr. Endang and friends later in the next sessions. I try to talk in the context of mythos versus facts, so hopefully it can be easier to understand in everyday practice.

First, disclaimer, because this is an emerging disease, the data that is displayed must be updated based on new things. Therefore, what I am telling you today is data that I can update based on literature or epidemiological reports that have been available until today. I started by summarizing some slides that were also conveyed by Dr. Endang, but hopefully I will bring it from a clinical perspective to be able to see

data data that exists so this data has also been displayed by Dr. Endang showing that although

Mpox as if the cases are decreasing and indeed the world's reports are decreasing but still friends ask why the KMKES is busy making us come back to discuss Mpox because indeed this case has never disappeared from the world so the case is in the world and if we remember the country at the beginning of Mpox reported was Africa Africa still reports cases and stable as well as other countries outside

So other regions also reported this Mpox case in several months, even until now. And even Indonesia, as Dr. Jaya said, reported Mpox cases in recent times.

What's interesting is this picture talks about which country reported Epoch in May 2026. Indonesia or doctor, it hasn't yet, so the color is still white. There are some countries in the surrounding area of Indonesia that also reported the case. Australia and China also reported the case of Epoch in the last month. Sorry, doctor, the slide hasn't been uploaded yet. Wait for me, I'll be right back.

I'll try to share it again, Doctor. Share window. Can you see it again, Doctor? Not yet? I can see it, Doctor. But, yes, it's done now. Okay, good.

So, other countries outside Indonesia reported the case. Earlier, our neighboring countries, namely China and then Australia, also reported several countries in Europe. And with very easy transportation progress, it is unlikely that there will be a very easy transmission of change between one country and another.

Ledo Tendang also said that it is underreported, so even though in Indonesia the place is scattered, in some islands, even in Indonesia, it shows that circulating in Indonesia actually exists. The only problem is whether we can detect this epoch and the purpose of this webinar is to be able to detect, improve the health of the business in detecting these cases so that it does not become a spread in the community.

We know that there are 1st, 2nd, then there are subclades, each 1A, 1B, then subclade 2, there are several 2B, and so on. Indonesia reported all of its cases at the time of 2022-2023 as 2nd, and at that time Indonesia did sequencing to find out that this is the 2nd. At that time, there were many reports in almost all countries in the world. All reported 2nd at the same time.

Well, the first case is the one in Africa, but we also see that the case in Africa has become a source of concern because it is not only now that it is being localized in Africa, but other countries have started reporting the case of the first case B, the closest to us is Thailand, then Australia also reported it, then India also reported it, so the first case B is also reported in many countries in the world.

The cases that are currently reported by the Ministry of Health and Welfare have not yet been analyzed, so it will be interesting to know which clit is diagnosed in Indonesian patients, so that we can know the source or potential spread. Hopefully this B1 is also emerging in Indonesia or in some places in the world. So when does it become important? So I start with the first myth and fact.

There is no difference in the appearance of Mpox clinical in various clits. What is it for? We were asked about clits, we know about clits. The answer is because clit 1 and clit 2 have clinical images or clinical appearance, both spread and different outcomes.

As an example, the most common one we found in 2022 is Clade 2B, which is exclusively human-to-human transmission, different from Clade 1. In Africa, the basic distribution is zoonotic, so there is a distribution of animals, animals are infected reservoir hosts, which then spread to intermediate or incidental hosts, which then spread among humans. That's for Clade 1.

Meanwhile, for the second lead, the zoonotic theory is less likely and more interfered with by human-to-human transmission through close contact. One of the close contacts is through sexual intercourse, but not necessarily only sexual intercourse. So, there are many other reports that sexual intercourse can also be through close contact. But the key word is close contact.

And it's different if you see one in Africa, then limited nosocomialismination, mostly intrafamilies, so families. So in Africa, most of the children are inherited from their parents who are affected by mpox, then become intrafamily. Meanwhile, if you see 2B, most of them are mostly sexually transmitted and mainly the relationship is MSM, men who have sex with men with multiple partners.

What about the outcome? So the outcome of the death if for 2B is small, 0.025%, but in immunocompromised or mild individuals, the death rate can increase to 15-30% in some cases. Meanwhile, the death rate of the first clock is higher, with a case fatality rate of up to 10%.

Why do we need to talk about clit? We have to be careful which clit is affected. If we used to have 2B, then in individuals who are relatively healthy, relatively immunocompetent, with low mortality, then if the previous 1 clit, 2 years ago, was close to Thailand, it became a concern because the mortality rate was naturally higher than with 2B clit.

Later, the doctor will convey the difference between mpox, with aqueous and with aqueous. So clinically, we can be a guidance to differentiate between the three clinical images that we often find in daily practice. Later, we will wait until the second session, Dr. Pras will convey this difference in more detail.

Epidemiology is not just about the spread of cases, but also about the risk factor. Therefore, I brought the data from the Ministry of Health, which was collected based on data from 2023-2024. The majority are men, only a few are women, but this shows that there can be cases in women, not only in men.

The age that is most affected is the age of active reproduction, so 25-39 years old, and sexual orientation is the most common, which is LSL. Once again, our goal is not to discriminate, but our goal is to help the population in the community, so that we can increase clinical suspicion that makes us be able to diagnose more accurately.

So it's not really the purpose of discrimination, but more towards how we are aware of the risk factor population. The most participating conditions are HIV, there are many cases with HIV, but there are other comorbidities that can also happen in patients with this mFox.

The most common causes of the outbreak are sexual contact, then the condition of symptoms that appear, most of them are symptomatic, so that they come even though there are asymptomatic, so the contact tracing at that time was not symptomatic and then we checked and it turned out to be positive in the eviction of the voxel.

The most common symptoms are lesions, then the second is fever and phlegm. These three are the main symptoms plus lymphadenopathy. So, friends in the clinic, if you are asked to enter, to suspect, there is lesion, there is a special phlegm, later on it will be explained by the next resource, there is fever and lymphadenopathy. This can be an entry point for us to increase the diagnosis and diagnosis of the population group.

The majority of cases are 99% healthy, even those who can experience independent isolation in some groups of patients.

Interestingly, if we suspect or diagnose mpox, the data in the world shows that 30% of it is a concomitant sexual transmitted infection line. So our PR is two sides. Every time we diagnose an STI case, we think of mpox as a comparative diagnosis if we suspect there is a suitable lesion.

On the other hand, if we face an Mpox case, then don't forget to stop until Mpox, but we have to eliminate the possibility of other diagnoses in the STI. The most common are syphilis, gonorrhea, and chlamydia. So we have to do active case finding so that we can track other infectious diagnoses that occur in patients, not just stop until Mpox diagnosis. Okay, that's number one.

Second, the diagnosis must be determined by blood test as soon as we suspect what we can do to the patient as a clinician or as a medical staff. It should be understood that there is an incubation period, which means the patient has been vaccinated from the mpox patient but has not shown clinical progress. The time is 5 to 21 days.

meaning that in 5-21 days, as long as the person is in contact with the Mpox patient, it can be not showing symptoms. Fortunately, unlike COVID, this incubation period does not spread. Unlike COVID, the incubation period is definitely spreading. If the incubation is on the Mpox patient, the patient does not spread, so the patient can still do the activity

But what is needed for health workers is to monitor the contact with the individual. And for that, in every MFOX case, the approach cannot only stop at the individual for us to diagnose when it is finished, but the approach must find a close contact with the patient so that we can monitor within 21 days.

In 21 days, if the patient shows symptoms, then we will do the diagnosis. But for the first 21 days, we don't need to do the diagnosis on the patient. What symptoms appear? Divided into two phases. The first phase is the prodromal phase.

fever, headache, enlargement of the parietal cartilage, this is quite special, then back pain, headache, and weakness, symptoms such as other viral diseases. In just 5 days, we can already do diagnostic tests. Then, on the day 1-3 after the prodromal, the ruam will appear. In the ruam, we can do other diagnostics.

What diagnosis can be done? In acute or prodromal diseases, we can take specimens from swab tonsil, swab anal, and serum. We can take these three.

But if the space has started to appear, then we can still do the swab examination, but if there is a vesicle or pustule, we can take the lesion fluid and the lesion fluid is destroyed, the lesion, the ventricle, then the vesicle, then we can do the PCR examination. And Indonesia has the capacity to do PCR examination for that epoch.

In the next discussion, we will discuss more details about specimens, management and delivery. But the clinical image complements the perception that for individuals who have a hard contact, not yet symptoms, no specimen examination is carried out. Individuals with hard contact with symptoms, starting to appear prodromal, we can do an examination from the anal swab or rectal swab or from the serum.

Third, the monkey's venom can be cured by itself. Again, there will be a more specific discussion on the procedure. But I will try to repeat a little, is it true that he can be cured by himself? So in general, he can be cured by himself in a longer time, 3 to 4 weeks. Our experience in treating some MFOX patients in Indonesia at that time, indeed the symptoms will disappear, it takes a relatively long time, 3 to 4 weeks for the lesion to disappear.

The most typical of this mpox is the sense of pain. So lesions are painful, unlike water stains. One of them is the gout. This one is the complaint of the vesicle, usually painful.

Although he can heal himself, in some cases it can potentially become severe or prognostic. This is why in patient education we still need to be patient, even though he can heal himself, but he must report or take medicine to the doctor.

so that the doctor can analyze which patient is at risk of becoming heavy, which later must be considered for antiviral treatment. So the group is divided into 4 groups. The first group is a group that does have a risk factor or comorbid that becomes heavy. For example, pregnant patients, immunocompromised or HIV uncontrolled, for example. Or patients with chronic skin disease, which then has a potential to be bad with the presence of MFOX infection. A group that is potentially heavy.

Or secondly, groups that already have heavy signs and symptoms, so for example patients with mucus, vomiting, there is lymphadenopathy, which is the area that interferes with the function of the patient, so for example dysphagia, so the lymphadenopathy is affected by the Tenggorokan area, for example, or oral oxygen is reduced because the lesion can also occur in the mucosa area, namely mucosal mucus, mucosal

constipation and makes it scary when swallowing and this is disturbing because it disturbs the food intake or there is hepatomegaly, dehydration, or stress, pneumonia, or cognitive disorder. So this is the analysis or second examination that we have to do.

Third, we are encouraged to do laboratory tests because there are signs and symptoms of weight that arise from lab tests such as increased leukocytes, increased aminase enzyme, decreased HUN or albumin or thrombocytes. And the fourth is the doctor needs to do a count of the amount of lesions. If it is heavy, it is 100 to 250, if it is very heavy, it is 250 lesions or more.

So the group that we as doctors, as clinicians, when we face mpox must do a screening to see the four images. Then later we will determine whether the patient needs independent isolation or must be treated, centralized isolation, and secondly whether antivirus should be given or not.

In addition to these two things, we will provide symptomatic therapy to relieve complaints, accelerate the development of lesions, we will overcome fever, loss of fluid, and then prevent the formation of a skin tissue on the lesion and then prevent the formation of secondary infections.

The most important thing is the management or understanding of prevention. So the key is close contact. Close contact is through droplets or through skin lesions. One of them is sexual intercourse. So to prevent this transmission, besides we can detect the case, we educate how to prevent transmission from one individual to another through the path of close contact, droplets, or skin lesions.

Lastly, about vaccination, the solution to all infection problems is vaccination. Is there vaccination or not? So vaccination is one way, but not the only one. The prevention of transmission in other ways must be empowered, starting from the Dini diagnosis, then the prevention of transmission is one way of vaccination.

The vaccination is given in the form of two doses and the dose is passed from one dose to another dose for four weeks, only to give a protective effect in two weeks.

This vaccination was given in Indonesia, in Jakarta at that time, at the end of 2023, there were 545 individuals who were invited to get vaccinated and 430 of them had already been vaccinated, two doses 87%. Now, together with the Ministry of Health and the Ministry of Health, we are also now evaluating antibodies or serology and immune response that appear as soon as

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But even without vaccination, it doesn't mean that we can't prevent this epoch. I have just mentioned many aspects that we can do in the prevention of vaccination. Indeed, the world is now focusing on vaccination for African countries because we know that Africa has become

endemic active for mpox that has been around for a long time. So, the spread of vaccination in other regions is not a priority, not much, but later we will see as we develop whether we really need this vaccination in Indonesia or not.

Okay, this is maybe what I can say in this short time, hopefully it can provide an overview of epidemiology, how we can describe disease distribution, and also how we can describe the transmission and prevention efforts, as well as the treatment of mpox, so that we can apply it in our daily practice. Thank you, Dr. Cita, once again I return the opportunity to Dr. Cita.

Thank you, Dr. Sinto. Let's give a pose for Dr. Sinto. Dr. Endang and Dr. Sinto, hopefully you can still join us for another material, so that we can discuss it later. Next, we invite Dr. Listiana Azizah, who is very cute, to tell us how the Swimvalent M-Pox works in Indonesia. We invite the cutest doctor.

Thank you, Ms. Cita, for the opportunity. This is the beginning. Ijin, can I get a transcript from Panitia? Yes, please. Thank you, Ms. Cita. Please, Dr. Listiana. May I have a slide, please?

Good morning, ladies and gentlemen. Assalamualaikum warahmatullahi wabarakatuh. Thank you for giving us the opportunity to convey the importance of the MFOC surveillance in Indonesia. We know that the Ministry of Health has been making a lot of efforts to monitor the MFOC

Next.

This is the situation of the M-POK in 2026. Earlier, the Director has also mentioned the general situation of the M-POK case in Indonesia, including the one in 2026.

This is a detailed picture of the four cases reported from the four provinces, namely Sumatra Selatan, then DKI, West Java and East Kalimantan. Of course, we really appreciate the provinces who have found this case.

So, it was found from the hospital and also from the puskesmas. From a total of four cases, all of them are men. Then, the age is around 25 to 39 years for the transmission through sexual contact. And most of them are bisexual, 50% and LSL, 50%.

Most of the cases are still isolated in hospitals, then one is cured and the other is isolated and one died because of other reasons.

Then related to the participant condition, it was said by Dr. Sinto that when we find an EMPOC case, it is necessary to pay attention or need to look for other diseases. Here, it turns out that the participant condition is HIV, then also civil. So, if you find a sexual disorder in the clinic, or in

hospital, you also need to pay attention that this may also be a disease. Then the incubation time is indeed 5 to 21 days, which is around 25%, 8 to 14 days, which is also 25%, and 1 to 7 days in 50% cases or in 2 cases. Then related to the symptom distribution, there are also

So,

detail related to the case of EMPOC and it was said that indeed the current clinical trial is what has been reported from three cases of four cases, this has been done sequencing analysis and the result is GLEAD 1B, so we can

Now, I'm not curious anymore because the second PHIC is related to circulation related to 1B. And Indonesia has just reported 1B in the year 2026. So, this is the first case reported in Indonesia related to circulation.

and this is also our understanding that Dr. Sinto said earlier, be careful if this is 1B, it is clinically heavy, so it is indeed in accordance with what Ms. Endang said earlier, then Dr. Sinto too. Okay, next slide. Then related to the epochal consciousness in Indonesia, next.

This is related to the regulations of the parents. So, when it comes to health transformation, we also have laws, then the instructions of the president, the government regulations, then the ministerial regulations, which were recently released, namely the first, third, so this can strengthen us in the future, especially for

Next.

The definition of operational case is also visible in the EMPOC document. There are suspect cases, probable cases, confirmation cases, discarded cases, and counter-reference cases. For the FASKES or the Ministry of Health, it is important to make sure that the cases

Next.

This is a suspect case, where the first one is someone who has contact with a probable or confirmation case within 21 days before onset of symptoms and signs and has one or more symptoms and signs as follows, namely acute fever, then headache, headache, back pain, fatigue, or

someone who has a ruam symptom since January 1st, this means January 1, 2022 because we adopted from the WHO's guideline, so at that time it was the first PHEC, but this is actually just ignored, so it means someone who has a ruam symptom, lesion in the mucosa or lymphadenopathy, where ruam in the skin includes single lesion or multiple lesion in the argyl area,

anogenital or other body areas then mucous lesions include single or single lesions in the mouth, conjunctiva, urethra, penis, vagina or lesions in the anorectal then lesions in the anorectal can also manifest as anorectal inflammation, bleeding and or bleeding then

Point number two is also accompanied by the general cause of the house of the mother, which does not explain the clinical picture, namely varicella, herpes zoster, herpes simplex, skin infection, and so on. So indeed, sometimes someone is asked, is it necessary to do a lab related to varicella, and so on. Actually, if with a clinical picture, I'm sure it's please stated as a suspect case.

Then, of course, this needs to be seen again related to the probable cases. Well, the probable case is someone with acute colorectal rupture symptoms that cannot be explained, lesion of the mucosa and liver demonopathy.

related to the explanation of the skin space, yes, ladies and gentlemen, related to single lesions or genital lesions and accompanied by one or condition of epidemiological factors, namely the first one has an epidemiological relationship with a probable case or confirmation case within 21 days before onset of symptoms, so it is indeed

whether he has been in contact with the probable case or the confirmation. Then the second is identified as gay, bisexual, or a group of LSL. So I emphasize here that this disease can be

influence or be affected by anyone but indeed by looking at images in the global or in Indonesia there are groups that are indeed risky related to lifestyle then the C is to have more than one sexual partner or anonim sexual partner in 21 days before the onset of the disease and this is mostly found in cases of

from 2022, most of them are intermarried and then the partner is anonymous, so he doesn't know, so he usually knows on the date app or knows at a party or in one area or place, then has a sexual relationship with

Then the antibody IgM or the positive result for the orthopoxvirus infection is detected. This is the important point for you to know.

This is for confirmation cases, of course, confirmation cases when the suspect case or the probable case is confirmed positive when checked with PCR and/or sequencing. Then the discard case is of course the cases that are checked with PCR testing, then the result of the PCR is negative. But be careful here, if the cases are

Next.

This is the contact rate of people who have contact with a probable case or a confirmation case since the symptoms began until the patient was released. Dr. Sinto said that this case is likely to be 2-4 weeks, so it can be as the infection period until the patient is released.

the ripples are peeling off. So, if the patient is diagnosed, the patient needs to find out when the last contact was. In the case of confirmation, who did the patient contact during the infectious period? This is what the patient needs to find out. The contact is physical contact directly with the skin, for example, touching, hugging, kissing, then contact with contaminated substances, then

even though it is possible to drop-light, but it must be in an intense and extended way, so the contact is for example a house. This is very possible for drop-light, even though it is very difficult for drop-light. Then, the NAKES who do not use the APD appropriately. How about the case detection and response?

This is generally a route of how we can conduct case discovery, how we can understand the response when the discovery can be done at the entrance door, friends, from the entrance door at the BKK, then, or the clinic at the BKK, then, the Deposkesmas or Vaskes or hospital, when finding people, then, it is done, for example, depending on whether it is referred to, depending on the clinic, yes, it was also said by Dr. Sinto,

because there is a clinical trial, it can be light, it can be heavy, then later the specimen is taken, then what is done in the hospital, of course the procedure, then for example in the hospital, further investigation can also be carried out.

Then reported, at this time the report is also through, for the specimen through the oral record, so later it will be explained by Mrs. Irma, Dr. Irma at the end of this session. Later the report will also be through ABS-SKDR, then later the court must also ensure that the cases are indeed appropriate, the response has been done correctly.

Of course, the information from the parents will be our basis for how we will implement the next policy. Then, regarding the laboratory, it is also necessary to ensure that the specimen test results are also reported through All Record. Next. Well, this is how we can be sensitive to finding cases. So,

It needs to be highlighted that for those who work in emergency care facilities, in dermatology clinics, patients come with acne, and the acne is not healed, the acne is big.

it also needs to be careful because some patients also come from beauty clinics or from dermatologists because of acne complaints this also needs to be careful then from urology or obstetric gynecology because it was said that the symptoms were also found in the vagina or anal because the lesion

There are also many of them, even though it's not like before when it was about animals, but if it's now, it can be single or multiple in the area.

anal. Then related to dental clinic because it was also mentioned by the doctor here too because it can be in mucosa mucosa. Then related to HIV and AIDS services. Well, this also needs to be careful, Mr. and Mrs. So when in the clinic or in the HIV service, find cases with symptoms of ruam, well, this is possibly one of them is EMPO because clinically

same as other sexual transmitted diseases. Then how to strengthen the community, so later it can be from local friends, it needs to be related again, related to the supporters or supporters to strengthen how to communicate the risk,

update the information related to this information, then related to the contact law or IHR notification and of course the response in each case, you can adjust it later, it has also been stated in the guidelines, how you must notify, where to notify, then what is the clinical procedure like

Okay, next.

This is an example of the discovery

cases for MFOX disease, for those of you who work at Sentinel Hospital, we also have a special line, how to find cases of people with acute acute brain syndrome, when patients come to the hospital, it is necessary to make sure or we remind again, even if it is possible that the patient who comes here, it is possible that one of them is MFOX, but maybe there are other diseases.

Next.

to

information such as sexual contact, sexual orientation, it also requires a lot of effort. And back then, people came to the

If it's hard now, it's usually a case of trust in one person. So, if one person is trusted, he wants it, so it's open to that. This is also for those of you who find this, you need to be careful. Don't let many people ask you, finally the case can't be contacted or can also run away. That can also happen, Madam.

based on the cases that have been in Indonesia yesterday, namely the experience in 2024, 2023, it is very, what, it has become a lesson for us that it is not as easy to find a contact, it is not as easy as finding a contact, like other manual diseases. Well, in this contact tracing process, of course, you are also very, this is the step, you already know very well how we need to identify the contact from the confirmation case, when the confirmation case is,

When is the infectious time? Well, that's looking for the contact details, just be ready at the time of the infectious time, when you find the contact details, later you will look for whether the contact is positive or not, then of course for monitoring the contact details, it is for 21 days since the last case then

for asymptomatic contact, there is no need for quarantine, ladies and gentlemen, just please, later the important thing is to do monitoring. Now for asymptomatic sexual contact, so for example, the case is in a house, already has a wife, for sexual contact, please be taken to do a swab test,

orovaring and or anal rectal. Of course, if asymptomatic, there is no sign of lesion, right, Bapak Ibu? So, it is taken as orovaring and anal rectal. Now, I need to underline several cases, Bapak Ibu, even though

the lesion has been taken, then swab rovaring, but it turns out that the lesion swab is negative, so the positive is the analysis of the anal swab or rectal swab. This is also very possible because there are also some possibilities that the taking is not appropriate,

or not fit. So, if your husband meets a suspect or a probable, please take it for anal rectal. Besides lesion, anal rectal, then oropharyngeal as well. Then,

the symptoms of lymphadenoma without a room, then it must be immediately isolated and monitored with additional signs of the room or lesion. Then, the tight contact that has symptoms of prodomal or without skin lesion, then PCR testing is carried out with oral swab,

Okay, next.

These are the media that you can access on the KMNCAS page or on the top link of the M-POK's website. You can easily click on KIE media, the domain, and then the FAQ, the risk assessment report, etc.

Okay, ladies and gentlemen, that's all from me as a closing statement. Of course, we invite all of you to continue strengthening this EMPOC awareness through quick, accurate detection and response.

and coordinated or continued to collaborate with various sectors or programs because if we collaborate together, of course we can be optimistic Indonesia can be able to control as it was in previous years and of course this is all to protect the Indonesian community

Thank you, I return it to Dr. Cita. Please, Dr. Cita. Thank you, cute sister. Let's give a round of applause for this cute sister. Thank you, Dr. Endang, Dr. Sinto, Dr. Lisa who have conveyed the material. And of course we will now read what has been conveyed by all of you to ask.

Maybe here it's a bit of a majority to Dr. Sinto, it seems, Doc. I start with the least, yes, Doc Sinto? Yes, Dr. Cita. From Ms. Endang, it happened that she had answered what was requested by all of you. Here the question is, is there an image

the global difference in mortality rate from mpox clade 1b compared to clade 2. Is there still a doctor Endang? Yes, for us, the answer for clade 1b is compared to clade

where in general for Clit 1, the symptoms will be heavier and the lesion will be larger, and for CFR it will be higher, like 5-10%, while for Clit 2, it is generally lighter, with CFR less than or equal to 1%, and the lesion is also smaller. Maybe that's all, Ms. Iqlita. Thank you.

Thank you, Dr. Endang. If the question is not clear, please open the Q&A because it has been answered by Dr. Endang. Thank you, Dr. Endang. Next is to Dr. Sinto. There are several questions and indeed the majority. The first is from

Mr. Hari Gunawan. Here is the question, is the type of clit related to race or genetics or location? That's the first one, Doc. Then the second one is,

In connection with the mechanism of the Mpox transmission, mainly through tight contact with lesions, body fluids, or contaminated items, is the use of APD as a mask still recommended in each patient handling activity or only in certain conditions?

Maybe two first, Doc, so we don't forget. Do you want to go, Doc? Okay, thank you, Dr. Cita, for this question. There are two questions. Thank you very much for the question to us too. I answered the second one first. So, the APD form that must be worked on, because this is indeed the contact and droplet body, so what we do is use a mask. The mask is a regular surgical mask, no need for N95 mask, except if we work and the patient

to carry out the procedure of injecting aerosol before we give it with the N95 mask. So if asked if it is really needed, yes the answer is yes. Now I develop the question, if so, starting now in IGD everyone wears a mask again, right? So I answer, if indeed IGD already has a good triage system or Polyclinic already has a good triage system, so for patients, for example, we used the keyword earlier, fever, then vomiting,

nevadinopathy, nevadinopathy may be difficult to ask directly, but it is fever plus room and we already have a separate room where the patient can be directed from the trihazard to the direction of the doctor who will do the examination later, examine with using a mask in the place, that approach can be done but every time we handle patients who we suspect of mpox, then the minimum we do is

contact area with droplet area. That's question number two. Number one, what is the relationship between clit and geographical location? The answer is very high. So,

Kled 1 is the initial Kled reported in Africa. So before the transmission happened, people or experts suspected that Kled 1 had an African area. Then Kled 1B was reported sporadically in several countries in 2024.

countries outside of Africa. That's why at that time WHO raised the MFOC as PHOC because it found cases 1B in countries outside of Africa, namely in Europe and even Thailand reported a class 1B.

But if we ask nowadays, is there a relationship between clades and geography? Well, the Global Map that was also displayed by Dr. Endang and I showed that in many places there is already a mixture of clades 1 and 2. So now we can no longer make borders, areas or geographical areas as the basis of clades. But I agree with what Dr. Endang said earlier that clades are related to slightly different clinical images.

Number one, if we used to think that MFOX would spread all places in general, but it turns out that in Clade 2B, the lesion can only be a little, as bright as it can even be in the genital area, for example, or the perioral area. So there are differences in appearance that appear in the differences in the clades. That may be my answer to those two questions, Dr. Cita hopefully can answer the questions. Thank you.

Thank you, Dr. Sinto. I hope the question is clear with what was said by Dr. Sinto. We will move to Dr. Lisa first. There is a question about the role of the zoonosis program in the health sector in terms of prevention and control of mpox in the working area. Please, Dr. Listiana, please answer it. Then the second,

Is there a report on direct contact transmission or not sexual contact in Indonesia? Please, Dr. Lisa. Thank you, Bu Cita.

Yes, so related to the M-POK, we inform you again that M-POKs today, especially in Indonesia, are indeed the dominant transmitter among humans, so the priority of the program, which will be in the area at the level of the city and municipality, of course needs to strengthen how surveillance

related to the discovery, especially involving HIV or AIDS partners, because most of them were in that group, even though all of them could be risky, right, Bapak Ibu? Related to the genosis aspect that was asked earlier, we still need to

need to be prepared regarding the approach of One Health because if there is an indication from animals or a source of transmission, it is very possible that you need coordination or joint surveillance with other animal health agencies because we also when the incident, later in the EIP, you will also be asked whether this is

at his house, for example, whether there are pets or not, that is asked because one of the cases found in France, if I'm not mistaken in France, is that there is a human or the pet has a dog so he is sick, it turns out that the dog was hit, this is also a form of certainty that there is a possibility that the human is a dog,

Or from humans to animals. That's the first priority. So our priority right now is still human to human. But it doesn't close the possibility that in the future it can spread the opposite. That's the second priority.