{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-07T14:43:52Z", "providers": [ "Codex", "Grok" ], "missingProviders": [], "pass": 2, "cost": { "grok": { "usd": 0.00821644, "turns": 1, "seconds": 65.2, "error": null }, "codex": { "seconds": 101.0, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.3\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a07c51-d159-7092-82c1-51e7379d0d0b\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: mpox\nRegistry id: vr.tr.mpox\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry: (none)\n\nA Vercy model s" } } }, "metaModel": { "id": "THING-Q382370", "registryId": "vr.tr.mpox", "name": "mpox", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q382370/", "model": { "registry_id": "vr.tr.mpox", "name": "mpox", "purpose": "Enable an AI agent to recognise a possible mpox episode, assess its clinical and transmission state, and identify evidence-supported next actions for authorised clinical or public-health review.", "definition": "Mpox is a zoonotic orthopoxvirus disease of humans and some other mammals, caused by monkeypox virus (MPXV), an enveloped double-stranded DNA virus in the genus Orthopoxvirus (family Poxviridae), that produces a febrile systemic illness with a characteristic centrifugal vesiculo-pustular rash and is transmitted by close contact, contaminated materials, and, for some clades, sexual networks.", "scope_statement": "This model owns the disease-specific recognition criteria, episode states, exposure relationships and decision requirements for mpox under vr.tr.mpox in XCT / XCT.STA, linking to separate models for patients, monkeypox virus, tests, interventions and outbreaks.", "in_scope": [ "Evidence supporting or contesting an mpox case classification", "Skin and mucosal manifestations, symptom progression and complications", "Exposure circumstances and potentially infectious contact intervals", "Host factors affecting severity and interpretation of illness", "Mpox-specific requirements for care, prevention and episode closure" ], "out_of_scope": [ "Monkeypox virus taxonomy, genome organisation and laboratory propagation", "The patient's complete medical record and unrelated conditions", "Laboratory assay engineering and specimen-processing procedures", "Vaccine and medicine manufacture, inventory and general prescribing models", "Population outbreak dynamics and public-health campaign management" ], "distinguishing_features": [ "Distinguish the disease mpox from its causative agent, monkeypox virus: a disease episode records illness and case evidence, while a virus record describes the pathogen. [WHO mpox fact sheet](https://www.who.int/news-room/fact-sheets/detail/mpox)", "For chickenpox, herpes and syphilis lookalikes, require differential assessment and appropriately interpreted testing; rash appearance alone does not establish mpox. [WHO mpox fact sheet](https://www.who.int/news-room/fact-sheets/detail/mpox)", "Distinguish an MPXV-specific result from a broad non-variola orthopoxvirus result; the latter does not itself identify a clade. [CDC public-health guidance](https://www.cdc.gov/monkeypox/php/public-health-strategy/index.html)", "Do not exclude mpox because lesions are localised or another sexually transmitted infection is diagnosed; concurrent infections are possible. [CDC clinical overview](https://www.cdc.gov/monkeypox/hcp/clinical-overview/index.html)", "Distinguish exposure from disease: contact history supports assessment but does not independently establish an mpox episode." ], "characteristics": [ { "name": "Case classification", "kind": "state", "unit_or_values": "Suspected, probable, confirmed, discarded or unresolved, qualified by case-definition authority and version", "why_it_matters": "Determines which diagnostic and public-health actions have sufficient support." }, { "name": "Diagnostic evidence", "kind": "relation", "unit_or_values": "Linked laboratory report, assay target, specimen site, collection time, result and interpretation", "why_it_matters": "Makes the classification auditable and separates negative evidence from absent testing." }, { "name": "MPXV clade attribution", "kind": "category", "unit_or_values": "Laboratory-reported clade or subclade with nomenclature version; untyped, pending or indeterminate", "why_it_matters": "Supports epidemiological linkage without inferring clade from geography or appearance." }, { "name": "Episode timing", "kind": "measurement", "unit_or_values": "Dates or bounded intervals for exposure, first symptom, first lesion, sampling and healing; elapsed days", "why_it_matters": "Supports temporal interpretation of tests, contacts and intervention eligibility." }, { "name": "Lesion distribution and evolution", "kind": "state", "unit_or_values": "Anatomical sites, observed morphology, new lesions, crusting and healing; explicitly unexamined sites", "why_it_matters": "Represents localised, mucosal and evolving presentations without requiring a single rash pattern." }, { "name": "Pain and functional impairment", "kind": "measurement", "unit_or_values": "Named pain scale and score; documented effects on swallowing, hydration, urination and defecation", "why_it_matters": "Captures care needs that lesion counts alone may miss." }, { "name": "Severe-disease modifiers", "kind": "relation", "unit_or_values": "Linked evidence of immune status, pregnancy, age and relevant skin conditions; known absent or unknown", "why_it_matters": "Supports individual severity assessment. [CDC clinical overview](https://www.cdc.gov/monkeypox/hcp/clinical-overview/index.html)" }, { "name": "Exposure route and setting", "kind": "category", "unit_or_values": "Reported contact mechanism, setting, timing and certainty, including unknown", "why_it_matters": "Guides contact assessment without treating demographic identity as exposure evidence." }, { "name": "Transmission-precaution status", "kind": "state", "unit_or_values": "Awaiting assessment, precautions indicated, precautions active or release documented under a named policy", "why_it_matters": "Separates operational precautions from uncertain biological infectiousness." }, { "name": "Prevention and treatment history", "kind": "relation", "unit_or_values": "Linked vaccination, prior mpox, supportive care and other treatment records with dates and provenance", "why_it_matters": "Supports interpretation of breakthrough illness, response and further options." } ], "affordances": [ "Assemble an evidence-linked mpox case assessment and flag missing diagnostic information", "Track lesion progression, pain and functional changes to flag clinical reassessment needs", "Construct a qualified exposure and potentially infectious-contact timeline", "Identify prevention or treatment options requiring review under current local guidance", "Prepare the minimum necessary case-reporting and contact-assessment information for authorised handling", "Evaluate episode closure against documented clinical and public-health criteria" ], "what_it_is_for": [ "Mpox is encountered in clinical care, public health surveillance and investigations of contact between infected people, animals and contaminated materials.", "Information about the disease supports assessment of suspected illness, transmission prevention and referral for authorised diagnostic review." ], "standards_and_regulation": [ "The International Classification of Diseases, Tenth Revision, issued by the World Health Organization, classifies monkeypox under code B04." ], "visual_identification": [ "Lesions can be firm, deep seated and centrally indented, although their appearance varies with disease stage.", "Lesions may involve genital, anal or oral sites, and a widespread rash is not required.", "Similar lesions can occur in other conditions, so visual appearance alone cannot establish mpox." ], "failure_modes_and_hazards": [ "Failure to recognise an infectious episode can expose close contacts and care workers.", "Severe disease can cause substantial tissue injury, eye complications or systemic illness.", "Misclassification based on appearance alone can delay appropriate care for mpox or another condition.", "Stigmatising assumptions about affected communities can discourage care seeking and undermine public health work." ] }, "sources": [ { "id": "who-mpox-2024", "title": "Mpox", "url": "https://www.who.int/news-room/fact-sheets/detail/mpox", "what_it_supports": "WHO disease definition, transmission, clades I/II, case-fatality, vaccination, and PHEIC history", "url_status": "live" }, { "id": "cdc-mpox-clades", "title": "Mpox in the United States and Around the World: Current Situation", "url": "", "what_it_supports": "Clade Ia/Ib/IIa/IIb epidemiology, 2022 global clade IIb outbreak, and U.S. public-health framing", "url_status": "dead" }, { "id": "who-icd11", "title": "ICD-11 for Mortality and Morbidity Statistics - 1E71 Mpox", "url": "https://icd.who.int/browse/2025-01/mms/en#321130838", "what_it_supports": "ICD-11 code 1E71 and the 2022 WHO renaming of monkeypox to mpox", "url_status": "live" }, { "id": "ictv-mpxv", "title": "Genus: Orthopoxvirus - Monkeypox virus", "url": "https://ictv.global/report/chapter/poxviridae/poxviridae/orthopoxvirus", "what_it_supports": "ICTV species Monkeypox virus (MPXV), family Poxviridae, dsDNA orthopoxvirus taxonomy", "url_status": "live" }, { "id": "wikidata", "title": "Wikidata item Q382370: mpox", "url": "https://www.wikidata.org/wiki/Q382370", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Mpox", "url": "https://en.wikipedia.org/wiki/Mpox", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "mpox-recognition", "name": "Mpox recognition", "description": "Establish what supports calling an episode mpox and what remains unresolved.", "rationale": "Similar rashes and differing assay targets can otherwise produce unjustified diagnostic certainty.", "layers": [ { "id": "case-definition-and-differentials", "name": "Case definition and differentials", "description": "Relate the observed presentation to a versioned case definition and competing explanations.", "findings": [ { "id": "supported-case-classification", "name": "Supported case classification", "description": "Record the classification, its supporting observations and unresolved alternatives separately.", "questions": [ { "text": "Which jurisdiction's dated mpox case definition applies, and which criteria are satisfied, absent or unknown?", "kind": "definition", "id": "supported-case-classification-q01" }, { "text": "How were varicella, herpes, syphilis and other plausible explanations assessed, including possible coinfection?", "kind": "boundary", "id": "supported-case-classification-q02" } ] } ] }, { "id": "laboratory-attribution", "name": "Laboratory attribution", "description": "Preserve what testing establishes about MPXV and what requires additional evidence.", "findings": [ { "id": "interpretable-mpox-test-evidence", "name": "Interpretable mpox test evidence", "description": "Link each interpretation to the actual assay, specimen and report rather than a standalone positive or negative label.", "questions": [ { "text": "What specimen site, collection date, assay target and laboratory report support the result?", "kind": "provenance", "id": "interpretable-mpox-test-evidence-q01" }, { "text": "Does the assay establish MPXV, broader orthopoxvirus detection or clade attribution, and what limitations qualify a negative or indeterminate result?", "kind": "boundary", "id": "interpretable-mpox-test-evidence-q02" }, { "text": "What unresolved discrepancy warrants clinician or laboratory review for additional testing?", "kind": "action", "id": "interpretable-mpox-test-evidence-q03" } ] } ] } ] }, { "id": "lesions-and-disease-course", "name": "Lesions and disease course", "description": "Represent the anatomical and temporal course of a suspected or confirmed episode.", "rationale": "Mpox assessment needs lesion-site detail and symptom chronology rather than a single rash-present flag.", "layers": [ { "id": "cutaneous-and-mucosal-involvement", "name": "Cutaneous and mucosal involvement", "description": "Capture observed lesions and symptoms at visible and less accessible sites.", "findings": [ { "id": "lesion-and-function-profile", "name": "Lesion and function profile", "description": "Record site-specific findings and distinguish unexamined areas from documented absence.", "questions": [ { "text": "Which skin, oral, genital, anal or ocular sites are involved, and which were not assessed?", "kind": "measurement", "id": "lesion-and-function-profile-q01" }, { "text": "What lesion evolution, pain and interference with eating, drinking, urination or defecation were recorded at each assessment?", "kind": "measurement", "id": "lesion-and-function-profile-q02" } ] } ] }, { "id": "episode-progression", "name": "Episode progression", "description": "Track onset, progression and recovery with uncertainty in dates preserved.", "findings": [ { "id": "dated-clinical-trajectory", "name": "Dated clinical trajectory", "description": "Keep symptom onset, lesion onset, new lesion formation and healing as distinct observations.", "questions": [ { "text": "When did systemic symptoms and lesions first appear, and which dates are recalled estimates?", "kind": "provenance", "id": "dated-clinical-trajectory-q01" }, { "text": "Does serial assessment show improvement, new lesions, persistent disease or deterioration, and what evidence supports that judgement?", "kind": "measurement", "id": "dated-clinical-trajectory-q02" } ] } ] } ] }, { "id": "severity-and-host-context", "name": "Severity and host context", "description": "Assess observed clinical burden alongside factors that can alter the course of mpox.", "rationale": "Present severity and vulnerability to future complications are separate decision inputs.", "layers": [ { "id": "host-vulnerability", "name": "Host vulnerability", "description": "Link relevant host conditions and prior protection to the episode assessment.", "findings": [ { "id": "individual-risk-modifiers", "name": "Individual risk modifiers", "description": "Use documented clinical context rather than group membership to qualify risk.", "questions": [ { "text": "What current evidence describes immune function, pregnancy, age-related considerations and relevant skin disease?", "kind": "provenance", "id": "individual-risk-modifiers-q01" }, { "text": "Which previous mpox episodes or vaccinations are documented, and what does the applicable guidance allow an assessor to infer from them?", "kind": "boundary", "id": "individual-risk-modifiers-q02" } ] } ] }, { "id": "complications-and-escalation", "name": "Complications and escalation", "description": "Record complications and the clinical criteria used to determine urgency.", "findings": [ { "id": "escalation-relevant-burden", "name": "Escalation-relevant burden", "description": "Track ocular, neurological, respiratory, hydration, pain and secondary-infection concerns without automatically attributing each to mpox.", "questions": [ { "text": "Which complications or functional impairments are observed, suspected or excluded, and how is their relationship to mpox assessed?", "kind": "measurement", "id": "escalation-relevant-burden-q01" }, { "text": "Which findings meet the applicable criteria for urgent assessment, specialist consultation or inpatient care, and who must review them?", "kind": "action", "id": "escalation-relevant-burden-q02" } ] } ] } ] }, { "id": "exposure-and-transmission", "name": "Exposure and transmission", "description": "Represent plausible acquisition events and opportunities for onward transmission.", "rationale": "A disease episode needs contact and timing evidence without claiming a proven transmission chain.", "layers": [ { "id": "acquisition-context", "name": "Acquisition context", "description": "Separate reported exposure mechanisms from inferred sources of infection.", "findings": [ { "id": "qualified-exposure-history", "name": "Qualified exposure history", "description": "Capture relevant human, material and animal contacts with timing and evidential confidence.", "questions": [ { "text": "What close contact, contaminated-material contact, animal contact or pregnancy-associated exposure is reported, and when?", "kind": "provenance", "id": "qualified-exposure-history-q01" }, { "text": "Is the proposed source confirmed, plausible or unknown, and what evidence would distinguish competing acquisition events?", "kind": "boundary", "id": "qualified-exposure-history-q02" } ] } ] }, { "id": "onward-transmission-assessment", "name": "Onward transmission assessment", "description": "Connect episode timing and contact circumstances to prevention decisions.", "findings": [ { "id": "contact-window-and-precautions", "name": "Contact window and precautions", "description": "Record the policy-defined assessment window separately from uncertain infectiousness at a particular moment.", "questions": [ { "text": "Which dated guidance determines the contact-assessment interval, and how do uncertain onset dates affect its boundaries?", "kind": "boundary", "id": "contact-window-and-precautions-q01" }, { "text": "Which household, intimate, healthcare or animal contacts fall within that interval, and what precautions or authorised follow-up require review?", "kind": "action", "id": "contact-window-and-precautions-q02" } ] } ] } ] }, { "id": "care-prevention-and-resolution", "name": "Care, prevention and resolution", "description": "Connect the episode assessment to supported interventions and documented closure.", "rationale": "Care decisions, exposure prevention and release from precautions require distinct evidence and current authority.", "layers": [ { "id": "intervention-eligibility", "name": "Intervention eligibility", "description": "Separate care for illness from prevention after exposure and record the basis for each option.", "findings": [ { "id": "care-and-prevention-options", "name": "Care and prevention options", "description": "Support review of symptom care, additional therapies and vaccination without embedding permanent eligibility rules.", "questions": [ { "text": "What symptom burden and complications determine supportive-care needs, and what response has been observed?", "kind": "action", "id": "care-and-prevention-options-q01" }, { "text": "For an exposed person, how do exposure timing, symptoms and vaccination history affect eligibility under current post-exposure guidance?", "kind": "action", "id": "care-and-prevention-options-q02" }, { "text": "If additional therapy is considered, what current evidence, eligibility criteria, local authorisation and clinician decision support it?", "kind": "provenance", "id": "care-and-prevention-options-q03" } ] } ] }, { "id": "resolution-and-public-health-disposition", "name": "Resolution and public-health disposition", "description": "Keep clinical recovery, release from precautions and administrative closure separate.", "findings": [ { "id": "documented-episode-disposition", "name": "Documented episode disposition", "description": "Record healing evidence, residual effects and the authority for closure; WHO describes infectiousness continuing until sores heal and new skin forms. [WHO mpox fact sheet](https://www.who.int/news-room/fact-sheets/detail/mpox)", "questions": [ { "text": "What skin and mucosal healing evidence supports release under the applicable guidance, and who documented that determination?", "kind": "action", "id": "documented-episode-disposition-q01" }, { "text": "What residual pain, scarring, other sequelae or unresolved symptoms require follow-up after the acute episode?", "kind": "measurement", "id": "documented-episode-disposition-q02" }, { "text": "Which local reporting duties remain, and what minimum necessary information may an authorised actor disclose?", "kind": "action", "id": "documented-episode-disposition-q03" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Clade I (Congo Basin / Central African) mpox - historically more severe, higher case-fatality, endemic in the Congo Basin", "Clade Ia - predominantly zoonotic spillover with limited human-to-human spread in Central Africa", "Clade Ib - recently expanded human-adapted lineage with sustained person-to-person transmission, including sexual contact, first widely documented in the DRC from 2023", "Clade II (West African) mpox - typically milder disease, historically West African", "Clade IIa - zoonotic/West African lineage with limited human chains", "Clade IIb - the lineage responsible for the 2022-ongoing global outbreak, predominantly among men who have sex with men in many non-endemic countries", "Human mpox (clinical case, confirmed / probable / suspected under WHO/CDC case definitions)", "Animal / wildlife mpox (reservoir and incidental hosts: rodents, non-human primates, and other mammals)" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of mpox this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "scheme": "Wikidata", "value_or_pattern": "Q69488 (mpox as disease); Q6906176 (Monkeypox virus)", "note": "Disease vs etiological agent are separate items" }, { "scheme": "ICD-11", "value_or_pattern": "1E71", "note": "WHO ICD-11 MMS code for mpox (renamed from monkeypox in 2022)" }, { "scheme": "ICD-10", "value_or_pattern": "B04", "note": "Monkeypox; many systems still use this code" }, { "scheme": "ICTV / NCBI Taxonomy", "value_or_pattern": "species Monkeypox virus (MPXV); NCBI taxid 10244", "note": "Virus species in genus Orthopoxvirus, family Poxviridae" }, { "scheme": "MeSH", "value_or_pattern": "D045908 (Mpox); D045909 (Monkeypox virus)", "note": "NLM Medical Subject Headings" }, { "scheme": "SNOMED CT", "value_or_pattern": "359814004 (Mpox); 424642009 (Monkeypox virus)", "note": "Clinical terminology; local editions may still say monkeypox" }, { "scheme": "Disease Ontology", "value_or_pattern": "DOID:3292", "note": "mpox (formerly monkeypox)" }, { "scheme": "MONDO", "value_or_pattern": "MONDO:0001969", "note": "mpox disease" } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of mpox this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "WHO: International Health Regulations (2005) - mpox has been a Public Health Emergency of International Concern (2022-2023 and again 2024 for clade I)", "WHO: recommended case definitions (suspected / probable / confirmed) and laboratory confirmation by PCR targeting OPXV then MPXV-specific assays, with clade differentiation", "WHO: 2022 renaming of the disease from monkeypox to mpox (virus species name Monkeypox virus retained by ICTV)", "CDC (United States): nationally notifiable condition; vaccination (JYNNEOS / ACAM2000) and isolation guidance; Select Agent rules apply to monkeypox virus (variola is select agent; MPXV clade I is a select agent in the U.S.)", "FDA / EMA: authorization of tecovirimat (TPOXX), brincidofovir, vaccinia immune globulin, and non-replicating MVA-BN (JYNNEOS/Imvanex/Imvamune) and replicating vaccinia (ACAM2000) vaccines", "IHR / national notifiable-disease laws: mandatory reporting of confirmed mpox in many jurisdictions", "ICTV: species nomenclature Monkeypox virus within Orthopoxvirus" ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of mpox this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Clinical diagnosis and isolation of febrile patients with a centrifugal vesiculopustular or anogenital rash, especially after close or sexual contact", "Public-health surveillance: case counting by clade, contact tracing, and outbreak control in endemic Central/West Africa and in global MSM sexual networks (clade IIb)", "Laboratory PCR confirmation from lesion swabs, with clade-specific assays to distinguish I vs II and Ia vs Ib", "Vaccination of contacts and high-risk groups with MVA-BN (JYNNEOS) or ACAM2000; ring vaccination and pre-exposure programmes", "Occupational biosafety: handling of lesion material and cultures under appropriate containment; clade I MPXV is a U.S. select agent", "Wildlife and One Health investigation of rodent and primate reservoirs after zoonotic spillovers", "Differential diagnosis work-ups that still start from 'smallpox-like rash illness' in emergency and dermatology settings" ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of mpox this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "quantity": "Incubation period", "typical_range": "3-17 (commonly 5-13)", "unit": "days" }, { "quantity": "Case-fatality ratio, clade I (historical, untreated, endemic settings)", "typical_range": "about 1-10 (often cited ~10 for classic Congo Basin; recent outbreaks lower with care)", "unit": "percent of cases" }, { "quantity": "Case-fatality ratio, clade II / IIb (2022 global outbreak)", "typical_range": "well below 1 (often ~0.1-0.2 in well-resourced settings)", "unit": "percent of cases" }, { "quantity": "Fever-to-rash interval (classic presentation)", "typical_range": "1-5", "unit": "days" }, { "quantity": "Lesion stage duration (each of macule/papule/vesicle/pustule/crust)", "typical_range": "about 1-2 per stage; total rash ~2-4 weeks", "unit": "days" }, { "quantity": "Genome size of MPXV", "typical_range": "approximately 197", "unit": "kilobase pairs (dsDNA)" }, { "quantity": "Reproductive number R0 in 2022 clade IIb sexual-network outbreaks (effective, setting-dependent)", "typical_range": "often estimated around 1.5-2.5 before behaviour change and vaccination", "unit": "dimensionless" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of mpox this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Misdiagnosis as varicella, herpes, syphilis, or molluscum, delaying isolation and partner notification", "Sustained human-to-human transmission (clade Ib, clade IIb) via close and sexual contact, household fomites, and healthcare exposure", "Severe disease, bacterial superinfection of lesions, encephalitis, myocarditis, and death - highest risk in children, pregnant people, and the immunocompromised (notably advanced HIV)", "Ocular involvement and corneal scarring with vision loss", "Vaccine adverse events: replicating vaccinia (ACAM2000) can cause progressive vaccinia, eczema vaccinatum, myopericarditis; MVA-BN is safer but two-dose and supply-constrained", "Laboratory escape or misidentification among orthopoxviruses; clade I is a select agent", "Stigma and delayed care in MSM and in endemic African communities, undermining surveillance", "Name-related racism and misinformation around 'monkeypox', which is why WHO adopted mpox" ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of mpox this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "WHO and most public-health agencies use mpox (2022); many clinical codes, older papers, and some languages still say monkeypox / variole du singe / viruela símica", "Clade I (including emerging Ib) is concentrated in the Democratic Republic of the Congo and neighbouring Central African states; clade II historically West Africa (Nigeria, etc.)", "The 2022 global outbreak (clade IIb) was driven by sexual networks of men who have sex with men in Europe, the Americas, and other non-endemic regions, with a different rash distribution (often anogenital, fewer lesions) than classic endemic disease", "Endemic African presentations more often follow zoonotic spillover (bushmeat, rodent contact) and show the classic centrifugal rash and higher pediatric burden", "U.S. select-agent status and vaccination stockpile policy differ from African endemic-country practice, where diagnostics and MVA-BN access have been limited" ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of mpox this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "name": "Smallpox (variola virus)", "difference": "Smallpox is eradicated; MPXV is distinguished by PCR and by clinically milder disease with prominent lymphadenopathy, which variola typically lacked" }, { "name": "Varicella (chickenpox)", "difference": "Varicella lesions are superficial, appear in crops at different stages, and are centripetal; mpox lesions are deep-seated, same-stage in a given area, centrifugal or anogenital, with lymphadenopathy; PCR or VZV vs OPXV assays separate them" }, { "name": "Herpes simplex / syphilis (especially anogenital clade IIb)", "difference": "HSV and Treponema pallidum serology/PCR vs MPXV PCR on lesion swabs; syphilis chancre is typically painless and single, mpox lesions often painful and multiple" }, { "name": "Cowpox, vaccinia, and other orthopoxviruses", "difference": "Species-specific PCR or sequencing; vaccinia is vaccine-related; cowpox is typically a single lesion after rodent/cat contact in Eurasia" }, { "name": "Molluscum contagiosum", "difference": "Umbilicated but chronic, pearly, without systemic prodrome; poxvirus family but different genus; PCR/histology distinguish" }, { "name": "Hand-foot-and-mouth disease / other vesicular exanthems", "difference": "Enterovirus PCR, distribution (oral-acral), and lack of deep umbilicated pustules and marked lymphadenopathy" } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of mpox this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does vr.tr.mpox own human disease episodes only, or must animal disease be represented here through host-specific extensions?", "Which case definitions and clinical or public-health authorities should govern classification and actions in each supported jurisdiction?", "What current evidence resolves the frequency and practical significance of asymptomatic, presymptomatic or post-healing transmission?", "Which severity assessments and escalation thresholds are sufficiently validated across ages, immune states, clades and care settings?", "What current evidence establishes treatment benefit, duration of vaccine protection and reinfection risk in the populations this model must support?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 31 } }