When Kwara State reported its first mpox cases in 2021, many colleagues asked a simple question: Are our routine systems strong enough to catch the next flare before it becomes a fire? Our evaluation from January to December 2022 was designed to answer that not with opinions, but with data from the people and platforms that actually run surveillance every week. This work is also a significant output towards the requirement to graduate from the Nigeria Field Epidemiology and Laboratory Training Program (NFELTP), where residents must assess at least one surveillance system to demonstrate applied epidemiology skills.
Why now? In July 2022, the World Health Organization declared mpox a Public Health Emergency of International Concern (PHEIC), underscoring how quickly a presumably localized zoonosis can leap borders and systems. That PHEIC was lifted in May 2023 after global declines, but for countries with recurrent transmission, the signal was clear: preparedness is built between outbreaks, not during them.
Where we looked. We evaluated surveillance across all 16 LGAs in Kwara State, speaking directly with Disease Surveillance and Notification Officers and reviewing line-listed data in SORMAS, a system developed during the 2014 West African Ebola outbreak and piloted in Nigeria in 2017 before nationwide scale-up by 2019, which has since become the real-time digital backbone for standardizing case reporting, sample tracking, and feedback
What was surprising? The system’s sensitivity was 100% during the period assessed. Reports were timely and complete (approximately 95–98%), with simple tools and strong representativeness across LGAs. In plain terms: if a laboratory-confirmed mpox case existed in the data stream, the system caught it, and it did so on time.
But the data also whispered caution. The positive predictive value (PPV) was 42%: less than half of suspected cases were laboratory-confirmed. That pattern usually means two things coexist: (1) deliberately broad clinical suspicion (to avoid missing cases) and (2) frictions in the confirmation pathway, everything from sample packaging and transport to reagent availability and result turnaround.
Three practical lessons
- Sensitivity without specificity strains trust and resources. Maintaining a wide clinical net is appropriate for rare but consequential events. Yet the system must help clinicians “think mpox” for the right patients at the right time.
- Digital tools are only as strong as the last mile. SORMAS gave us standard forms, timestamps, and a shared language for data. The gaps, which include low acceptability (17%) and stability (51%), were not software bugs but human-systems issues: recognition, feedback, and consistent support.
- Timeliness thrives on habits, not heroics. The impressive on-time reporting we saw reflected habits, such as weekly rituals and agreed-upon channels.
A One Health lens matters. Mpox remains a zoonosis. Surveillance must be interoperable with veterinary and environmental intelligence to spot and interpret risk early.
What keeps us up at night? Preparedness can erode when headlines fade. The 2022 PHEIC created urgency, the lifting risked forgetfulness. Our take-home is pragmatic: protect routine competencies, practice the same playbook for other rash fevers, and invest in the steady systems that keep skilled people in place.
For peers elsewhere, three questions to ask your system tomorrow:
- If a suspected case is seen today, how long until a confirmed result reaches the clinician’s phone?
- What’s your last 3-month PPV for suspected mpox?
- When did your DSNOs last receive actionable feedback?
In the end, preparedness is a behavior. Our evaluation showed a system that can find cases quickly and report on time. It also showed where routine investments, such as logistics, recognition, and inter-sector linkages, convert sensitivity into impact. That is the quiet work of outbreak preparedness. It is also the difference between a flare and a fire.