By: Blessing OPEYEMI
The monkeypox virus first broke out in 1971 with two reported cases. The subsequent case was in 1978. These three cases were the first ever recorded cases in Nigeria, of the viral zoonosis that had emerged in the Democratic republic of Congo (DRC) in a colony of monkeys kept for research purposes (hence, the eponymous name, monkeypox) in 1958
Throughout the early eighties, up until 2017, there was no record of reported cases of this infection. However, in September, 2017, the virus re-emerged; and between 2017 and 2018, there were about 300 suspected cases, 137 confirmed cases and 7 deaths from about 75% of the states in the country with most cases from the south-south region, and a case fatality rate of 5.3%. Since then, the numbers dwindled as only a trickle of cases were recorded between 2019 and 2021. In 2022, the monkeypox virus re-emerged again with the Nigeria Centre for Disease Control recording no fewer than 110 suspected cases from January 1 to June 5, 2022. In the period under review, the NCDC recorded 31 confirmed cases and one death.
Monkeypox, a little-known disease, is rising globally as it extends to the US, UK, Canada, and Australia. It bothers the mind what this virus is about.
Monkeypox is a viral zoonosis which is caused by the orthopoxvirus which is similar to the smallpox virus but less severe. While smallpox was officially eradicated globally in 1980, the monkeypox had emerged 22 years before then. The first human case was in a 9 months old boy in the Democratic Republic of Congo in 1970.
Its clinical signs and symptoms include fever, headache, muscle pain, swollen lymph nodes, back pain, lack of energy and rashes which appear in various stages beginning with the face, the palms of the hands, soles of the feet and other parts of the body. Although the monkeypox was discovered in a colony of monkeys, are monkeys really the natural hosts?
Researches and studies have shown that the natural host of the monkeypox is still unidentified but rodents are said to be the most likely natural reservoirs. It is found in squirrels, rats and other non-human primates and it is primarily found in Africa with two known strands: the Central African strand and the West African strand. The Central African strand is known to be very severe and more transmissible than the latter and Cameroon is the only country where the two strands had been found.
In the streets of Nigeria, although stories of the Monkeypox infection have been making the news, the call for precaution by the NCDC to the citizens is being taken lightly. The Director-General of the NCDC, Ifedayo Adetifa, last month warned Nigerians to avoid bush meat, stressing that there is no cure for the virus. It is doubtful to say that Nigerians heeded his warning.
The general lack of concern may be due to a number of factors, including the severity of the infection, the fatality rate, the human to human transmission, the total number of cases and deaths in the country since 2017 – all of which are low. Although monkeypox is similar to smallpox, it is less severe and less fatal with the fatality rate of 3 – 6% with symptoms lasting from 2 to 4 weeks according to the World Health Organisation. Also, it has a reduced human to human transmission and this means the wider public is at a low risk of the infection; it is not a pandemic!
The monkeypox is not a pandemic and the human to human transmission rate is not high or airborne like the coronavirus, it is however endemic in the Central and Western Africa and emerges periodically to affect human according to a publication titled National Monkeypox Public Health Response Guidelines by Federal Ministry of Health – Nigeria Centre for Disease Control. It has a wide fatality rate of 1 to 10% and deaths occur in infected people of younger ages. Transmission is primarily animal to human by direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals, including through their bite or scratch.
Also, eating inadequately cooked meat of infected animals has also been identified as a possible risk factor for transmission. Human contact with materials contaminated with the virus can also lead to infection. The virus enters the body through broken skin , the respiratory tract, or the mucous membranes (of the eyes, nose, or mouth). Human-to-human or secondary transmissions occur primarily through droplet respiratory particles requiring prolonged face-to-face contact, or by direct or indirect contact with skin lesions or body fluids of an infected person, and by contact with objects recently contaminated by patient fluids or lesion material (such as clothing or linens).
The largest outbreak in Africa till date was the 2017. Till date, there has had a total of 578 suspected cases, 247 confirmed cases and 9 deaths with Rivers, Bayelsa, Lagos, Delta, Crossriver having a total of 53, 45, 34, 31 and 16 confirmed cases respectively. Oyo state, although has had 6 suspected cases from 2020 till date, there has not been any confirmed case lately. Does this then mean we’re not at risk of the infection? No! From all indications, anyone who does not take precautions can be infected with the disease and this poses a threat to public health.
As regards cure or vaccines against the infection, there is no specific treatment or vaccine for human monkeypox infection and researches are still on-going; however prior smallpox vaccination has been reported to offer a high degree of cross-protection (approximately 85%) to monkeypox. One of the two cases of monkeypox recorded to have been reported in 1971 was in a four year old with no previous smallpox vaccination.
In fact, countries including Canada, the United Kingdom and the United States have begun implementing a strategy called ‘ring vaccination,’ to try to halt the spread of the virus in their countries. This involves administering smallpox vaccines.
Regarding preventive measures in Nigeria, the NCDC advises Nigerians to avoid contact with rodents and primates which are considered as sources of primary transmissions as well as limiting direct exposure to their blood and other body fluid and inadequately cooked meat (i.e bush meat preparation and or consumption). Control of rodents is an important measure to prevent the spread of diseases. This can be ensured through good hygiene among household members of closed settings, regular removal of refuse and breeding grounds, screens on windows and doors as well as fumigation.
In secondary transmission, humans should avoid close contact with infected persons, their blood or body fluids, contaminated materials like beddings, clothes etc and they should be isolated for medical attention by medical professionals.