An outbreak of the rare disease Monkeypox has raised fears of an imminent epidemic in Nigeria. Infected people break out in a rash that looks a lot like chicken pox. But the fever, malaise, and headache from Monkeypox are usually more severe than in chicken pox infection.The disease can spread quickly and in previous outbreaks one of 10 people have died. The first cases were reported in Bayelsa state in south Nigeria in late September. Since then suspected cases have been reported in seven of the country’s 36 states, including Lagos. A total of 31 suspected cases have been reported. What is Monkeypox and should the world be worried? The Conversation Africa’s Declan Okpalaeke asked Oyewale Tomori for some insights.
What is Monkeypox and how is it contracted?
Monkeypox is a viral zoonotic disease – it’s caused by a virus transmitted from animals to humans. The virus was first identified in Denmark in 1958 during an investigation into a pox-like disease among monkeys. Hence its name. The natural host of the virus remains undefined. But the disease has been reported in many animals including squirrels, rats, mice and primates.
There appear to be two distinct groups of the Monkeypox virus – the Congo Basin and the West African groups. The Congo Basin virus group is more virulent. According to the United States Centre for Diseases Control, the Monkeypox virus has only been isolated twice from an animal in nature; first in 1985 from an apparently ill African rodent in the Equateur Region of the Democratic Republic of Congo and in 2012 from a dead infant mangabey found in the Tai National Park in Cote d’Ivoire.
The first reported case of Monkeypox infection in humans was in 1970 in the Democratic Republic of Congo (DRC). A 9-year old boy was diagnosed in a region in which smallpox had been eliminated two years earlier. In 1996-97 there was a major outbreak of the disease in the country.
Most cases of human Monkeypox have been reported in the rainforest regions of the Congo Basin - particularly in the DRC where it’s considered to be endemic - and in western Africa. Other African countries reporting the disease include Ivory Coast (2 cases in 1971 and 1981), Liberia (4 cases in 1970), Sierra Leone (2 cases in 1970 and 2014), Nigeria (3 cases in 1971 and 1978), a total of six cases in Cameroon between 1976 and 1990, Central African Republic (32 cases with 2 deaths between 1984 and 2016), Gabon (8 cases in 1987 and 1992- 8), and 19 cases in Sudan in 2005. There are also reports of sporadic cases in the Republic of Congo (formerly Zaire).
In 2003 the first reported cases of human Monkeypox outside of Africa were confirmed in the US, with a total of 37 in six states. Most of the patients had had close contact with pet prairie dogs. The virus transmission is thought to have first occurred between animals imported from Africa which had been co-housed with prairie dogs.
Primary infection is through direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of an infected animal. Eating inadequately cooked meat of infected animals is also a risk factor.
Human-to-human transmission can result from close contact with infected respiratory tract secretions, skin lesions of an infected person or objects recently contaminated by patient fluids or lesion materials. Household members of active cases are at greater risk of infection via droplet respiratory particles during prolonged face-to-face contact.
Transmission can also occur by inoculation or via the placenta (congenital Monkeypox).
Monkeypox can easily be confused with other rash illnesses such as smallpox, chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies.
In the early stage of the disease Monkeypox can be distinguished from smallpox because the lymph gland gets enlarged. A laboratory test is needed for a definitive diagnosis.
Should the world be worried about Monkeypox? How can it be treated?
Sure, we should be worried. The disease can cause the death of one out of 10 infected people and can spread very quickly. The symptoms (fever, malaise, and headache) of Monkeypox are more severe than those of chickenpox.
The other reason for concern is that there is no specific treatment or vaccine available for Monkeypox infection. In the past, the anti-smallpox vaccine was shown to be 85% effective in preventing Monkeypox. But smallpox has been eradicated so the vaccine isn’t widely available anymore.
Nevertheless outbreaks can be controlled. The first step is preventing infections. This can be achieved through public health awareness campaigns to reduce the risk of animal-to-human transmission. Key messages would include the fact that people should avoid contact with sick or dead animals that could harbour the virus, especially in areas known to be Monkeypox hotspots. Other precautions include ensuring that infected people are isolated and that health workers caring for ill people must wear gloves and protective equipment.
A key part of managing the spread of the disease is good surveillance so that cases can be detected quickly and the outbreak contained.
What’s behind the recent outbreak in Nigeria?
At the moment only a few of the suspected cases have been confirmed. We only have laboratory confirmation of some cases. But we must remember that there are other rash illnesses that mimic Monkeypox symptoms. This is not the first report of monkeypox cases in Nigeria. Between 1971 and 1978, ten human Monkeypox infections were reported in the country. Three were laboratory confirmed (two in 1971 and one in 1978).
Does the claim that the outbreak was triggered by government delivering free medical treatment hold any water?
The claim of government involvement in the outbreak is absolute nonsense, and it is an unwarranted and unnecessary diversion from the main issue of confirming and controlling the spread of the disease.