Wanted: Coordinated urgent global response against monkeypox

THE World Health Organisation (WHO) on July 23,  declared the current monkeypox outbreak a public health emergency of international concern. As at August 9,  nearly 32 000 confirmed cases of monkeypox had been reported across 82 nonendemic countries. This underlines the level of  health emergency the disease currently poses globally.

  THE United States was the fourth country, outside Africa with endemic rate of the  monkeypox to experience an outbreak in 2022. The first case was documented in Boston, Massachusetts, on May 19. On August 4,  the Biden administration declared monkeypox a public health emergency, giving federal agencies the ability to quickly direct funds toward vaccines, therapeutics, and other immediate needs. As at  August 22, monkeypox had  spread to all 50 states in the United States, as well as Washington, D.C., and Puerto Rico.

TODAY, United States has the highest number of monkeypox cases in the world, while California has the highest number of cases in the United States.

  IN NIGERIA, a total of 172 Monkeypox infections and four deaths have been recorded so far this year.

  THE latest situation report, which was released on August 14, by the Nigeria Centre for Disease Control (NCDC) noted that more than 50 per cent of the cases were recorded among men.

  THE report further shows that of the 172 cases reported from January 1 to August 7, men accounted for 115 cases, corroborating the WHO report that the latest outbreak is high among men.

 BREAKDOWN of the cases shows that Imo State topped with three cases, followed by the FCT (2), Ondo (2), Rivers (2), Abia (1), Anambra (1), Ebonyi (1), Edo (1), Ogun (1) and Nasarawa (1).

 NCDC noted that since the re-emergence of monkeypox in September 2017,  985 suspected cases have been reported from 35 states in Nigeria while  398 of the figure representing 40.4 per cent were confirmed, 263 of them are  male, 135 female, from 30 states.

  THE disease control centre added that 12 deaths have been recorded since September 2017 in nine states: Lagos (3), Edo (2), Imo (1), Cross River (1), FCT (1), Rivers (1), Ondo (1) Delta (1) and Akwa Ibom (1).

  ACCORDING to the National Monkeypox Public Health Response Guidelines released  in 2019 by NCDC, monkeypox is a viral zoonotic disease (a virus transmitted to humans from animals) with symptoms in humans similar (but less severe) to those seen in the past in smallpox patients. Although smallpox was declared eradicated by the WHO in 1980, monkeypox  continues to occur sporadically in Central and West Africa. The monkeypox virus was first isolated in 1958 at the State Serum Institute in Copenhagen (Denmark) during an investigation into a pox-like disease among colonies of monkeys kept for research. The virus, being given its name from the species it was initially isolated from.

  IT WAS first identified in humans in 1970 in the Democratic Republic of Congo (then known as Zaire) in a nine-month-old boy within a region where smallpox had been eliminated in 1968. Since then, the majority of cases reported have been in the rural Rain Forest regions of the Congo Basin and western Africa – particularly in the Democratic Republic of Congo (DRC), where it is considered to be endemic. There are two recognised strains of the virus – West African monkeypox virus clade (which is associated with milder disease) and the Central African monkeypox virus clade which is typically associated with more severe illness.

  ACCORDING to WHO, monkeypox endemic countries are: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.

  NIGERIA is one of the West African countries that have reported monkeypox in the past – two recorded human cases in 1971 and one in 1978. Other African countries that have reported the disease include: Cote d’voire, Liberia, Sierra Leone, Gabon, Cameroon, Republic of Congo, Central African Republic and South Sudan. The United States of America (USA) reported the first occurrence of the disease outside of the African continent in 2003 where 47 cases were linked to wild animals that were shipped to the USA as part of the pet trade.

  THE virus, which is transmitted from its animal reservoir to a human host, is currently believed to have limited secondary spread through human-to-human transmission (HHT). The case fatality rate (CFR) is reported to vary widely (between1% and 10% for various outbreaks), with the majority of deaths occurring in younger age groups. There is no specific treatment or vaccine available for human monkeypox infections. However, prior smallpox vaccination has been reported to offer a high degree of cross-protection against  monkeypox.

  THE virus can be transmitted from animal-to-human, human-to-human and from a contaminated environment-to-human. Index cases are mostly  infected by direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals, including through their bite or scratch.

  HUMAN infections through the handling of infected monkeys, Gambian giant rats and squirrels have been documented in Africa, while 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 (even if not visible), the respiratory tract, or the mucous membranes (of the eyes, nose, or mouth).

  CLINICAL manifestations of monkeypox usually develop within 5–21 days of infection (incubation period), with infection usually mild-to-moderate in nature and can be divided into two periods.

  EXPERTS inform that the disease manifests in skin eruption within 1-3 days after appearance of fever while rashes appear in various stages often beginning on the face and then spreading elsewhere on the body. The face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of cases) are most affected. The evolution of the rash which occurs over a period of 10 days, progresses through stages: Maculopapular (lesions with a flat base), Vesicles (small fluid filled blisters), Pustules (pus-containing rash), crust (dried blisters).

  THE Nigeria outbreak showed that all parts of the body can be affected by monkeypox. However, the parts of the body most affected by rashes were in the following order from most affected to the least affected: Face, legs, trunk, arms, palms, genitalia and  soles.

  ALTHOUGH monkeypox is treatable, there are no specific regimes of treatment for it. It is treated with antiviral medications like Tecovirimat (TPOXX) and brincidofovir(Tembexa) used in the treatment of small pox. The smallpox vaccine can also be used for prevention of monkeypox virus.

  AMONG the measures suggested by experts to prevent the spread of the disease are: Avoiding contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs, eating infected animals or meat that has not been thoroughly cooked, contact with any materials, such as bedding, that has been in contact with a sick animal.

  OTHERS are isolating infected patients from others who could be at risk for infection, practicing good hand hygiene after contact with infected animals or humans, using personal protective equipment (PPE) when caring for patients and reporting to the nearest health facility if the known signs and symptoms are  noticed.

  GIVEN the rapid pace with which cases are being diagnosed, a coordinated international response is essential. The current monkeypox outbreak illustrates why global health cannot be ignored. If the world had taken the disease seriously and didn’t see it as a disease for Africans, necessary clinical trials on treatments and vaccines would have been done decades ago. This could have saved  the world from the mess it finds itself today because of the disease.

  NATIONAL Light therefore, calls on countries and governments at all levels to strengthen surveillance at national and sub-national levels, to increase awareness, and to promptly detect and respond to the outbreak. There is need to increase test capacity for the disease, ensure adequate contact tracing , while ensuring the data systems are informing the response in rapid fashion.

  THERE should be adequate sensitisation to ensure individuals at risk for monkeypox are engaged with the health care system to avoid making diagnosis, containment, and prevention challenging. There should equally be adequate distribution of vaccines as the demand for vaccines far exceeds availability as at date.