Monkeypox: The return of an ailment without cure 39 years after

The current suspected monkey pox outbreak in Nigeria, which has now spread to seven states, is the third in the nation’s history. There were a total of three recorded human cases previously  in 1971 and 1978 according to the Centres for Disease Control, CDC.The virus was first isolated from colonies of monkeys kept for research, hence the name “monkey pox.”

The first recorded human case of monkey pox was in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox. There were also reports of cases in Liberia and Sierra Leone.

Monkeypox

The following year, 1971, there was one case in Cote d’Ivoire and two cases in Nigeria. Then in 1976 there were two cases in Cameroon and again in Nigeria, in 1978, one case was recorded. Since then, monkey pox has remained strictly a disease of Central and Western African countries, except in 2003, when 47 cases were reported in the US.

The 2003 US outbreak is the only time monkey pox infections in humans were documented outside of Africa.   Most of those affected had close contact with pet prairie dogs believed to have had contact with animals that were imported.

The current outbreak in Nigeria is of West African origin and associated with milder disease, fewer deaths, and limited human-to-human transmission. Studies have shown that the monkey pox virus can cause a fatal illness in humans and, although it is similar to human smallpox which has been eradicated, it is much milder.

A professor of virology and former President, Nigeria Academy of Science, Professor Oyewale Tomori, described as a shame Nigeria’s inability to diagnose monkey pox.

Tomori, who spoke to Sunday Vanguard from the US, remarked: “It is indeed a shame for us in this country that, nearly 60 years after our so called independence, we are still unable to confirm a case of most diseases without sending our samples to laboratories overseas.

“And which overseas, are we talking about. Senegal! Just imagine. And there was a time when our laboratory system was able to confirm many of these diseases, now, none of these diseases are we able to confirm.

“We do not have appropriate and well equipped laboratory facilities to definitely confirm suspected cases. Samples have been sent to Dakar and plans are being made to send additional samples to the smallpox laboratories of the WHO Collaborating Center for Smallpox and other Poxvirus Infections at the Center for Disease Control in Atlanta”.

Causes

Monkey pox is a rare disease caused by infection with monkey pox virus, that belongs to the same family of viruses that includes variola virus (the cause of smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus.

The natural reservoir remains unknown. However, African rodent species are expected to play a role in transmission.

The monkey pox virus can cause an illness with a generalised vesicular skin rash, fever, and painful jaw swelling. In previous outbreaks, it has led to death in about 1-10 per cent of infected cases.

There is no specific medicine to treat the disease, but intensive supportive care helps patients to recover fully.

Confirmation of suspected cases

We do not have appropriate and well equipped laboratory facilities to definitely confirm suspected cases. Samples have been sent to Dakar and plans are being made to send additional samples to the smallpox laboratories of the WHO Collaborating Center for Smallpox and other Poxvirus Infections at the Center for Disease Control in Atlanta.

Rapid spread

I think it is too early to say  that we are having a rapid spread of the disease as we do not have laboratory confirmation of the reported cases from different states. However, this is not to say that the disease cannot be spread easily, especially from an infected person.

Largest outbreak

The largest outbreak ever reported in Africa was the 1996 DR Congo outbreak, with more than 70 cases. The outbreak lasted for a period of one year. During the outbreak, there was a significant association of human contacts with squirrel (trapping, preparing raw meat for cooking) and human-to-human transmission through direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected persons.

In Africa, there are reports of human infections associated with handling of infected monkeys, Gambian giant rats and squirrels, with rodents being the major reservoir of the virus. Eating inadequately cooked meat of infected animals is a possible risk factor.

Cause for concern 

There is definitely a danger and cause for concern, as between 1- 10 percent of people infected with monkeypox may die, most deaths occurring in younger age groups. However, we need to confirm the cases before we think of declaring a national emergency. If we have to declare an emergency at all, it is to declare emergency for the poor state of national health. Otherwise, we will be declaring emergencies for every outbreak. And we have many in our country- Lassa, Meningitis and pardon me, and the most severe and devastating disease – corruption.

There is no cure 

In as much as the government has taken appropriate steps and measures – alerting citizens, calling for calm, sending samples for laboratory testing, contacting international agencies for assistance- our national response is adequate. Unfortunately, there is no cure for the disease, although it is known that people who have received smallpox vaccine suffer a mild form of the disease. But remember smallpox vaccination was stopped in the 1980s, so should people born after that time contract the disease, they are likely to suffer a severe form.

What to do to prevent infection 

First is to prevent transmission from animal to man through contact with any of the animals listed as natural hosts of the virus – monkeys, rodents, rats, squirrels etc. Those handling sick animals, raw or infected tissues, must wear gloves and other appropriate protective clothing. We must thoroughly cook all animal products (blood, meat) before eating.

During a monkey pox outbreak, we must avoid close and direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of an infected person. Since there is neither a vaccine nor a specific treatment for the disease, you need to raise awareness of the risk factors and educate people about the measures that must be taken to reduce exposure to the virus.

Also upgrade our surveillance for the disease to rapidly identify new cases and isolate them. We must implement standard infection control in our health facilities, while providing our health workers with gloves and protective equipment when taking care of ill people.

We cannot over stress the need for regular hand washing, especially after caring for or visiting sick people. Finally, we must keep our environment clean and free from invasion by rats and rodents.