MONKEYPOX (MPX) is a zoonotic viral disease that was discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research in Copenhagen, Denmark. The host range include small mammals such as rodents, rope squirrels, tree squirrels, Gambian pouched rats, captive and wild non- human primates. The first human case of the disease was reported in the Democratic Republic of Congo in 1970. This occurred at a time when efforts to eliminate small pox was intensified globally. Monkeypox virus belongs to the Orthopox virus genus in the family poxviridae. It is closely related to the variola virus which is responsible for smallpox, vaccinia virus ( used in small pox vaccine and cow pox virus. There are two distinct genetic clades of the virus; the central African (Congo basin) clade and the West African clade. The Congo basin clade is historically known to be more virulent in terms of the severity of the disease and transmisability. Since the first case in 1970, the disease has been reported in other Central and West African countries such as Cameroon, Central African Republic, Cote d’lvoire, Liberia, Gabon, Republic of Congo, Sierra Leone and Nigeria.
   In recent times, the disease has been reported outside the shores of Africa in the most unexpected manner. Such countries include Israel, Singapore, United Kingdom, Australia, Canada and the United States of America. Although the natural reservoir of monkeypox is still unknown, African rodents and non-human primates such as monkeys may harbour the virus and transmit to people. It is important to note that monkeypox is usually a self-limiting disease with symptoms usually ranging from two to four weeks. Severe cases may occur especially due to late presentation at the hospital. The case fatality ratio is between 3-6 per cent. Since 2017, large outbreaks have been reported in Nigeria with over five hundred suspected cases and more than two hundred confirmed cases. It is pertinent to note that cases continue to be reported till date. The epidemiology of the disease, especially as it affects the mechanism of spread in countries that are not known to be endemic is currently undergoing rigorous scientific investigation. How is monkeypox transmitted? There are various routes of transmission of monkeypox. This includes animals to human transmission, i.e. zoonotic transmission in which there is a direct contact of humans with the blood, bodily fluids, skin and mucosal lesions of infected animals.
  Human-to-human transmission can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects. If there is prolonged face-to-face contact, transmission through droplet or respiratory particles is possible. Transmission is also possible via the placenta from mother to fetus or during close contact during and after birth. The certainty of transmission through sexual route is not yet clear. What are the signs and symptoms? The incubation period of monkeypox is usually between 6-13 days, though it may range between 6 to 21 days. Signs and symptoms include fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches) severe asthenia (lack of energy). It is important to know that Lymphadenopathy is a distinctive feature of monkey pox. This lesion separates monkeypox from diseases that may appear similar initially i.e. chickenpox, measles, and small pox. Other symptoms include skin eruptions (within 1-3 days of appearance of fever).
  This rash tends to be more concentrated on the face and extremities rather than on the trunk. It affects the face (in 95 per cent cases and palms of the hands and soles of the feet (in 75 per cent of cases), oral mucous membranes (in 70 per cent of cases), genitalia (30 per cent of cases), conjunctivae (20 per cent). The rash evolves from being flat base (Macudes), slightly raised firm lesions (papules), lesion filled with clear fluid (Vesicles), lesions filled with yellowish fluid (pustules) and crusts (which dry up and fall off).The skin lesions (rash or eruptions) may vary from a few to several thousand while in severe cases, lesions may coalesce until large sections of the skin slough off. Are there vaccines to prevent monkeypox? It has been established that those who were vaccinated against small pox cannot succumb to monkeypox infection because of cross protection. However, small pox was eradicated globally in 1980. It means those born after 1980 may not have  been vaccinated with small pox vaccine. At the present time, the original (first generation small pox vaccines are no longer available to the general public. A newer vaccine was approved for the prevention of Monkeypox in the United States of America in 2019. The availability of this vaccine is very limited. How can we prevent monkeypox infection? Prevention of monkeypox is possible by following the following steps: 1. Public health education, through sensitization and awareness programs by all stakeholders using both conventional means and the deployment of new media. 2. Adoption of hand washing as frequent as possible, as a matter of lifestyle. 3. General improvement of hygiene and environmental sanitation. This will reduce or eliminate rodent- human interaction. 4. Since close contact with infected person is the most significant risk factor, family care givers and health workers caring for patients with suspected or confirmed monkeypox virus infection or handling specimens from them should implement standard infection control precautions.
 If possible, persons who were vaccinated against smallpox should be selected to care for the patient. 5 Samples taken from people and animals with suspected monkeypox virus infection should be handled by trained staff working in suitably- equipped laboratories. The specimens must be safely prepared for transport with triple packaging in accordance with World Health Organization guidelines for transport of infectious substances. 6. People whose means of livelihood revolves around the bush such as pot hunters and bush meat vendors should take extra precaution when handling animal carcasses. No apparently sick or wildlife that are found dead should be processed for human consumption. 7. All foods of animal origin must be well cooked before consumption. In conclusion, the government should improve on the existing mechanisms deployed to combat infectious disease outbreaks. The success recorded in the control of Covid-19 should be an encouragement to invest more in human and material resources in the control of infectious diseases such as Monkeypox. Inter-agency collaborations should be strengthened at this time.
 The recent collaboration between the National Veterinary Research Institute, Vom and the Nigerian Centre for Disease Control (N.C.D.C) with the support of the United States Defense Threat Reduction Agency (US-DTRA) in the area of manpower training and development through intensive workshops for medical, veterinary, paramedical and paraveterinary professionals is highly commendable, enviable and appropriate. It is a confirmation of the need for paradigm shift in the battle against emerging and re-emerging diseases in the spirit of one Health in Nigeria. Certainly, with concerted efforts, the days of monkeypox are numbered in Nigeria.
 •Dr. Faramade is a lecturer at the Federal College of Animal Health and Production Technology, Apata, Ibadan.
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