Monkeypox in Nigeria: All you need to know about the virus

On May 27,2022, the director-general, NCDC, Dr. Ifedayo Adetifa, disclosed that the Nigeria Centre for Disease Control (NCDC) activated a national multisectoral Emergency Operations Centre for Monkeypox (MPX-EOC) at level 2 to strengthen and coordinate ongoing response activities in the country while contributing to the global response.

According to the NCDC, as at 29th May 2022, a total of 21 confirmed cases with one death have been reported from 9 states and the FCT – Adamawa (5), Lagos (4), Bayelsa (2), Delta (2), Cross River (2), FCT (2), Kano (2), Imo (1), Rivers (1). 

According to the National Monkeypox Public Health Response Guidelines released in 2019 by the NCDC, Monkey pox 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, monkey pox however continues to occur sporadically in Central and West Africa. The monkey pox 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 recognized 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 the World Health Organization (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.

Below is a table showing cases of monkeypox in endemic countries between 15 December 2021 to 1 May 2022 as reported by the World Health Organization (WHO)

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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 to monkeypox.

Transmission

The virus can be transmitted from animal-to-human, human-to-human and from a contaminated environment-to-human. Index cases are 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).

Signs and Symptoms

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.

Invasion/prodromal period (0-5 days) with clinical manifestations of fever, intense headache, lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle ache) and an intense asthenia (lack of energy)
Skin eruption period (within 1-3 days after appearance of fever) where 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 the following 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
Soles

Prevention

There are number of measures that can be taken to prevent infection with monkeypox virus:

Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).
Avoid eating infected animals or meat that has not been thoroughly cooked.
Avoid contact with any materials, such as bedding, that has been in contact with a sick animal.
Isolate infected patients from others who could be at risk for infection.
Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.