We still don’t know exact reservoir for monkeypox — Odaibo
In this interview with Sade Oguntola, Professor Georgina Odaibo, head, Department of Virology, University of Ibadan , speaks on the reported cases of monkeypox in Nigeria, how individuals can protect themselves from contracting this virus that has no known cure, as well as the need for research support.
What is monkeypox? And how concerned do Nigerians need to be about it?
Monkeypox is a rare disease that is caused by infection with the monkeypox virus. It belongs to a group of viruses called orthopox virus. This group of viruses also includes the vaccinia virus, smallpox virus, and the cowpox virus. One thing that is common with this group of viruses is that some of their antigens are similar. So, antibodies produced against one provide some level of protection against the other. In the time of smallpox, cowpox which causes a less severe disease was used for immunization. It was observed that people that had been infected with cowpox did not come down with smallpox. That gave an idea that there is a relationship between these two pathogens. Cowpox produces less severe disease and it stimulates an immune response that protects against the more severe smallpox.
In 1980, smallpox was declared eradicated globally. You will observe that monkey pox is a more severe infection in the younger age groups. In fact, data show that those between 20 and 40 years are more affected. Most of the more senior people took the vaccination against smallpox and must still have a good level of protective immunity. So, that could explain why monkey pox occurs more in younger age groups. This age group is usually more affected and it is more severe in them.
Over 500 monkeypox cases are said to have been reported in Nigeria. Can you comment on this number of infections?
Well, the number is likely to be the cumulative figure of cases and not just for this year. The first monkey pox cases in Nigeria were reported in the 1970s, and after that, no further cases were reported. But in 2017, monkeypox re-emerged in Nigeria and a lot of cases were reported. Since then, its incidence has been going up and down. In fact, cases were reported in the United Kingdom, USA and I think Israel in people who travelled from Nigeria. So, there is a need for concern because the virus seems to have become more important than earlier thought. The more than 500 supposed cases must have included the suspected and reported cases.
The information available to me is about 240 confirmed monkeypox cases cumulative from 2017 to April 2022 in the country. When you talk of suspected cases, it means all cases with similar signs and symptoms of monkeypox. Until the case is confirmed clinically and in the laboratory, it can’t be said to be monkeypox because there are other diseases that will present with similar symptoms. In Nigeria, a couple of states have reported monkey pox cases over time. The 32 states in Nigeria that have reported cases of monkey pox in the last five years include Lagos, Oyo, Ogun, Ekiti and all the eastern states and the south-south states.
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Does it mean that monkey pox is remerging in Nigeria?
When you say that a disease is re-emerging, it means that it disappeared for some time and then for various reasons, started to reoccur, and that is the situation with monkeypox. As you know it is a zoonotic disease and the first case was found among sick monkeys in Copenhagen in Denmark in the 1950s. That was why it was named monkeypox. Thereafter, it has been reported mainly in Central and West African countries. We don’t know the exact reservoir (s), but there is the suspicion that it is most likely to be rodents. In our environment, we have a lot of rodents, including the ones that live in the bush that come into the house during bush burning. Also, people get exposed when they go into the wild and when they get in contact with the body fluids of infected persons or contaminated surfaces and linens.
What does the monkeypox virus do to humans?
In humans, the symptoms of monkeypox are similar to but milder than the symptoms of smallpox. It usually starts with fever, headache, muscle aches, rash and exhaustion. While monkey pox causes the lymph nodes to swell, smallpox does not. Rash due to monkey pox is unique because it usually starts from the face and then spreads all over the body, including one’s palms and soles. This is different from the rash that is due to smallpox and other members of the orthopoxviruses. In comparison with smallpox, monkeypox is milder, but it can also kill. Its case fatality rate is between 1 and 10 percent. There are two variants of the virus but with different virulence: the West African type and the Central African (Congo) strain. The Central African strain causes more severe disease.
Can it be sexually transmitted?
No, that has not been documented. But it can be transmitted through contact with contaminated surfaces, through body fluids of infected animals and wrong handling of animals. At the abattoirs, butchers still use bare hands when processing animals. In the presence of a cut on their hand, a virus can easily enter the body. When we are processing animals, it should be hygienically such as while wearing hand gloves. There is a need to avoid unprotected contact with the blood or meat of animals.
It means one can contract monkey pox while processing an infected animal?
Yes, you might not know that the monkey or rodent is infected when you are processing it. And because it is in body fluid and with a little opening on the surface of your skin, it goes in easily. So, we need to handle it carefully. Then, if you must eat the meat of the wild, it should be properly cooked.
How treatable is monkeypox?
There is no antiviral for its cure; its management includes preventing a superimposed bacterial infection and possible complications. It is also advised that when an eruption leaves sores, such should be covered so that it doesn’t infect other parts of the skin that are not infected.
How can individuals protect themselves from contracting this infection?
One, maintaining a hygienic environment will help ward off rodent infestation. We also make sure that we don’t keep things that will attract them into the house. We must also limit our intrusion into the wild, because that is where you get exposed to those animals that are possibly their natural host. This will not only work for monkeypox, but also for other zoonotic diseases. Many people like bush meat a lot, but we have to be very careful. If we must eat it, then it should be properly processed and well cooked.
Do you have a word of caution for individuals and the government in stopping monkeypox?
Individuals need to avoid going into the wild to disrupt the ecosystem. We still need a lot of research to know its exact burden, rather than rely only on reported cases. To be able to prevent cases, there must be surveillance. Surveillance is expensive and it is something that needs to be done continuously. Any identified pattern can then help develop policies and advise the population accordingly in the control of the disease. We actually don’t know for sure the reservoir of this virus; more research is needed to identify this and then be able to control it accordingly.
Is it a disease that people should be scared about, like COVID-19?
Every disease should be a cause for worry. You might say it is only about 1 percent that will be affected, but even that one percent is 100 percent for a family, an individual and a community. So, we shouldn’t look at it by saying the magnitude is low, and so we should not worry about it. Every disease should be a thing to worry about because it can affect life, and life is very precious.