Containing the monkey pox outbreak

What was reported as a lone incident by the United Kingdom Health Security Agency (UKHSA) in far away London has burgeoned into a real epidemic of another round of monkey pox in Nigeria, following the confirmation of the disease by the Nigeria Centre for Disease Control (NCDC). The report immediately raised questions about assumptions that monkey pox might be getting extinct; and the country’s preparedness to contain outbreak of deadly diseases. The UKHSA said the patient had recently travelled from Nigeria and is receiving care at the Infectious Disease Unit of Guy’s and St. Thomas’ NHS Foundation Trust in London.

One of the questions arising is why the disease was not detected in Nigeria. Is the patient a Nigerian or British? How did s/he sojourn or pass through Nigeria without being detected? In which state did s/he contract the disease since it has spread to 32 states? What happened to surveillance and monitoring of infectious diseases?

There is need for thorough investigation to determine the source of the latest outbreak of the disease for proper containment, even though, Nigeria has continued to report sporadic cases of the disease, with a National Technical Working Group (TWG) monitoring infections and strengthening preparedness/response capacity. The containment of the deadly Ebola disease in the country some years back was largely due to close monitoring by health authorities, spearheaded by Dr. (Mrs.) Stella Adadevor who paid the supreme price for her bravery in forcefully isolating an uncooperative patient from Liberia

On Monkey pox, the NCDC indicates that 46 suspected infections were reported between January 1 and April 30 this year in addition to 15 confirmed cases from seven states – Adamawa (3), Lagos (3), Cross River (2), Abuja (2), Kano (2), Delta (2) and Imo (1), though, no death has been recorded. Furthermore, the NCDC said ten new suspected cases in April were reported from seven states – Bayelsa (3), Lagos (2), Kano (1), FCT (1), Delta (1), Edo (1) and Ogun (1). From September 2017 to April 30, 2022, a total of 558 suspected cases were reported from 32 states.

Although, the casualty figure has been minimal, the rapid spread of the disease demands emergency management action from the federal, state and local governments. All hands must be on deck to combat this highly contagious disease. Luckily, most of the victims are not dying from the disease. A victim who in a previous epidemic reportedly committed suicide in Bayelsa State might have done so out of frustration, probably, due to lack of proper counseling. All the suspected cases should be subjected to appropriate medical care and monitored for improvement clinically.

Usually, during outbreaks of the disease, the NCDC activates an Emergency Operation Centre (EOC) to coordinate the outbreak, its investigation and response across the affected states. Even when indications are therefore strong that the disease is being contained, this is no reason to view the situation as less grim. There should be no disposition, as was the case with Lassa fever not quite long ago, that the impact of the disease has not reached alarming level. That would be insensitive. The Ebola epidemic, in 2014, claimed just about three casualties in Lagos and a national emergency was declared, which helped to check the spread.

Authorities should, therefore, not wait for the situation to get to crisis proportion before waking up to their responsibilities. The proactive measures already put in place should be sustained to curb a public health concern that could debilitate a large segment of the population if unchecked. Nigerians move a lot around all parts of their country, which is why the disease could spread easily.

Given the propensity for a rapid spread and the lack of capacity in most states to contain the disease, the Federal Government should lead the containment. What is needed, at this juncture, is not panic but precautionary hygienic measure by members of the public. All persons suspected of experiencing the symptoms should immediately report to the nearest health facility and be put in isolation.

Monkey pox is a rare viral zoonotic disease caused by the monkey pox virus. Symptoms begin with fever, headache, muscle pains, swollen lymph nodes and tiredness. This is then followed with rashes that form blisters and scabs over the body. The incubation period is around ten days but typically two to four weeks before presenting symptoms.

The virus is believed to circulate among certain rodents and squirrels. Eating these animals for food could be a source of transmission. Infection is diagnosed through testing a lesion for the virus DNA. The disease can appear similar to chickenpox. The transmission could be via contact with infected animals, humans or contaminated materials. Animal to human transmission occurs through bites, scratch, bodily fluids from an infected person and bush meat preparation and consumption.

The disease, which is endemic in West and Central Africa, was first identified in 1958 among laboratory monkeys. The first case of human infection was found in 1970 in the Democratic Republic of Congo. An outbreak that occurred in the United States in 2003 was traced to a pet store that sold imported Gambian rodents. Control measures include isolation of suspected or confirmed cases, strict adherence to universal precautions, especially, frequent hand washing with soap and water and use of personal protective equipment.

The smallpox vaccination could prevent the infection considering that the two are closely related. But this has not been conclusively demonstrated as routine vaccination against smallpox was discontinued following the apparent eradication of smallpox. For now, there is need to educate members of the public. Adequate information on measures for prevention and control should be disseminated by all local governments, state ministries of health and even faith-based organisations, which can easily reach the people. Personal and environmental hygiene are of course critical.

Also, all health workers should adopt universal safety precautions in the management of suspected or confirmed cases by wearing appropriate personal protective equipment and wash hands after each contact with a patient or contaminated materials. Surveillance systems must also be strengthened.