Monkeypox In Nigeria

MONKEYPOX

BY

OMOGE ADEYEMI O.

PUBLIC HEALTH STUDENT 

DEPARTMENT OF PUBLIC HEALTH

FACULTY OF BASIC MEDICAL SCIENCES

ADELEKE UNIVERSITY, EDE, OSUN STATE

 OCTOBER, 2017

INTRODUCTION 

Monkeypox is a rare disease that occurs primarily in remote parts of Central and West Africa, near tropical rainforests. Monkeypox is a rare viral zoonosis (a virus transmitted to humans from animals) with symptoms in humans similar to those seen in the past in smallpox patients, although less severe. However, monkeypox still occurs sporadically in some parts of Africa. Monkeypox is a member of the Orthopoxvirus genus in the family Poxviridae. The virus was first identified in the State Serum Institute in Copenhagen, Denmark, in 1958 during an investigation into a pox-like disease among monkeys. Monkeypox virus causes the disease in both humans and animals. It was first identified in 1958 as a pathogen of crab-eating macaque monkeys (Macaca fascicularis ) being used as laboratory animals. The crab-eating macaque is often used for neurological experiments. The virus was first discovered in monkeys (hence the name) in 1958, and in humans in 1970. Between 1970 and 1986, over 400 cases in humans were reported.

OUTBREAKS

Human monkeypox was first identified in humans in 1970 in the Democratic Republic of Congo (then known as Zaire) in a 9 year old boy in a region where smallpox had been eliminated in 1968. Since then, the majority of cases have been reported in rural, rainforest regions of the Congo Basin and western Africa, particularly in the Democratic Republic of Congo, where it is considered to be endemic. In 1996 - 1997, a major outbreak occurred in the Democratic Republic of Congo.

The first reported outbreak in the United States occurred in 2003 in the Midwestern states of Illinois, Indiana, and Wisconsin, with one occurrence in New Jersey. The outbreak was traced to a prairie dogs infected from an imported Gambian pouch rat.

In 2005, a monkeypox outbreak occurred in Unity, Sudan and sporadic cases have been reported from other parts of Africa. In 2009, an outreach campaign among refugees from the Democratic Republic of Congo into the Republic of Congo identified and confirmed two cases of monkeypox. Between August and October

2016, a monkey pox outbreak in the Central African Republic was contained with 26 cases and two deaths.

On the 22nd of September, 2017, NCDC was notified of a suspected outbreak of monkeypox in Bayelsa State. Currently, seven States (Bayelsa, Rivers, Ekiti, Akwa Ibom, Lagos, Ogun and Cross River) have reported 33 suspected cases with no deaths. 

RESERVOIR OF INFECTION

In Africa, monkeypox infection has been found in many animal Species: Rope Squirrels, Tree Squirrels, African Squirrels (Heliosciurus, and Funisciurus), Gambian pouched rats (Cricetomys gambianus), striped mice, dormice (Graphiurus sp.) and primates. The use of these animals as food may be an important source of transmission to humans. Doubts persist on the natural history of the virus and further studies are needed to identify the exact reservoir of the monkeypox virus and how it is maintained in nature.

INCUBATION PERIOD

The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 7 to 14 days but can range from 5 to 21 days.

SUSCEPTIBILITY

Severe cases occur more commonly among children. In general, the younger age groups appear to be more susceptible to the infection.

OCCURRENCE

Most human cases of monkeypox occur in remote villages in Central and West Africa close to tropical rainforests where there is frequent contact with infected animals.

MODE OF TRANSMISSION

Transmission of monkey pox virus results from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. In Africa human infections have been documented through the 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.

Secondary, or human-to-human, transmission can result from close contact with infected respiratory tract secretions, skin lesions of an infected person or objects recently contaminated by patient fluids or lesion materials. Transmission occurs primarily via droplet respiratory particles usually requiring prolonged face-to-face contact, which puts household members of active cases at greater risk of infection. Transmission can also occur by inoculation or via the placenta (congenital monkeypox). There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population.

SIGNS AND SYMPTOMS

The symptoms of the infection can be divided into two periods:

The invasion period (0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle ache) and an intense asthenia (lack of energy)

The skin eruption period (within 1-3 days after appearance of fever) where the various stages of the rash appears, 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 (75%) are most affected. Evolution of the rash from maculopapules (lesions with a flat bases) to vesicles (small fluid-filled blisters), pustules, followed by crusts occurs in approximately 10 days. Three weeks might be necessary before the complete disappearance of the crusts.

DIAGNOSIS

The differential diagnoses that must be considered include other rash illnesses, such as, smallpox, chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish it from smallpox. Monkeypox can only be diagnosed definitively in the laboratory where the virus can be identified by a number of different tests:

Enzyme-linked immunosorbent assay (ELISA)

Antigen detection tests

Polymerase chain reaction (PCR) assay

Virus isolation by cell culture

TREATMENT AND VACCINE

There are no specific treatments or vaccines available for monkeypox infection, but outbreaks can be controlled. Vaccination against smallpox has been proven to be 85% effective in preventing monkeypox in the past but the vaccine is no longer available to the general public after it was discontinued following global smallpox eradication. Nevertheless, prior smallpox vaccination will likely result in a milder disease course.

PREVENTION

PREVENTING MONKEYPOX EXPANSION THROUGH RESTRICTIONS ON ANIMAL TRADE

Restricting or banning the movement of small African mammals and monkeys may be effective in slowing the expansion of the virus outside Africa. Captive animals should not be inoculated against smallpox. Instead, potentially infected animals should be isolated from other animals and placed into immediate quarantine. Any animals that might have come into contact with an infected animal should be quarantined, handled with standard precautions and observed for monkeypox symptoms for 30 days.

REDUCING THE RISK OF INFECTION IN PEOPLE

During human monkeypox outbreaks, close contact with other patients is the most significant risk factor for monkeypox virus infection. In the absence of specific treatment or vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus. Surveillance measures and rapid identification of new cases is critical for outbreak containment.

Public health educational messages should focus on the following risks:

REDUCING THE RISK OF HUMAN-TO-HUMAN TRANSMISSION

Close physical contact with monkeypox infected people should be avoided.

Gloves and protective equipment should be worn when taking care of ill people. 

Regular hand washing should be carried out after caring for or visiting sick people.

Isolate infected patients from others who could be at risk of infection

Avoid contact with any materials such as bedding that has been in contact with infected person

REDUCING THE RISK OF ANIMAL-TO-HUMAN TRANSMISSION

Efforts to prevent transmission in endemic regions should focus on thoroughly cooking all animal products (blood, meat) before eating. 

Gloves and other appropriate protective clothing should be worn while handling sick animals or their infected tissues, and during slaughtering procedures.

Practice of regular hand washing should be carried out after contact with infected animals.

Avoid contact with any materials that has been in contact with infected animal

CONTROLLING INFECTION IN HEALTH-CARE SETTINGS

Health-care workers caring for patients with suspected or confirmed monkeypox virus infection, or handling specimens from them, should implement standard infection control precautions.

Healthcare workers and those treating or exposed to patients with monkeypox or their samples should consider being immunized against smallpox via their national health authorities. Older smallpox vaccines should not be administered to people with comprised immune systems.

Samples taken from people and animals with suspected monkeypox virus infection should be handled by trained staff working in suitably equipped laboratories.

REFERENCES

CENTERS FOR DISEASE CONTROL AND PREVENTION

https://www.cdc.gov/poxvirus/monkeypox/index.html

MEDICINENET: MONKEYPOX

https://www.medicinenet.com/monkeypox/article.htm

NIGERIA CENTRE FOR DISEASE CONTRIOL: UPDATE ON SUSPECTED MONKEYPOX OUTBREAK

http://www.ncdc.gov.ng/news/108/press-release%3A-update-on-suspected-monkeypox-outbreak

WHO: MONKEYPOX FACT SHEET, NOVEMBER 2016

www.who.int/mediacentre/factsheets/fs161/en/

WIKIPEDIA: MONKEYPOX

https://en.m.wikipedia.org/wiki/Monkeypox