Following the resurgence of the Monkeypox in Nigeria and other parts of the world, Deborah Tolu-Kolawole writes on the response of the Nigerian health authorities to the disease amidst a harvest of deaths from an ongoing outbreak of the Lassa Fever disease
As the Nigerian health authorities worry about the harvest of deaths from the Lassa Fever disease, citizens and health workers alike are jolted by the report of sporadic cases of the monkeypox disease, which has begun to cause panic across the globe.
Monkeypox, which is caused by the monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae, is a zoonotic viral disease in tropical rainforest areas of Central and West Africa and is occasionally exported to other regions.
According to the World Health Organisation, the disease “typically presents clinically with fever, rash, and swollen lymph nodes.”
Monkeypox virus is mostly transmitted to people from wild animals such as rodents and primates, but human-to-human transmission also occurs.
The virus can be transmitted from one person to another by contact with lesions, body fluids, respiratory droplets, and contaminated materials such as beddings.
Typically, up to a tenth of persons ill with monkeypox may die, with most deaths occurring in younger age groups.
The WHO explains that the “clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection which was declared eradicated worldwide in 1980.
The global body also noted that the vaccine developed to eradicate smallpox was effective against the monkeypox.
“Vaccinia vaccine used during the smallpox eradication programme was also protective against monkeypox. A new third-generation vaccinia vaccine has been approved to prevent smallpox and monkeypox. Antiviral agents are also being developed.
Corroborating the WHO’s stance on the efficacy of the smallpox vaccine in the fight against monkeypox, Chikwe Ihekweazu, Lucile Blumberg, Richard Kock, et al., while writing on the topic, “Monkeypox — Enhancing public health preparedness for an emerging lethal human zoonotic epidemic threat in the wake of the smallpox post-eradication era,” in January 2019, observed that a certain age group affected during the monkeypox outbreak that occurred in Nigeria in September 2018, were largely unvaccinated against the smallpox disease.
“New cases of monkeypox continue to be detected in Nigeria. As of October 13, 2018, there were 116 confirmed cases (with 8 deaths = 6% mortality) and 280 additional suspected cases from across 16 Nigerian States (Nigeria CDC, 2018) affecting children and adults of all ages.
“The majority of confirmed monkeypox cases are under 40 years with a median age of 31 years. Notably, these people were born after the discontinued global vaccination programmes for smallpox in 1978.
“Studies in monkeys have shown that immunisation with smallpox vaccine induces cross-protection against monkeypox (McConnell et al., 1968). The question arises – did the mass smallpox vaccination program help prevent the spread of human monkeypox?
There have been several suggestions (Durski et al., 2018a, Rimoin et al., 2010, Reynolds and Damon, 2012) that the increasing number of monkeypox cases in Central and West Africa is probably a consequence of the cessation of smallpox vaccination in the early 1980s, following the eradication of smallpox.
“The apparent lack of cross-protection against monkeypox among the non-vaccinated younger age groups and the waning smallpox vaccine-induced population immunity in the vaccinated groups may contribute to the increased susceptibility to monkeypox infection. This creates an ecological niché where the monkeypox virus can expand in humans outside its natural reservoir”.
Official Monkeypox disease reports from the Nigeria Centre for Disease Control website revealed that from September 2017 to April 2022, Nigeria has continued to report sporadic cases of the disease.
For instance, there were 197 suspected cases in 2017, and a total of 114 suspected cases of the disease were reported in 2018.
In 2019, 113 suspected cases were reported.
Though the NCDC did not make available the situation reports of the disease for the year 2020, it noted that it only confirmed 8 cases.
In 2021, the NCDC reported 98 suspected cases, of which 34 were confirmed.
So far in 2022, the centre noted that it had reported 46 suspected cases, with 15 cases confirmed.
Speaking on the disease, an infectious disease expert, Professor Oladapo Ashiru, noted, “Monkeypox is a viral zoonosis (a virus transmitted from animals to humans) with symptoms comparable to those seen in smallpox patients in the past.
“However, it is less severe clinically. It has emerged as the most dangerous Orthopoxvirus after the eradication of smallpox in 1980 and the consequent suspension of smallpox vaccination. Monkeypox was first identified in 1958, when two outbreaks of a pox-like disease occurred in research colonies of monkeys, hence the name.
“During the increased effort to eradicate smallpox, the first human case of monkeypox was recorded in the Democratic Republic of the Congo in 1970.
Monkeypox has been documented in 11 African nations since 1970: Benin, Cameroon, Central African Republic, Democratic Republic of Congo, Gabon, Ivory Coast, Liberia, Nigeria, Republic of Congo, Sierra Leone, and South Sudan.
“Monkeypox’s natural reservoir has yet to be discovered. People have contracted monkeypox outside of Africa due to foreign travel or imported animals, with cases reported in the United States, Israel, Singapore, and the United Kingdom.
“African rodents and non-human primates (such as monkeys) may carry the virus and infect humans. In the Democratic Republic of Congo, a severe monkeypox outbreak was suspected in 1996–97, with a lower case-fatality rate and a more significant attack rate than typical.
“Varicella virus was found in some patient samples, while others had varicella and monkeypox viruses. Concurrent outbreaks of chickenpox and monkeypox on this occasion could explain the shift in transmission dynamics.
“The primary prevention strategy for monkeypox is to raise public knowledge of risk factors and educate individuals about the steps they may take to decrease virus exposure. Scientific investigations are currently being conducted to determine the viability of utilizing the vaccinia vaccine to prevent and control monkeypox.
“Some nations have or are considering rules for using the vaccinia vaccine to prevent infection, such as laboratory workers and healthcare professionals who may be exposed.”
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