For over two years, the world has had to contend with Covid-19 disease caused by the SARS-COV-2 virus. Thus, the world’s most devastating pandemic in human history. Just when the world begun to adapt to living in the midst of covid-19, another virus hitherto only endemic in the West and Central Africa, has found its way into Europe. This virus is the cause of a skin damaging disease called the monkeypox disease. Monkeypox is a contagious zoonotic viral disease caused by the monkeypox virus. First discovered in the 1958 among monkeys kept for research showing pox-like manifestations, the first case of human infection was reported in the 1970 in the Democratic Republic of Congo. Since then cases continue to be reported in the West and Central African countries in the rural areas close to tropical rain forests.
The first case of monkeypox disease reported outside of the West and Central African was an outbreak in the United State of America in 2003 following the importation of rodents from Africa. During this period both humans and pet Prairie dogs were affected. Human cases were associated with contacts with infected pets but no fatalities were recorded.
Outside of Africa, sporadic cases have been reported in 2018-2021 in the UK, 2021 in the USA, Singapore 2019 and Israel, 2018. The index cases were linked to individuals with travel history particularly from the Nigeria.
map of monkeypox endemic areas – Bing images
What is known about the monkeypox virus?
The Monkeypox virus is a double stranded DNA virus of the Orthopoxvirus genus of the Poxiviridae family with two distinctive genetic clades.  The Central African (Congo Basin) clade and the West African clade. The Central African clade, is prevalent in the Central African Republic, the Democratic Republic of the Congo and other countries. Clinically, virus in this clade causes more severe illness and case fatality up to 11%. The West African clade, found in Nigeria, Côte d’Ivoire, Liberia and Sierra Leone causes less human to-human transmission, less severe illness, and death in up to 6% of cases. Cameroon is so far the only country reporting both clades. The natural host and reservoir of the monkeypox virus is unknown and many rodents and non-human primates are susceptible to the virus. The virus has so far been detected among rope squirrels, tree squirrels, Gambian pouched rats, different species of monkeys and dormice. Monkeypox disease is transmitted through close contact with infected animals, humans or materials contaminated with the bodily fluids of people with Monkeypox virus. It can also been transmitted through broken skins, mucous membranes (nose, eyes, mouth) and the respiratory tract. Infected people may start showing symptoms of the disease 5 -21 days after coming into contact with the virus and will remain infectious until the scab formed from the rash has falling with intact skin underneath.
Monkeypox viral infection progresses in two phases. The invasion period (0-5 days) characterized by fever, headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches), and fatigue; and a characteristic rash appearing in stages 1-3 days after the onset of fever, beginning on the face and spreading to the trunk and limbs. Severe illness occurs more commonly in children.
What is new about Monkeypox outbreak?
While genomic sequencing is still understudy to identify the origin of the current outbreak, preliminary investigations has identified the West African clade of the Monkeypox virus. The first known case was reported in London, United Kingdom, in an individual with recent travel history to Nigeria. Since it was first reported on 7th May 2022, 28 countries where monkeypox disease is non-endemic has been reported, making it an atypical for monkeypox virus. As of the 31st of May, 2022, 557 confirmed cases have been reported. The United Kingdom and Spain have so far reported 179 and 120 respectively of the total confirmed cases making them the two countries with the highest confirmed cases.
The recent outbreak is also considered atypical because of the absence of any link with infected animal contacts and all cases reported were among gay men, men who have sex with men and bisexual. The WHO described the outbreak as moderate risk due to the nature of spread and feared the virus could establish itself as a human pathogen leading to widespread transmission with devastating consequences to young children and people with immunosuppression.
Is there treatment, and is monkeypox preventable?
The most effective way of breaking the outbreak is prevention. The World Health Organisation recommends the following strategies of prevention.
- Avoid unprotected close contact with infected people
- Do not share bedding, clothing, towels or utensils with sick people
- Use personal protective equipment (PPE) when caring for patients
- Avoid contact with wild animals specially those found sick or dead
- Always wash hands before and after caring for or visiting sick persons
- Thoroughly cook food containing animal parts or meat before eating
- Isolate infected people at home or hospital until the scab has fallen and skin underneath is intact
Treatment is mainly supportive because the disease is self-limiting in healthy people. However, outbreak control may necessitate the use of smallpox vaccine which has been proven to be 85% effective in preventing monkeypox virus when used before or after exposure to the virus. Medications such as cidofovir and tecovirimat may also be considered for outbreak control.
Kwame Awiagah,
References
- BNO News – Monkeypox Tracker, accessed on 31/05/2022 at 02:50
- MOOCs – start to enjoy learning now | OpenWHO, accessed on 30/05/2022 at 03:30
- Monkeypox: background information – GOV.UK (www.gov.uk) accessed on 30/05/2022 at 03:30
- Monkeypox outbreak reaches 257 confirmed cases worldwide, WHO says – CNN accessed on 31/05/2022 at 03:20
- https://www.bing.com/images accessed on 31/05/2022 at 0400
- https://www.msn.com/en-xl/travel/other/monkeypox-what-we-know-about-the-smallpox-like-virus-in-spreading-in-the-uk-portugal-and-spain/ar-AAX4CC2?fullscreen=true#image=1
