46 Years After, Monkeypox Still a Challenge in Nigeria

While Nigeria is still grappling with curbing the present outbreak of Monkeypox virus which has spread to at least 11 states across the country (Bayelsa, Akwa Ibom, Cross River, Delta, Ekiti, Enugu, Imo, Lagos, Nasarawa, Rivers, as well as the Federal Capital Territory) with 74 suspected or confirmed cases already, indications show this is not the first time Nigeria is experiencing the health challenge.

In 1971, the country experienced its first case of Monkeypox virus with two persons affected just a year after the first human case was recorded in the Democratic Republic of Congo. Also in 1978, Nigeria recorded another outbreak.

The present outbreak makes it the 46th year since Nigeria started experiencing the outbreak, but like in many other health cases, the country is yet to have a laboratory for treating the virus, not to talk of providing a cure.

The recently confirmed cases of the disease among the 74 affected persons in Nigeria were diagnosed in Senegal, a neighbouring country that can’t boast of the human, natural and economic resources Nigeria wields.

No wonder a Professor of Virology and former President, Nigeria Academy of Science, Professor Oyewale Tomori, described Nigeria’s inability to diagnose the Monkeypox virus as shameful, adding that nearly 60 years after the country’s independence, it is still unable to confirm cases of most diseases without sending  samples to laboratories overseas.

“And which overseas are we talking about. Senegal. Just imagine! And there was a time when our laboratory system was able to confirm many of these diseases, now, none of these diseases can be confirmed here.

“We do not have appropriate and well equipped laboratory facilities to definitely confirm suspected cases. Samples have been sent to Dakar and plans are being made to send additional samples to the smallpox laboratories of the World Health Organisation Collaborating Centre for Smallpox and other Poxvirus Infections at the Centre for Disease Control in Atlanta.”

Also, a Virologist, Dr. Olaolu Akinjide believes Nigeria’s leaders do not give priority to the health of their citizens, as they are often only good at fire brigade approaches to outbreaks.

“This is same thing we see during Lassa fever outbreaks. It is almost 50 years since Lassa fever was discovered in Lassa community in Borno State. Naturally, it behoves on us to find a lasting solution to the recurring bouts of the outbreak, but yet nothing.

“The fact that we are even unable to provide laboratory diagnosis, and even cure for Monkeypox here, shows how much attention we are giving to researches in this country. We have a medical research institute that should be funded to come up with solutions in this regard,” he said.

This again brings to fore the level of priority placed on medical research in the country. While the United States National Institute of Health will spend about 32.3 billion dollars this year alone on medical research for the American people, the entire health budget for Nigeria cannot be said to be close to that figure.

Earlier last week, the Health Minister, Prof. Isaac Adewole had said the ministry received laboratory confirmation for the Monkeypox virus from three of these cases from the WHO Regional Laboratory in Dakar, Senegal.

According to Adewole, patients with the disease were “doing well clinically”. Of the 14 other cases identified, 12 have come back as negative while results for the last two are not yet available.

“The most likely source of infection is a primary zoonotic transmission, from an animal, with secondary person-to-person transmission,” Adewole said.

The minister sought to reassure the public that “all the necessary public health measures have been put in place and will continue to be implemented.”

The Nigeria Centre for Disease Control (NCDC) said it has set up an emergency operations centre to coordinate its response and test samples. Public health messages have been broadcast calling on people to frequently wash their hands and avoid eating bush meat.

In September, at least 10 people in the Central African Republic died in a Monkeypox outbreak. There have also been fatalities in the Democratic Republic of Congo.

According to the World Health Organisation (WHO), Monkeypox is a rare disease that occurs primarily in remote parts of Central and West Africa, near tropical rain forests, and it can cause a fatal illness in humans, although it is similar to human Smallpox which has been eradicated, it is much milder.

WHO says the virus is transmitted to people from various wild animals but has limited secondary spread through human-to-human transmission. “Typically, case fatality in Monkeypox outbreaks has been between one per cent and 10 per cent with most deaths occurring in younger age groups. There is no treatment or vaccine available although prior Smallpox vaccination was highly effective in preventing Monkeypox as well,” the health body added.

Infection of index cases results from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals.

WHO says 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 said to be 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, according to WHO 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.

There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population.

The incubation period (interval from infection to onset of symptoms) of Monkeypox. According to the health body is usually from six to 16 days but can range from five to 21 days, adding that the infection can be divided into two periods; the invasion period (0-5 days) characterised by fever, intense headache, lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle ache) and an intense asthenia (lack of energy); and 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 per cent of cases), and palms of the hands and soles of the feet (75 per cent) 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. The number of the lesions varies from a few to several thousand, affecting oral mucous membranes (in 70 per cent of cases), genitalia (30 per cent) and conjunctivae (eyelid) (20 per cent), as well as the cornea (eyeball).

“Some patients develop severe lymphadenopathy (swollen lymph nodes) before the appearance of the rash, which is a distinctive feature of Monkeypox compared to other similar diseases. Monkeypox is usually a self-limited disease with the symptoms lasting from 14 to 21 days. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and severity of complications. People living in or near the forested areas may have indirect or low-level exposure to infected animals, possibly leading to subclinical (asymptomatic) infection,” the world health body says.

Experts say 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.

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

WHO says 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,” it says.

WHO says 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 per cent 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.