Monkeypox Outbreak

Monkeypox is a viral disease similar to smallpox and chickenpox transmitted majorly by rodents. The virus can spread both from animal to human and from human to human.

On the 22nd of September, 2017, the Nigeria Centre for Disease Control (NCDC) was notified of a case of suspected Monkeypox.

The case was identified in an 11-year-old male patient who was presented to the Niger Delta University Teaching Hospital (NDUTH) in Yenagoa, Bayelsa State in Nigeria.

Subsequently, 11 other cases were identified. All the cases are currently receiving appropriate medical care. All the patients are improving clinically and there have been no deaths.

A medical doctor and 10 persons who came down with the monkeypox had been quarantined in an isolation centre at the Niger Delta University Teaching Hospital, Okolobiri, in Yenagoa Local Government Area of the state.

As at 1st October 2017, 32 close contacts of the cases have been identified, advised appropriately and are being monitored.

Infection from animal to human can occur via an animal bite or by direct contact with an infected animal’s bodily fluids. The virus can spread from human to human by both respiratory (airborne) contact and contact with infected person’s bodily fluids.

Risk factors for transmission

  • close contact with infected persons eg- sharing a bed, room
  • using the same utensils as an infected person
  • Eating inadequately cooked meat of infected animals
  • Anything that favors the introduction of the virus to the oral mucosa.

Incubation period

It takes about 5-21 days but ideally it is 10–14 days. symptoms of monkeypox are similar to smallpox, although it is often milder.

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Signs and symptoms

A distinctive feature of monkeypox compared to other similar diseases is that some patients develop severe lymphadenopathy (swollen lymph nodes) before the appearance of the rash.

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 the appearance of fever) where the various stages of the rash appear.

Rash often begins

  • 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 begins with lesions with a flat base 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.
  • Rash can also affect oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (eyelid) (20%)

Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and severity of complications.

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.

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Vaccination against smallpox is assumed to provide protection against human monkeypox infection however routine smallpox vaccination was discontinued following the apparent eradication of smallpox.

Prevention

Any human that might have come into contact with an infected animal/human 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.

  •  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.
  • 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.
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  • 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.
"Mad cow, deer tick, monkey pox, what's next?"
“Mad cow, deer tick, monkey pox, what’s next?”

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Information from WHO, EpidAlert and Wikipedia was used in this article

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Author: Dr Ahmad Abdullah, MBBS, MSc Clinical Pathology

Ahmad is a father, a husband and a poet. He was born and raised in Lagos, Nigeria. He earned his medical degree from the University of Juba, currently in South Sudan. He is interested in medical research and currently practicing in Lagos, Nigeria.

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