Monkeypox: Nigeria must strengthen her response system as WHO declares virus Global Health Emergency
While COVID-19 plunged the world into a world health crisis, another epidemic growing its infectious spread is the monkeypox. Although the disease is not presently just known, its spread, recently, has drawn global concern. From a gradual stage which was taken not too serious, it has now grown in its spread to a global health emergency.
Since the 1st of January 2022, several countries worldwide have been affected by an unprecedented outbreak of monkeypox which took an astronomic spread since May. Monkeypox was first discovered in central Africa in the 1950s. Noted symptoms of monkeypox include fever, headache, weakness of the body, sore throat, and enlargement of glands under the jaw and in the neck. Clinical observation shows it can also come with the appearance of rash on the face, palms, soles of the feet, genitals, and other parts of the body, which can appear solid or fluid-filled at the onset. It can manifest within a period of two to three weeks following infection, depending on the health status of the individual. The descriptions of classic monkeypox disease describe a prodrome including fever, lymphadenopathy, headache, and muscle aches followed by the development of a characteristic rash culminating in a firm, deep-seated, well-circumscribed and sometimes umbilicated lesions. The rash usually starts on the face or in the oral cavity and progresses through several synchronized stages on each affected area and concentrates on the face and extremities, including lesions on the palms and soles. The virus can be transmitted from infected animals and rodents such as rats, mice, squirrels, and even monkeys through contact with infected blood, body fluids, spots, blisters or scabs, and sharing of objects. There are vaccines and treatments available for monkeypox, although they are in limited supply.
Protective measures against the virus include avoiding contact with dead or live wild animals such as small mammals including rodents (rats, squirrels) and non-human primates (monkeys, apes). Thoroughly cooking all foods containing animal meat before eating. Avoiding unprotected contact with infected animals, humans, their beddings, and other linen; washing hands regularly, and use of sanitiser when water is not available.
It has been reported that when scientists investigate the spread of infectious disease, one area they look at is the genetic sequences of the pathogen. However, it is apparent there’s a snag when it comes to the monkeypox virus, which is now causing an unprecedented outbreak of several hundred infections in several countries where it’s not typically seen. The DNA viruses, particularly those with relatively big genomes like poxviruses (the family that includes monkeypox), generally accrue mutations much more slowly than, say, an RNA virus-like SARS-CoV-2, which causes Covid-19. This means examining the sequences might be less fruitful in terms of tracking how the virus is spreading from person to person. There are fewer chances to the virus’ genome that might shine a light on transmission chains. However, as researchers around the world share sequences from the current outbreak, the genomes have revealed something odd: “There are way more mutations than expected.” So many mutations in such a short amount of time might seem worrisome, if, perhaps, it meant the virus is evolving to spread more efficiently among people. Scientists appear to have a different hypothesis (one they say needs to be further studied) about what these mutations say about these infections and, in turn, what that can illuminate about the outbreak.
Late June, the World Health Organisation (WHO) had declared that Monkeypox is not an international public health emergency. The announcement came two days after WHO Director-General, Tedros Adhanom Ghebreysus convened an Emergency Committee on the disease, under the International Health Regulations (IHR), to address the rising caseload. The WHO Chief, who expressed worry about the surge of the outbreak of the disease, had said the monkeypox outbreak was clearly an evolving health threat that they are following extremely closely.
“The “global emergency” label currently only applies to the coronavirus pandemic and ongoing efforts to eradicate polio, and the U.N. agency has stepped back from applying it to the monkeypox outbreak after advice from a meeting of international experts. The WHO Director-General concurs with the advice offered by the IHR Emergency Committee regarding the multi-country monkeypox outbreak and, at present, does not determine that the event constitutes a Public Health Emergency of International Concern (PHEIC),” WHO had held. The PHEIC declaration is the highest level of global alert which applies to the COVID-19 pandemic and polio. Since May, upsurge in cases emerged in countries, many of which have never previously reported the disease. The highest numbers are currently in Europe, and most cases are among men who have sex with men. Cases in central Africa, where the disease is more common, have also been reported, chiefly in the Democratic Republic of Congo.
Later, early in July, when over 6,000 cases of monkeypox were reported from 58 countries in the current outbreak, according to the WHO, the UN agency had reconvene a meeting of the committee that will advise on declaring the outbreak a global health emergency, – WHO’s highest level of alert. July 23, 2022, the WHO declared the monkeypox outbreak in over 50 countries an “emergency of international concern. “Although I am declaring a public health emergency of international concern, for the moment this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners,” WHO Chief Tedros Adhanom Ghebreyesus had said. “That means that this is an outbreak that can be stopped with the right strategies in the right groups,” he added.
An ongoing outbreak of the viral disease monkeypox was confirmed in May 2022, beginning with a cluster of cases found in the United Kingdom. From May 18 onwards, cases were reported from an increasing number of countries and regions, predominantly in Europe, but also in North and South America, Asia, Africa, and Australia. As of July 23, there had been a total of 17,186 confirmed cases. Since the beginning of 2022, over 72 deaths were reported, all in Africa.
In Nigeria, the growing rate of the disease is becoming disturbing. The Edo State Ministry of Health disclosed on Monday, 25th July, 2022, that eight persons had so far tested positive for monkeypox in the state. The state’s Commissioner for Health, Prof. Akoria Obehi, who made the disclosure to journalists in Benin on Monday was quoted, “Amid the rise in the number of confirmed cases of monkeypox in Edo, it has become imperative to warn on the health risks that the virus poses and reiterate the need for residents to be cautious and adhere to safety measures.”
Records of infection had been on the rising scale. As at June 17, 2022, suspected monkeypox cases rose to 141 in 13 States in Nigeria. The Nigeria Centre for Disease Control (NCDC) had said that as many as 141 suspected cases of monkeypox have been reported in-country, up from the previous 110 cases. The NCDC, via its verified website, on Friday, June 17, 2022, disclosed that from January 1 to 12th June 2022, there have been 141 suspected cases in total and 36 confirmed cases from fifteen (15) states. It said that the states were; Lagos (7), Adamawa (5), Delta (3), River (3), Cross River (2), FCT (2), Kano (2), Bayelsa (2), Edo (2), Imo (2), Plateau (2), Nasarawa (1), Niger (1), Oyo (1) and Ondo (1).
“One death was recorded in a 40-year-old man with co-morbidity that was receiving immunosuppressive drugs. Overall and from September 2017 to 12th June 2022, a total of 653 suspected cases were reported from 33 states in the country. Of the reported cases, 262 (40.1 per cent) have been confirmed in 23 states – Rivers (55), Bayelsa (45), Lagos (37), Delta (32), Cross River (16), Edo (12), Imo (10), Akwa Ibom (7), Oyo (7), FCT (8), Plateau (5), Adamawa (5), Enugu (4), Abia (3), Nasarawa (3), Benue (2), Anambra (2), Ekiti (2), Kano (2), Niger (2), Ebonyi (1), Ogun (1) and Ondo (1). In addition, from September 2017 to June 12th, 2022, a total of nine (9) deaths have been recorded (CFR= 3.4 per cent) in six states – Lagos (3), Edo (2), Imo (1), Cross River (1), FCT (1) and Rivers (1),” it had stated.
July 1st, the NCDC, had disclosed that between January and June, the Country recorded a total of 204 suspected cases of monkeypox out of which 62 cases were confirmed to be positive. During a Virtual media dialogue on monkeypox titled, ‘Monkeypox Spread, Infodemic and Public Health Response in Nigeria,’ the Incident Manager, National Monkeypox Emergency Operations Centre, Dr Lateefat Amao, trailed the records of the spread of the virus in Nigeria, noting that between 2017 and June 2022, about 25 States have recorded cases of monkeypox in Nigeria. She had said, “Monkeypox is endemic in some part of Nigeria. The epidemic has been mostly stable over the last five years since the resurgence. Some progress has been made in improving, prevention, detection and response. However, obvious challenges and gaps remain. There is a need for sustained MPX preparedness and response efforts with the support of all stakeholders and partners. In 2017 there were 198 suspected cases whereas 88 cases were confirmed and test positivity rate, TPR per cent was 44.4. In 2018, suspected cases were 116, 49 confirmed and TPR was 42.2 percent. In 2019, 65 suspected cases, and 47 cases were confirmed and 72.3 TPR per cent. In 2020, there were 35 suspected cases, then eight confirmed cases and 22.8 TPR percent. In 2021, there were 98 suspected cases and 34 confirmed cases then 35.0 TPR percent. Finally, in 2022, 204 suspected cases, then 62 confirmed cases and 30.4 TPR percent.”
Records have shown that before 2022, South East, South-South and South-West were the regions where these cases were confirmed, but due to closer awareness and efforts to unravel its spread, cases were discovered in the other parts of the Country that were under-reported, such as Zamfara, Adamawa, Plateau and Taraba.
Following the upscale in the spread of the virus, the U.S. Centers for Disease Control and Prevention (CDC) had in June issued sexual guidance for infected people with monkeypox. The WHO had in June said that most reported cases, so far ?, have been presented through sexual health or other health services and have mainly involved men who have sex with men.The CDC had issued a list of safe sexual activities for sexually active patients to follow. The NCDC should, among other measures, follow suit with mass enlightenment.
The need to enlighten citizens to observe safety measures to reduce the spread of the virus and other infectious diseases in the Country, is pertinent. For the monkeypox, ramping up surveillance and disease management measures to curb the spread of the virus is sacrosanct. Strengthening dialogue as part of risk communication and infodemic management efforts by the NCDC in collaboration with the WHO and other partners to strengthen response to monkeypox in Nigeria, is pertinent.
Checking against wrong perception and misinformation on monkeypox, factors which are capable of fuelling false narratives about the virus, and the potential risk of discrimination and stigmatisation, remains critical actions that must be put into view. Fortifying genomic sequencing at NCDC’s National Reference Laboratory to identify possible mutations and the epidemiology of the virus is pertinent.
Although, it has been observed that since its sudden resurgence in 2017, a multi-agency Technical Working Group (TWG) coordinated at the NCDC was instituted to improve the detection, prevention, and control of monkeypox, to get a better understanding of the epidemiology of the virus to inform preparedness and response in-country, more is demanded.
Over the last five years, Nigeria has witnessed negative impacts of infectious diseases such as Ebola, Lassa fever, Dengue, rabies, yellow fever, COVID-19, and most recently, monkeypox. The need to strengthen partnership with critical stakeholders to institutionalise a system for effective management of infodemics associated with these outbreaks in the country is pertinent. The birth of the National Infodemic Management Team (NIMT) domicile in NCDC that conducts active social and community engagement to identify information gaps relating to the monkeypox outbreak, with critical support from partners, is a welcome development, but more efforts must be concerted to coordinate the working patterns of the system for a robust architecture responsive for the rising realities.
Increased surveillance at all levels, strengthened public health laboratory services, training of healthcare workers, development of guidelines on IPC and case management for the disease and other critical areas, are subject matters demanding more attention.
