NIDS ADVISORY ON THE ONGOING MONKEY POX OUTBREAK

• Post by: Adamu Abba
• June 10, 2022
• No Comment

 

 

 

NIGERIAN INFECTIOUS DISEASES SOCIETY (NIDS) ADVISIORY ON THE ONGOING MONKEYPOX OUTBREAK

Preamble
There is an ongoing outbreak of human Monkeypox outside endemic countries in Africa, with over 900 confirmed cases
reported across Europe, America, and Asia. This outbreak is reported to be caused by the West African Clade of the
Monkeypox virus, and unlike previous cases outside Africa which were linked to travel from Nigeria, the ongoing outbreak
is reported to have no direct link to travel from Monkeypox-endemic countries in Africa.
Since the re-emergence of human Monkeypox in Nigeria in 2017, sporadic cases of the disease are being reported across
the country. According to the Nigeria Centre for Disease Control (NCDC), between January and May 2022, a total of 21
confirmed cases of human Monkeypox were reported across nine states and the Federal Capital Territory (FCT) in
Nigeria. The states affected are: Adamawa (5), Lagos (4), Bayelsa (2), Delta (2), Cross River (2), FCT (2), Kano (2), Imo
(1), and Rivers (1). A total of nine deaths have been reported since the outbreak began in 2017, including one death in
2022.

About Monkey Pox
Monkeypox is a zoonotic disease (primarily transmitted from animals to humans) caused by the Monkeypox virus. There
are two distinct genetic clades of the Monkeypox virus: the central African (Congo Basin) clade which is responsible for
outbreaks in the Central African Republic, the Democratic Republic of the Congo, Gabon and parts of Cameroon, and the
West African clade, known to have caused outbreaks in Cote d’Ivoire, Liberia, Nigeria, and Sierra Leone.
Transmission of the virus to humans occur through contact with infected animals and humans and from viral-contaminated
environment/materials. The virus enters the human body through broken skin (even if not visible), the respiratory tract, or
the mucous membranes (eyes, nose, or mouth). The specific animal reservoir of the disease is unknown, but the virus has
been found in various species of rodents (e.g., squirrels and rats) and other non-human primates (e.g., monkeys and
chimpanzees). Animal to human transmission occurs through close contact with infected animals, especially during
hunting and handling of animals, and consumption of undercooked infected bush meat. Person-to-person spread may
occur through contact with contaminated environment especially in hospital and household settings; direct contact with
Monkeypox skin lesions or scabs; and from droplets produced during coughing or sneezing by a person with a Monkeypox
rash. Epidemiological data from the 2017 Nigeria outbreak and the ongoing outbreak outside Africa suggest person to
person spread is occurring from intimate contact during sexual intercourse, but transmission through seminal or vaginal
secretions is yet to be established.
After an incubation period ranging from 5 to 21 days, infected persons typically develop prodromal symptoms such as
fever, malaise, headache, and lymphadenopathy, among other symptoms, accompanied 1 to 3 days later by skin rashes
which most often appear on the face and spread to other parts of the body. The rash evolves sequentially from macules
(lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions
filled with yellowish fluid), and crusts which dry up and fall off. The disease is usually mild and self-limiting, with skin
lesions and systemic symptoms resolving spontaneously after 2 to 4 weeks. However, severe disease and complications
may occur in a few cases and result in deaths in 3 to 6% of cases. Prior smallpox vaccine offers about 85% protection
against Monkeypox virus infection. Some antivirals (e.g., Tecovirimat) and smallpox vaccines (e.g., Jynneos -also known
as Imvamune or Imvanex) have been licensed for Monkeypox treatment and prevention in parts of Europe and America,
but these medical interventions are currently not available for licensure and subsequent use in Monkeypox-endemic
countries in Africa, Nigeria inclusive.

Advisory for healthcare workers and healthcare facilities
Healthcare workers (HCW) are at risk of Monkeypox infection during care of patients, especially if recommended infection
prevention and control practices are not observed. The NIDS enjoins HCW and health facilities to: (i) Review institutional
preparedness to care for suspected Monkeypox patients. (ii)Train hospital staff on recognition, isolation and other aspects
of infection prevention and control-relating to Monkeypox (iii.) Train and designate staff who can provide care to patients
with suspected or confirmed Monkeypox. (iv) Observe strict contact and droplet precautions during care of patients with
suspected or confirmed Monkeypox. (v) Establish protocols for referral, and reporting cases to the designated Federal,
State and/or Local Government Area Public Health Departments immediately, or directly call NCDC toll free line on 6232.

Advisory for the general public
Monkeypox presents with a mild self-limiting illness in majority of infected individuals. The public is advised not to spread
fear, misinformation, and misconceptions about Monkeypox, and to always seek accurate and updated information about
Monkeypox from established sources such as the publications from the various Ministries of health, NCDC, and World
Health Organization, among others. Members of the public should take responsibility for their health, practice good
personal hygiene, especially regular washing of hands with soap and water or use of alcohol-based hand sanitizers as
necessary, and immediately report to the nearest hospital for appropriate diagnosis should they develop any chicken poxlike
skin rash with or without fever. Household members of Monkeypox cases are at risk of contracting the virus through
close contact. Consequently, the public is advised not to care for suspected Monkeypox patients at home except following
appropriate advice from certified health workers and hospitals. In view of the potential of spread of Monkeypox during
sexual intercourse, the public is advised to practice safe sex. Persons with symptoms of Monkeypox including fever and
skin rash, irrespective of location of skin rash, should abstain from sex until skin rashes and all other symptoms have
completely resolved. The public is advised to always seek advice from certified health workers and hospitals should they
have any concerns about Monkeypox.

Advisory for States and Federal Governments
After the 2017 human Monkeypox outbreak in Nigeria, the number of cases reported yearly in the country has declined
significantly. It is most probable that the reported number of human Monkeypox cases in Nigeria is underestimated due to
inadequate surveillance and case identification across the country. Furthermore, there are still significant knowledge and
health system gaps regarding Nigeria’s preparedness and response to Monkeypox.
Federal and state Governments are advised to heighten awareness creation, and risk communication relating to
Monkeypox, and to invest in Monkeypox-related surveillance, diagnostic and research. The Federal Government through
the NCDC, National Primary Healthcare Development Agency, NAFDAC, and other related agencies, should explore
procurements of Monkeypox-related therapeutics and vaccines for Clinical trials or Emergence Use Authorization in
Nigeria, as necessary.
National and international health authorities and stakeholders should consider access, equity and cost in the development
and deployment of the various medical countermeasures for Monkeypox prevention and control.

About the NIDS
The Nigerian Infectious Diseases Society (NIDS) is a multi-disciplinary professional society established to advance the
prevention and control of infectious diseases in Nigeria. We are actively involved in advocacy, education, training,
research, and partnerships to expand the understanding and the prevention and control of infectious and communicable
diseases in Nigeria.

More on the NIDS: https://nids.org.ng/about/
For more resources on Monkeypox, kindly check out the NCDC sites:
Fact sheet on Monkeypox: https://ncdc.gov.ng/diseases/factsheet/55
National Monkeypox Public Health Response: https://ncdc.gov.ng/themes/common/docs/protocols/96_1577798337.pdf
World Health Organization: https://www.who.int/news-room/fact-sheets/detail/Monkeypox
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –
Prof. Dimie Ogoina                                                                                            Dr. Iorhen E. Akase
President, NIDS                                                                                                  Chairman, Epidemic Response Committee, NIDS