There is an ongoing outbreak of Monkeypox, which was confirmed on May 6, 2022, when a British resident, who travelled to Nigeria, returned to the United Kingdom on May 4, presenting symptoms consistent with Monkeypox. The disease had hitherto been considered as being restricted to tropical rainforest regions of Central and West Africa. Since May 18, however, cases have been reported from at least 20 countries, though predominantly in Europe, but also in North and South America, the Middle East, and Australia, thus representing the first incidence of widespread community transmission outside of Africa.
Monkeypox, as the name implies, was first identified in 1958 among laboratory monkeys used for research in Copenhagen, Denmark. The first case in humans was seen in 1970 in the Democratic Republic of Congo (formerly Zaire). Almost 50 cases were reported between 1970 and 1979 with more than two thirds of these being from DR Congo. Other cases originated from Liberia, Nigeria, Cote d’Ivoire (formerly Ivory Coast) and Sierra Leone. Between 1981 and 1986, 338 confirmed cases and 33 deaths were recorded, and between 1991 to 1999, 511 cases were reported in DR Congo. Between 1971 and 1978, ten Monkeypox infections were reported in Nigeria, and re-emerged in September 2017, 39 years after it was last reported.
In a report released on May 9, the Nigeria Centre for Disease Control (NCDC) stated that 230 cases and six deaths were confirmed across 20 states and the Federal Capital Territory, between 2017 and 2022. Rivers State was the most affected, followed by Bayelsa and Lagos. Outbreak of the disease occurred in the United States of America in May 2003, when a child became ill with fever and rash after being bitten by a dog purchased from a pet store where rodents imported from Ghana were sold. In total, 71 cases were reported in the US through June 20, 2003. The number of reported Monkeypox cases has increased and the geographical occurrence broadened to date.
It is instructive to note that Monkeypox is an infectious disease caused by the virus, affecting humans and animals. Symptoms begin with fever, headache, swollen glands, muscle pain, and fatigue. This is followed by rashes in the mouth, eyes, palms, soles, and on the genitals, resembling smallpox, measles or chickenpox. The time from exposure to onset of symptoms is usually seven to 14 days and symptoms usually clear up in two to four weeks. As with many viral diseases, cases may be severe, especially in children, pregnant women or people with compromised immune systems. Human-to-human transmission occurs primarily through close contact with an infected person, and there are indications that transmission occurs during sexual intercourse.
Family members, care-givers and hospital staff are particularly at risk while animal-to-human transmission may occur through animal bite or scratch (especially rodents), handling or eating bushmeat that has not been cooked thoroughly, direct contact with body fluids or indirect contact with contaminated materials such as animal skin or fur, just as veterinarians, veterinary staff, animal health workers and animal control officers are more at risk. Treatment for Monkeypox is mainly symptomatic. According to the World Health Organisation (WHO), smallpox vaccine is assumed to provide protection against the disease because they are closely related viruses and the vaccine protect animals from experimental lethal Monkeypox challenges. Routine smallpox vaccination has, however, been discontinued since 1980, following the eradication of smallpox worldwide.
The United States Centre for Disease Control (CDC) recommends that as for the Coronavirus disease (COVID-19), infected persons should be quarantined, in-contact persons should be traced, persons involved in field investigations and care-givers should receive pre-exposure smallpox vaccination using first generation stockpiles of smallpox vaccines, deploy full set of personal protective equipment, and maintain non-pharmacological measures of personal hygiene. According to the Division of Pathogens and High Consequence Pathology of CDC, all cases of Monkeypox reported outside Africa since 2018, had come from Nigeria. This is quite alarming and further dampens the international image of the country.
What should be done? It is high time the Federal Government put all efforts in motion to curtail this worrisome trend. Prof. Oyewale Tomori, a renowned virologist, pointed out that the number of Monkeypox infections in Nigeria through 2021, is likely to be under-reported, as many Nigerians avoid healthcare facilities due to the stigma associated with such, preferring to self-medicate. In the United Kingdom, Monkeypox is classified as a high consequence infectious disease and patients are managed in designated treatment centres coordinated by a national network. This can be replicated in Nigeria where the ministries of health, agriculture and other relevant government agencies carry out surveillance of the disease to see where transmission levels are now and understand where it is going.
Bushmeat (Eran igbe), is highly valued throughout the West African region as a source of income and food and a good addition to the livestock industry. Wild animals such as grass cutter (Oya), bush rat (Okete), alligator (Alegba), antelope (Etu), bush pig (Elede igbo), squirrel (Okere), monkey (Obo) are hunted for the consumer market by professional hunters. No doubt, these animals serve as disease reservoirs, even though used as food, but could serve as important source of transmission to humans. WHO reported that approximately 75 percent of all emerging infectious diseases such as COVID-19 and Ebola, in the last decade, have been linked to bushmeat trade, causing tremendous health and economic impacts. Nigeria has flourishing legal and illegal bushmeat markets in major cities with their trade being largely unregulated.
The process of trapping and transporting wild animals is stressful and done under unhygienic conditions and coming in contact with humans and domestic animals further increases the risks of new disease introduction and transmission. Given the nation’s economic and cultural importance in the West African region, Nigeria could make a proactive model response to curtail the spread of the disease. To this end, proper mechanisms should be put in place for regulation, enforcement and large-scale public awareness campaigns with clear and sustained messaging to educate people about the health and ecological risks of consuming high-risk bushmeat species, as it is now evident that Monkeypox is an emerging, potentially-dangerous, neglected and global health threat, which is capable of cross-border spread and onward transmission.
Without taking chances, this may be attributed to the waning cross-protective immunity among persons vaccinated before 1980, and to the gradually-increasing proportion of unvaccinated persons. Monkeypox outbreaks may continue to occur and the world must remain ever vigilant. Closely-related viruses of humans and animals, such as smallpox, which had hitherto been eradicated, may again raise their ugly heads since the world is afterall a global village. Hence, the time to stop the disease is now. As the Yorubas would usually say, “Igba ara la n bura, enikan kii bu sango lerun”, literally translated to mean; make hay while the sun shines!
Dr. Adenubi, an Associate Professor and Veterinarian, is a columnist with FarmingFarmersFarms; +2348025409691; bukiadenubi@gmail.com
