Biological Health Hazard – Monkeypox Outbreak: Nigeria

MONKEYPOX – AFRICA (08): NIGERIA
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Published Date: 2017-10-10 12:24:30
Subject: PRO/AH/EDR> Monkeypox – Africa (08): Nigeria
Archive Number: 20171010.5369514

Date: Mon 9 Oct 2017
Source: Nigerian Centre for Disease Control [edited]

Following the notification of a suspected monkeypox outbreak on the 22 Sep 2017 in Bayelsa State, other suspected cases have been reported from 6 more states, bringing the total number of suspected cases so far to 31 across 7 states — Bayelsa, Rivers, Ekiti, Akwa Ibom, Lagos, Ogun, and Cross River States. Samples have been collected from each suspected case for laboratory confirmation. Results are still awaited. So far, there have been no deaths recorded. It is unlikely that many of the suspected cases are actually monkeypox, but all are being investigated.

All the suspected cases are currently receiving appropriate medical care, and the patients are all improving clinically in their various states. The Federal Ministry of Health through the Nigeria Centre for Disease Control (NCDC) is supporting the affected states to ensure the outbreak is brought under control and to limit further spread.

NCDC has activated an Emergency Operation Centre (EOC) to coordinate the outbreak investigation and response across the affected States. The EOC is currently supporting State Ministries of Health in their response to the outbreak through active case finding, epidemiological investigation, and contact tracing. Measures have been put in place to ensure effective sample collection and testing to enable laboratory confirmation. Risk communication activities have been heightened to advise the public on preventive measures. All 36 states and the FCT [Federal Capital Territory, Abuja] have been notified for preparedness.

In light of the above, it is important to be reminded that monkeypox is a rare viral zoonotic disease with symptoms in humans similar to those seen in smallpox patients, but much less severe and with a low fatality rate. Transmission is via contact with infected animal, human, or contaminated materials. Animal-to-human transmission occurs through bite or scratch from animals and bush meat preparation. It can also be transmitted from one person to another. Human-to-human transmission occurs through respiratory droplets, contact with infected persons, or with contaminated materials. Control measures include isolation of suspected or confirmed cases, strict adherence to universal precautions, especially frequent handwashing with soap and water, and use of personal protective equipment.

Signs and symptoms include fever, headache, body pain, malaise, lymphadenopathy (enlargement of glands), sore throat, the characteristic generalized vesicular rash. The rashes might last between 2-4 weeks. Monkeypox is self-limiting, which means patients tend to recover with time. However, supportive care and management of condition is required and mostly successful.

The CEO, of the Nigeria Centre for Disease Control, Dr Chikwe Ihekweazu again emphasizes that “Nigerians are once advised to remain calm, avoid self-medication and report any suspected case to the nearest health facility. Public health authorities across the country have been well informed on what to do when a suspected case arises.”
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Communicated by:
Melissa Dudley
Senior Health Intelligence Analyst
<mlsdudley@gmail.com>

[Laboratory confirmation of the 31 suspected monkeypox cases is essential. Rapid appearance of the disease across 7 states in less than 3 weeks is unusual for monkeypox. Isolated and scattered cases are more common. Monkeys are not the reservoirs of the virus, despite the name that the virus has received. Although not determined, the main reservoirs of monkeypox are suspected to be rodents, including rope squirrels (_Funisciurus_ spp; an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_).

The current outbreak appears to be more characteristic of direct transmission between individuals, rather than spill-over from a wild rodent reservoir, raising the question about involvement of some other transmissible pathogen such as varicella (chickenpox). The USA CDC describes varicella infections as, “Varicella in Unvaccinated Persons. The rash is generalized and pruritic (itchy). It progresses rapidly from macules to papules to vesicular lesions before crusting. The rash usually appears 1st on the head, chest, and back then spreads to the rest of the body. The lesions are usually most concentrated on the chest and back. In healthy children, varicella is generally mild, with an itchy rash, malaise, and temperature up to 102 F [38.9 C) for 2 to 3 days. Infants, adults, and immunocompromised people are at risk for more severe disease and have a higher incidence of complications. Recovery from primary varicella infection usually provides immunity for life.” (https://www.cdc.gov/chickenpox/hcp/clinical-overview.html).

Maps of Nigeria can be accessed at http://www.un.org/Depts/Cartographic/map/profile/nigeria.pdf and http://healthmap.org/promed/p/62. – Mod.TY]

See Also

Monkeypox – Africa (07): Nigeria 20171009.5368881
Monkeypox – Africa (06): Nigeria 20171007.5366637
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Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases

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Monkeypox: 31 suspected cases reported in seven Nigerian states, public asked to ‘remain calm’