By Cosmas Omegoh (Lagos), Fred Eze (Abuja),  Ighomuaye Lucky (Benin), George Onyejiuwa (Owerri), Femi Folaranmi (Yenagoa), and Billy Graham Abel (Yola)

 

Watch out for those rashes. They might be clear signs of Monkey pox in its early stage. This is the truth many are yet to know let alone realise.  

The Nigeria Centre for Disease Control (NCDC) and medical experts are warning that in reality, Monkey pox disease has berthed. No one should take this new threat lightly especially as Nigeria and, indeed, the world are gradually enjoying a reprieve from COVID-19.

Thus, all lovers of bush meat or animals generally as pets should beware.  They should try to keep such love at least for now. Reason? The NCDC has warned that animals are possible sources of the Monkey pox that is currently spreading across the country like wildfire. Infected animals and persons are potential harbingers of the dreaded disease.

Our correspondents gathered that several states are already recording rising cases. Nearly all the geopolitical regions are having their own share of the infection.

Already, states affected have activated their emergency response systems. 

Experts in those states acknowledged that although high fatality figures had not been recorded, the disease nevertheless is fast spreading.      

NCDC in its epidemiological report for Week 22 released on June 5, 2022, indicated that Monkey pox had been reported in 14 states.

It noted that there were 44 new suspected cases reported in Week 22, 2022 (May 30 to June 5, 2022) from 14 states with Kebbi State leading with 11 cases.

The breakdown shows:  “Lagos State had eight, Gombe four, Plateau four, Rivers three, Adamawa two, Edo two, Kano two, FCT two, Niger two, Ondo one, Katsina one, Bayelsa one, and Imo one.

NCDC data also indicated that a grand total of confirmed cases of Monkey pox between September 2017 and June 5, 2022 was 257. Suspected cases during the period stood at 622.

 The agency reported a total of nine deaths during the period.

However, those figures have continued to change as days go by as more cases emerge every day.  

Now, states that consider themselves gravely at risk have been warning residents to be conscious of Monkey pox. 

The authorities in those states have been disclosing how they have been fighting the outbreak.  

How monkey pox is transmitted  

According to the NCDC, monkey pox being a communicable disease is transmitted through direct contact with body fluids or sores on the body of someone who has the disease.

It noted that “the disease can also spread through direct contact with materials that have touched body fluids or sores, such as clothing or linens, and can also spread through respiratory secretions when people have close, face-to-face contact.”

It also noted that animal-to-human transmission is highly possible, and can occur by direct contact with the blood, body fluids, the skin or mucosal lesions of infected animals, notably, monkeys, squirrels and rodents, which can also happen through a bite, scratch, handling, eating of inadequately cooked infected bush meat.

 

NCDC calls for disease prevention  

NCDC recalled that it had consistently encouraged hygienic environment devoid of animals that could harbour the virus, including sick or dead animals in areas where Monkey pox cases had occurred.

The Centre advised Nigerians to avoid contact with any material that has been in contact with a sick animal, and isolate potentially infected animals from other animals.

It recommended quarantine of animals that might have come into contact with an infected animal, handling them with standard precautions and observing for Monkey pox symptoms for 30 days, as well as washing with soap and water after contact with infected animals.

It advised that thorough cooking of all animal products before eating is strongly recommended, as well as isolation of infected patients, including use of Personal Protective Equipment (PPE) and implementation of standard infection control precautions by health workers.

In addition to other measures, it strongly recommended regular hand washing after caring for or visiting sick people, and also abiding by other public health education on monkey pox preventive measures.

 

Symptoms to watch out 

According to the NCDC, the incubation period of monkey pox is usually between six to 16 days, but that can also range from five to 21 days.

It said the clinical manifestation of the disease is in two phases, with an initial invasive period in the first five days, where the main symptoms are fever, swelling of lymph nodes, back pain, intense headache, muscle ache, and severe asthenia (lack of energy), among others.

The agency further noted that “with time, skin lesions with a flat bases appears one-three days after the outset of fever, developing into small fluid-filled blisters (vesicles), which become pus-filled (pustules) and then crust over in about 10 days. 

According to it, “complete resolution takes up to three weeks. Nearly all patients have face lesions; three quarters have lesions on the palms of their hands and soles on their feet, and 30 per cent have genital involvement. The eyes are involved in most cases; 20 per cent have lesions on the eyelid, with some on the cornea.” 

However, the agency assured that “Monkey pox is usually self-limiting, with symptoms lasting between two and three weeks. Severe cases occur more commonly among children, who also have greater mortality, and the case fatality has ranged from one per cent to 10 per cent.”

 

Expert’s firsthand experience

Dr Juliet Merem, an infectious diseases specialist, at the Federal Medical Centre, Owerri, recalled that “Monkey pox has no ‘specific symptoms,’ but infected persons will have prominent rashes all over their bodies, with severe headaches, high fever, body and back aches, as well as sore throat or redness of the eyes.

 

Treatment of disease 

Information from NCDC says like COVID-19, “there are no specific treatments available for Monkey pox. But various novel anti-virals have in-vitro and animal data supportive of effect.”  

It also has it that vaccination against smallpox has been proven to be 85 per cent effective in preventing the disease, but that is no longer routinely available following global smallpox eradication.

“Prior smallpox vaccination will likely result in having a milder disease course, while screening and management of co-morbidities, and all other secondary infections should be carried out.”

 

Related News

States confirm cases 

Already, some states aside NCDC have on their own, confirmed cases of Monkey pox in their domains.

The Edo State Commissioner for Health, Prof Obehi Akoria, said, for instance, that as at June 6, 2022, five suspected Monkey pox cases were reported in the state with two of the cases confirmed. 

He said to stem the spread of the disease, the state had to set up a Monkey pox Rapid Response Team to control the outbreak.

In Imo State, Dr Merem confirmed that two patients were currently at the facility.

But, the Imo State Commissioner for Health,  Dr Success Ohayagba, could not confirm or deny the cases.  

In Bayelsa State, the Incident Manager and Director, Public Health, Dr Jones Stow, confirmed two cases from several tests the state carried out.

Similarly, Adamawa State Director of Public Health, Dr Celine Laori confirmed an outbreak of the disease.

Dr Laori said that as at June 12, 2022, there were five laboratory-confirmed cases of Monkey pox in the state and another 57 suspected cases. 

Dr Laori said that the disease was first noticed between late April and early May at an army barracks, and later at the Yola correctional facility. She explained that so far, the disease had been reported in two local governments of Yola North and Yola South.

According to Dr Laori, “there was a case that was picked up in the army barracks then. But if you pick up one case, it is not enough to declare an outbreak.

“Subsequently, there was also an outbreak at the correctional facility in Jimeta. Few other cases were picked up from other places. 

“But so far, there have been 57 suspected cases reported, and we have about five laboratory-confirmed cases as of June 12, 2022. But no mortality has been recorded yet.”

 

What states are doing

Prof Akoria said that the Edo State government was already engaging stakeholders across the 18 local government areas of the state on Monkey pox sensitisation and other preventive measures. 

He assured that the government has the political will to protect the lives of the citizens of the state with the measures being taken.

According to Dr Stow, Bayelsa State had begun a sensitisation and enlightenment campaign to educate the people on the symptoms and ways they could possibly be infected.

 “We have run a couple of tests, but we only have two confirmed cases which were around communities in Yenagoa Local Government Area.

“We have begun an enlightenment campaign because some people think Monkey pox is an ordinary skin infection. We have also been talking to them on the dangers in eating bush meat or uncooked meat.”

Dr Stow also disclosed that all the health centres in the state had been activated, while training had been carried out to ensure that health personnel were abreast of ways to handle the cases.

 He assured that comfortable isolation centres were in place to keep those who might be infected for adequate treatment.

He said that “the state Ministry of Health was in touch with officials of  NCDC, providing updates on the situation across the state which it monitors through the emergency situation room it activated recently.”  

Speaking on her state’s response to the outbreak, Dr Laori said: “The state government has already set up an Emergency Operational Centre, which is much more like a control centre to curb the spread of the virus.” 

She recalled that since “the disease is caused by a virus similar to small pox virus, we immediately swung into action; an active case search was initiated; workers were trained to be able to identify Monkey pox which is relatively new to our community.

“This is the first time we are having the case in the state; so workers had to be trained by our WHO partners; they are back in our communities trying to actively search for new cases. 

“We also went back to the correctional centre where the inmates were sensitised, and the place fumigated. Those that needed case management were also treated. So we are still doing follow-ups on the cases, but most of them have been resolved.”

 

Monkey pox advisory to the public

Dr Merem advised members of the public to avoid the consumption of bush meat, also warning them to advise persons with high fever and rashes to seek medical attention.

“If you see a person with high fever and a rash all over their body, you should advise them to seek medical attention. Such persons should be isolated. Avoid consumption of bush meat whose source you don’t know.”

She assured that “Monkey pox which is so called because it first appeared on monkeys, is a curable disease like chicken pox and the small pox.

“It is a self-limiting rash, and will eventually clear out within a period of two to three weeks with proper medical attention.”

On her part, Dr Laori counseled: “Patients are cautioned to take note of the symptoms and report themselves to the nearest medical facility.”

She identified Monkey pox’s distinguishing features as “low-grade fever,” adding that “some form of pyrexia, in most cases one has rashes all over the face and the body which resemble the rash of a chicken pox; but this one typically presents with pores inside the rashes. That is how we differentiate between Chicken pox from Monkey pox.”

Advice against Monkey pox

Dr Laori wants “anyone who has the rash to rush to the closest health facility where distinction between Monkey pox and Chicken pox could be made. 

“It cannot be made by the person involved; so, they have to go to the hospital for samples to be taken and sent to Abuja for test; that is the only way we can confirm if it is Monkey pox or something else.”

She reminded the public that “Monkey pox is a contagious disease; so anyone who contracts it should be isolated and be managed – not at home. The person should be isolated.

“Usually it is mild; it does not require hospitalisation except for the serious cases, but if it is very serious, we can hospitalise and isolate.”

She advised that “hygiene should also be observed. Keep the environment clean; let the patient bath with soap and water; that way, they will prevent other people from contracting the disease.”

She assured that “the disease is not life-threatening even though there are variants that can also lead to mortality, but the one we have around here is not. 

“But our neighbours in Cameroon have the life-threatening variant; so because of movements across the border, the possibility of the deadly variant being imported into Adamawa State (the country) is real.”