By Enyeribe Ejiogu
When the Federal Ministry of Health announced on Thursday that the outbreak of monkeypox had spread to 11 states with 74 recorded cases, apprehension, as would be expected, is naturally growing among the populace. There is concern that the outbreak may grow to the level of an epidemic if steps are not taken by the citizenry, to break the chain of transmission.
A casual look at the monstrous blisters all over the face and body of an infected person, when the disease is at the advanced stage (as seen in the picture on this page) should be enough incentive to make every effort to avoid getting infected.
Since the outbreak occurred in Bayelsa State on September 22, 2017, the Nigeria Centre for Disease Control (NCDC) has said the virus has marched into Rivers, Ekiti, Akwa Ibom, Lagos, Ogun and Cross River and five other states.
Monkeypox is a viral zoonosis (a virus that is transmitted to humans from animals) which shows symptoms in humans similar to those seen in the past in smallpox patients, although less severe. Smallpox was eradicated in 1980. According to medicine.com, monkeypox occurs sporadically in some parts of Africa.
The symptoms of monkeypox include severe headache, fever, back pains among others. Other physical manifestations are huge rashes, the size of which are far bigger than those seen when a person has chicken pox. The rashes spread out all over the body of the infected person.
There is no treatment or vaccine available for monkeypox, however, medical researchers have found that giving a non-infected person smallpox vaccination is highly effective in preventing monkeypox as well.
This therefore creates an action point for the mass media organs of the federal and state governments as well as the religious bodies to massively re-educate the populace about the need to get vaccinated.
The World Health Organisation (WHO) and the NCDC have given guidelines on what people could do to support the national effort to break the transmission chain. Adopting and actively following the guideline would ensure a reasonable level of safety from infection.
Avoid contact with possibly infected monkeys, rodents
The disease is primarily transmitted to humans from animals like rodents and primates through contact with the animal’s blood or other bodily fluids, or through a bite or scratch. Monkeys, giant rats, grasscutter and squirrels are the usual suspects in this category. Hence you must diligently avoid physical contact with these animals.
Avoid “bush meat” not properly cooked
For people in areas where monkeys and some other higher rodents are eaten as delicacies should take a holiday on eating meat from these sources for the mean time. But if you must eat at all please make that it was properly cooked at high heat for some time, to prevent yourself from consuming meat of a potentially infected monkey or rodent. Death doesn’t automatically disinfect tainted meat.
Be very careful in making contact with infected people
Monkeypox passes from human to humans as the secondary mode of transmission. Therefore an infected person is a real threat to uninfected people. It is for this reason that an energetic effort was made to trace, document and observe the people who had contact with the infected individuals in Bayelsa State.
Monkeypox can spread among humans through the air (as the infected person breathes, spits, sneezes or coughs) thereby releasing droplets of his own infected body fluids such as saliva, tears, urine and sweat. The virus can penetrate the body through broken skin or the respiratory tract or the mucous membranes such as eyes, nose or mouth. Other risk factors for transmission include sharing a bed, a room, or using the same utensils as an infected patient.
Therefore, there is a clear and present need to avoid close contact with an infected person.
There’s no known cure for monkeypox yet, but smallpox vaccine has been reported to reduce the risk of infection. Despite the observation of all safety measures, health workers involved in caring for infected patients are advised to get a smallpox vaccination.
Implement a good personal hygiene regime
Become very religious about washing your hands often with soap and running water from a tap, whether you have had contact with an infected animal or not. By washing your hands often, you reduce the risk of infection. Hence families should drum this into the minds of their children as they are more likely to pick up the infection from their playmates, whose parents may be very observant, especially in this day age when parents are daily engaged in the quest to earn their living. Regular washing of the hands with soap and water, or with alcohol-based hand sanitizer is enough to avoid potential infection.
There is no treatment or vaccine available although prior smallpox vaccination was highly effective in preventing monkeypox as well.
Human monkeypox was first identified in humans in 1970 in the Democratic Republic of Congo (then known as Zaire) in a nine-year-old boy in a region where smallpox had been eliminated in 1968. Since then, the majority of cases have been reported in rural, rainforest regions of the Congo Basin and western Africa, particularly in the Democratic Republic of Congo, where it is considered to be endemic. In 1996-97, a major outbreak occurred in the Democratic Republic of Congo.
In the spring of 2003, monkeypox cases were confirmed in the Midwest of the United States of America, marking the first reported occurrence of the disease outside of the African continent. Most of the patients had had close contact with pet prairie dogs.
In 2005, a monkeypox outbreak occurred in Unity, Sudan and sporadic cases have been reported from other parts of Africa. In 2009, an outreach campaign among refugees from the Democratic Republic of Congo into the Republic of Congo identified and confirmed two cases of monkeypox. Between August and October 2016, a monkeypox outbreak in the Central African Republic was contained with 26 cases and two deaths.
Signs and symptoms
The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 16 days but can range from 5 to 21 days.
The infection can be divided into two periods:
The invasion period (0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle ache) and an intense asthenia (lack of energy);
The skin eruption period (within 1-3 days after appearance of fever) where the various stages of the rash appears, often beginning on the face and then spreading elsewhere on the body. The face (in 95% of cases), and palms of the hands and soles of the feet (75%) are most affected. Evolution of the rash from maculopapules (lesions with a flat bases) to vesicles (small fluid-filled blisters), pustules, followed by crusts occurs in approximately 10 days. Three weeks might be necessary before the complete disappearance of the crusts. The number of the lesions varies from a few to several thousand, affecting oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (eyelid) (20%), as well as the cornea (eyeball). Some patients develop severe lymphadenopathy (swollen lymph nodes) before the appearance of the rash, which is a distinctive feature of monkeypox compared to other similar diseases.
Monkeypox is usually a self-limited disease with the symptoms lasting from 14 to 21 days. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and severity of complications.
Treatment and vaccine
There are no specific treatments or vaccines available for monkeypox infection, but outbreaks can be controlled. Vaccination against smallpox has been proven to be 85% effective in preventing monkeypox in the past but the vaccine is no longer available to the general public after it was discontinued following global smallpox eradication. Nevertheless, prior smallpox vaccination will likely result in a milder disease course.