Monkeypox: Community transmission likely with Nigeria’s detection rate –Virologist

A Medical Virologist and Immunologist at the Adeleke University, Ede, Osun State, Dr. Oladipo Kolawole speaks with LARA ADEJORO on the need for Nigeria to intensify its surveillance to get a true picture of what is going on in the country regarding monkeypox.

What is monkeypox and how it be identified?

Monkeypox is a rare disease that is caused by infection with the monkeypox virus. Monkeypox cases in people have occurred outside of Africa linked to international travel or imported infected animals. Firstly, monkeypox was discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox’.

The first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo during a period of intensified effort to eliminate smallpox. After this first outbreak monkeypox has been reported in people in many other central and western African countries such as Cameroon, Central African Republic, Cote d’Ivoire, the Democratic Republic of the Congo, Gabon, Liberia, Nigeria, Republic of the Congo, and Sierra Leone.

While Nigeria has only recorded 15 cases this year alone, countries in Europe are reporting dozens of cases, should Nigerians be worried?

Yes, we need to worry because of our detection rate; there is the likelihood of missing out on some individuals who have been infected with the virus because the screening is not done routinely in our clinics. We need to intensify more surveillance for this virus to have a true picture of what is going on in the country.

The Nigeria Centre for Disease Control was notified by the United Kingdom authorities of a confirmed case of Monkeypox with a connection to Nigeria; this was after the individual had left Nigeria, are there possibilities of community transmission in the country?

Looking through the link, we cannot rule out the possibility because such an individual would have had contact with many people, which could be a source of community transmission if the contact tracing is not well done.

Is there a system in place in Nigeria or the world to manage the spread of monkeypox?

Yes, Nigeria has the experience and with the improvement, we have had in healthcare as a result of COVID-19 we will be able to manage the spread of Monkeypox. Also, healthcare workers in Nigeria have been trained in case management and communication to the public regarding the risk of monkeypox from previous experience in the year 2017.

With the confirmed cases, is the infection resurging?

Yes, we have what we called emerging and re-emerging infectious diseases, a disease can surface back after a time being. The virus has been detected in the United States, United Kingdom, Canada, Australia, Israel, Spain, Portugal, Sweden, France, Belgium, Germany, Italy, and Switzerland. Monkeypox is an uncommon disease and has raised concerns worldwide after multiple cases were detected in European countries recently. The monkeypox outbreaks mostly occur in west and central Africa. Occasionally it spreads elsewhere.

Experts say monkeypox can be passed on by direct contact during sex, does it mean it can be sexually transmitted?

What they meant is fluid contacts of infected individuals. Although, anyone can spread monkeypox through contact with body fluids, monkeypox sores, or shared items that have been contaminated with fluids or sores of a person with monkeypox.
What are other ways one can contract the disease?

Self-protection includes avoiding skin-to-skin or face-to-face contact with anyone who has symptoms, practicing safer sex, keeping hands clean with water and soap or alcohol-based hand rub, and maintaining respiratory etiquette.

What are the symptoms?

The major symptoms are headache, Acute onset of fever (>38.5oC), lymphadenopathy (swollen lymph nodes), Myalgia (muscle and body aches), Back pain, and Asthenia (profound weakness). Chickenpox-like rashes are also found on the hands and face.

How can it be managed and treated?

Previously as far as the treatment is concerned, it doesn’t exist which is specifically for monkeypox, but the symptoms usually clear up after two to four weeks. But antiviral drugs for smallpox could also be used to treat monkeypox under certain circumstances. Although one specific treatment (tecovirimat) was approved this year but not yet widely available.

Is there a functional surveillance system to trace and identify cases in Nigeria?

I think the NCDC has a good surveillance system to trace and identify cases and this needs to be strengthened so that we can be more proactive in early and timely detection.

What should Nigeria do to prevent the spread of the disease?

We need to sensitise the general populace about this virus, the methods of transmission, clinical signs, and its prevention using various outlets such as radio, TV, social media, and others.