Isioma Madike 
•It’s a zoonotic disease, affects both animals and humans, says Prof. Ezeibe
•Compromised immunity could expose individuals to infections -Prof. Onajole
•Preventive, control measures limit transmission, says NCDC
The recent occurrence of Mpox, a viral disease, was confirmed a few weeks ago in Nigeria. It is a skin infection that leads to inflammation of the skin and fever and affects both animals and human beings. But can it be tamed? Isioma Madike reports
Current outbreak/NCDC reactions
An ongoing outbreak of Mpox, a viral disease, was confirmed in the nation on August 16, when the Nigerian authorities placed key entry points into the country on high alert following its occurrence in other parts of Africa.
In its press statement, the Nigeria Centre for Disease Control and Prevention (NCDC), said it was closely monitoring several endemic diseases including Mpox which has been declared a Public Health Emergency of International / Continental Concern (PHEIC / PHECC) by both the WHO and the Africa Centre for Disease Control and Prevention (Africa CDC).
So far, about 2,863 confirmed cases and 517 deaths across 13 African countries have been reported since the current outbreak of the disease. This alarming increase, according to Dr Jide Idris, head of the Nigerian CDC, is linked to a new strain of the virus which emerged in eastern Congo and has since been detected in Kenya, Rwanda, and Uganda.
In Nigeria, a total of 39 confirmed cases and zero deaths have been recorded across 19 states including the FCT, Idris added. He noted the significant concern of the ease of cross-border transmission, and said that the NCDC is intensifying its efforts in coordination and communication with stakeholders to manage the spread of the virus and prevent further importation of the disease.
Dr Idris, who told journalists in Abuja that it’s best to be prepared, said: “We’re intensifying surveillance activities by tracking cases across Nigeria to swiftly detect and respond to any new cases. Along this line, five designated international airports, some key seaports … land and foot crossing borders have been placed on high alert.
“Declaration forms have been distributed to airlines where there’s an ongoing outbreak of Mpox in the last 90 days.”
The NCDC said authorities are distributing diagnostic tools to states. They also have issued a public advisory on ways to prevent the spread of the Mpox virus, including limiting contact with animals such as rodents and monkeys.
“We’re also considering vaccination efforts for high-risk groups, as Nigeria expects to receive about 10,000 doses of the new vaccines that have just recently been approved for emergency use. We’re also meeting with collaborative agencies like the Ministry of Environment and Agriculture for support and coordination efforts,” Idris said.
He further said that a new strain of the virus, which is more deadly and more easily transmitted, is responsible for the recent spread. The strain was first discovered in the Democratic Republic of Congo and later reported in Kenya, Rwanda and Uganda, all previously unaffected nations.
To prevent the spread of Mpox, Idris said, it is important members of the public strongly adhere to proven infection prevention and control measures. These practices, he added, are essential in limiting the transmission of the virus.
This includes: Avoiding contact with animals that could harbour the virus including sick or dead animals in areas where MPX has been confirmed and avoiding contact with any material that has been in contact with a sick animal.
Others are avoiding unnecessary physical contact with persons infected with MPX; isolating potentially infected animals from other animals; practicing frequent hand washing with soap and water, especially after caring for or visiting sick people
Ensuring all animal food products are properly cooked before eating; use of appropriate protective clothing and gloves while handling sick animals or their infected tissues and during slaughtering procedures.
Individuals, he also said, should report all cases with the associated symptoms mentioned above to the nearest health facility for care, and/or call the NCDC toll-free line on 6232. Idris equally said that the Nigerian government is making an effort to make vaccines available to the public, especially hotspot areas. The vaccine, he said, has been shown to have a favourable safety profile.
Speaking on why Mpox was declared a Public Health Emergency, Jean Kaseya, head of the Africa CDC, said: “This declaration is not merely a formality. It’s a clarion call to action. It’s a recognition that we can no longer afford to be reactive; we must be proactive and aggressive in our effort to contain and eliminate this threat.”
Medical experts
A Professor of Community Medicine, Bayo Onajole, who is also a consultant public health physician, has urged Nigerians to avoid the abuse of addictive drugs that can reduce their immunity, saying such could expose an individual to Mpox infection.
Onajole, who is also an epidemiologist and a consultant community physician, similarly advised that early reports of suspected cases for prompt isolation could reduce contact with infected persons. That, he added, is another factor to curb the disease spread whose origin is from animals, most especially monkeys.
“The disease has, however, cross spread leading to man to man transmission. In that case extreme care should be taken by all to curtail it,” he said.
A Professor of Veterinary Medicine and Clinical Virology at the Michael Okpara University of Agriculture, Umuahia, Abia State, Maduike Ezeibe, told this reporter that Mpox is a skin infection that leads to inflammation of the skin (dermatitis) and fever. This, he said, can be complicated to become life threatening.
He said: “It is a zoonotic disease which means it affects both animals and human beings. So, veterinary doctors and other professionals who work on or with animals are more at risk of contracting the infection. The virus spreads by contact between infected animals or infected persons and susceptible persons.
“To avoid contracting the infection, people should avoid contact with live animals, especially wild animals and infected persons. Those who must handle live animals or infected persons should be provided with protective clothes and they should thoroughly wash and disinfect their hands after handling any animal or suspected persons.”
Former President, Guild of Medical Directors (GMD), Professor Olufemi Babalola, has also emphasised that Mpox virus is a member of the orthopoxvirus genus in the family Poxviridae.
According to Babalola, Mpox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. It usually begins within a week, he said, but can start 1–21 days after exposure but may last longer in someone with a weakened immune system.
In recent times, he said, the case fatality ratio has been around 3–6 per cent, meaning that out of every one hundred people who contract the disease, 3-6 people would die.
The professor also confirmed that Mpox is transmitted to humans through close contact with an infected person or animal (such as rats), or with material contaminated with the virus (such as rat faeces or urine on food to be consumed).
Obviously, monkeys, he said, act as a reservoir for the virus but are not affected by the disease. Complications from Mpox, Babalola continued, include secondary skin infections, pneumonia, confusion, and eye problems. In the past, according to him, about one to 10 per cent of people with Mpox have died.
It is important to note that death rates in different settings may differ due to a number of factors, such as access to healthcare, he added. He said these figures may be an overestimate because surveillance for Mpox has generally been limited in the past.
He said: “Mpox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as beddings and spread commonly among men, who have sex with men, particularly in the West.
“It is a viral zoonotic disease that occurred primarily in tropical rainforest areas of Central and West Africa. But it has now spread to several countries in Europe, Asia and the Americas. It is endemic in Nigeria, other West African countries, Central Africa and the Congos.
“An anti-viral agent developed for the treatment of smallpox has been licensed for the treatment of Mpox. The clinical presentation of Mpox resembles that of smallpox, a related orthopoxvirus infection, which was declared eradicated worldwide in 1980.
“However, it is less contagious than smallpox and causes less severe illness. It typically presents clinically with fever, rash and swollen lymph nodes and may lead to a range of medical complications.
“Vaccines used during the smallpox eradication programme also provided protection against Mpox. Newer vaccines have been developed of which one has been approved for prevention of Mpox. However, it is doubtful if Nigeria has any stockpile of the vaccine at the moment.”
A virologist and former President of the Nigerian Academy of Science, Prof. Oyewale Tomori, had, while speaking to journalists in Abuja on the Mpox outbreak, warned that the country is at a critical juncture in healthcare delivery.
He highlighted the urgent need for improving disease surveillance, enhanced laboratory support, while finalising plans to produce vaccines locally to contain outbreaks like Mpox.
He also stressed the importance of raising awareness about the diseases plaguing the country while fully engaging and empowering communities in surveillance efforts. He said that Nigeria’s ability to effectively combat emerging infectious diseases rests on robust surveillance systems.
“A balanced integration of these aspects of disease control and response is crucial for national preparedness for controlling Mpox and, also, for responding to other current and future disease outbreaks.
“The foundation for controlling any disease, including Mpox, is surveillance. Eternal vigilance is the price of liberty from any disease outbreak.
“Without early detection and monitoring, we will always play catch-up, running helter-skelter like decapitated chickens after rampaging diseases. For the good health of our people and our national health security, that is not a position we can afford to be in,” he said.
He described the ongoing upsurge of Mpox in the Democratic Republic of Congo, where inadequate surveillance has led to the spread of the disease to neighbouring countries, as a cautionary tale for Nigeria.
“Effective disease control requires the integration of several capabilities: rapid detection, reporting, laboratory confirmation, isolation and treatment of cases.
“Proper data management allows us to plan and implement an appropriate response, limiting the spread of cases and preventing a national, continental, or international emergency,” he added.
Tomori said that many African countries had the necessary human health workforce to prevent and control outbreaks. But criticised governments for failing to provide sustained funding to create and maintain an enabling environment for health workers.
He said: “Instead of building on our strengths, our experienced health workers, governments have underfunded public health systems and turned around to beg foreign governments and agencies for vaccines.
“We forget that with effective surveillance, we can prevent outbreaks that become international concerns, reducing the need for vaccines.
“We are far from being able to produce human vaccines locally, despite past efforts. In my father’s time, Nigeria was self-reliant in many areas.
“Today, though significant efforts are being made by the government, we have wasted too much precious time and are not close to achieving an acceptable position in local vaccine production.”
He nonetheless warned that relying on external sources for vaccines could leave Nigeria vulnerable, especially in times of global shortages. The professor therefore called for a comprehensive national strategy that prioritises health system strengthening, local vaccine production, and research.
“We cannot continue to repeat the same mistakes we have made for the last 50 years. It is time for Nigeria to take control of its public health destiny and ensure that we are prepared for the next pandemic,” he added.
Another Clinical Virologist, Dr Abike Fowotade, had earlier told one of our reporters that people should ensure regular hand washing and avoid contact with sick or dead animals that have vesicular lesions on the skin as part of strategies to prevent getting infected with the virus.
Fowotade in addition, had also advised persons with suspicious skin rashes to ensure they visit a recognised health facility to get tested for Mpox, insisting that contact with an infected source can be human or animals, monkeys, rodents and dogs as major suspects.
She had said: “Avoid close contacts with other people, especially if they work in a hospital or have been in an area, region or environment where there have been cases of Mpox.”
Other experts have said that environments can become contaminated with the Mpox virus, for example when an infected person touches clothings, beddings, towels, objects, electronics and surfaces. Someone else who touches these items can then become infected.
It is also possible to become infected, according to the experts, from breathing in skin flakes or viruses from clothings, beddings or towels.
This route is what they call fomite transmission. Although asymptomatic infection has been reported, it is not clear whether people without any symptoms can spread the disease or whether it can spread through other bodily fluids.
However, pieces of DNA from the Mpox virus have been found in semen, but it is not yet known whether infection can spread through semen, vaginal fluids, amniotic fluids, breast milk or blood.
Research is said to be underway to find out more about whether people can spread Mpox through the exchange of these fluids during and after symptomatic infection.
Sign and symptoms
Symptoms of Mpox illness include fever, headache, body aches, weakness, swollen lymph nodes (glands) and a rash. After about 1 to 3 days of fever, the rash erupts, beginning on the face and then spreading to the body with the face and palms/soles being mostly affected.
They can also occur in and around the genitals which is why contact during sex is another suspicious mode of transmission.
Treatment
Currently there is no treatment approved specifically for Mpox virus (MPXV) infections. For most patients with Mpox, who have intact immune systems and don’t have a skin disease, supportive care and pain control will help them recover without medical treatment.
However, others, who are severely immunocompromised or have certain skin conditions, such as eczema, are at particular risk of uncontrolled viral spread, a severe manifestation of Mpox that can be life-threatening.
Origin
Human Mpox was first identified in humans in 1970 in the Democratic Republic of the Congo in a 9-month-old boy in a region where smallpox had been eliminated in 1968. Since then, most cases have been reported from rural, rainforest regions of the Congo Basin, with increasing human cases being reported from across Central and West Africa.
Most notable of these places are Benin, Cameroon, Gabon, Cote d’Ivoire, Liberia, Nigeria, Sierra Leone and South Sudan. However, the true burden of Mpox is unknown. For example, in 1996–97, the outbreak in the Congo was said to have had a lower case fatality ratio and a higher attack rate than usual.
