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Although 2016 was an active year for Human Monkeypox infections in Central Africa, with the DRC and the CAR both reporting relatively large outbreaks (see WHO Update On The Monkeypox Outbreak In The Central African Republic), 2017 has - until now - been relatively quiet.
The name `monkeypox’ is a bit of a misnomer. It was first detected (in 1958) in laboratory monkeys, but further research has revealed its host to be rodents or possibly squirrels. It produces a remarkably `smallpox looking' illness in humans, albeit not as deadly. The CDC's Monkeypox website states:
The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the diseaseHumans can contract it in the wild from an animal bite or direct contact with the infected animal’s blood, body fluids, or lesions, but consumption of under cooked bushmeat is also suspected as an infection risk. Human-to-human transmission is also possible.
This from the CDC’s Factsheet on Monkeypox:
The disease also can be spread from person to person, but it is much less infectious than smallpox. The virus is thought to be transmitted by large respiratory droplets during direct and prolonged face-to-face contact. In addition, monkeypox can be spread by direct contact with body fluids of an infected person or with virus-contaminated objects, such as bedding or clothing.Once rare - likely suppressed by the universal dispensing of smallpox vaccines until the late 1970s - Monkeypox outbreaks have become more common over the past couple of decades.
A 2016 study (see EID Journal:Extended H-2-H Transmission during a Monkeypox Outbreak) looked at a large 2013 outbreak of Monkeypox in the DRC and suggested that the virus's epidemiological characteristics may be changing (possibly due to the waning smallpox vaccine derived immunity in the community).
The DRC had reported a 600% increase in cases over both 2011, and 2012. The authors also cite a higher attack rate, longer chains of infection, and more pronounced community spread than have earlier reports.All of which brings us to the following statement, posted by Nigeria's CDC, on an outbreak which appears to have started in late September.
SUSPECTED MONKEYPOX OUTBREAK IN BAYELSA STATE
05 October 2017 | Abuja – SUSPECTED MONKEYPOX OUTBREAK IN BAYELSA STATE
On the 22nd of September, 2017, the Nigeria Centre for Disease Control (NCDC) was notified of a case of suspected Monkeypox in an 11 year old male patient who presented to the Niger Delta University Teaching Hospital (NDUTH) in Yenagoa, Bayelsa State. Subsequently, 11 other cases were identified. All the cases are currently receiving appropriate medical care. All the patients are improving clinically and there have been no deaths. As at 1st October 2017, 32 close contacts of the cases have been identified, advised appropriately and are being monitored.
A Rapid Response Team from NCDC was immediately deployed to support the Bayelsa State Government in the investigations and public health response to the outbreak. The team has been supporting the Bayelsa State Department of Public Health and the State Epidemiologist to respond to the outbreak. As the outbreak investigation and response continues, the Bayelsa State Government has started an aggressive public enlightenment campaign to advise clinicians and the public on the symptoms of the disease and the steps required to manage the cases and to prevent further spread. NCDC has also collected appropriate clinical samples from the cases and these are being analysed through the National Reference Laboratory in Abuja.
(SNIP)
Health care workers are strongly advised to practice universal precautions while handling patients and/or body fluids at all times. They are also urged to be alert, be familiar with the symptoms and maintain a high index of suspicion. All suspected cases should be reported to the Local Government Area or State Disease Surveillance and Notification Officers.
The Chief Executive Officer of NCDC, Dr. Chikwe Ihekweazu has advised that health workers must continue to manage their patients without fear. He advised, “As long as universal infection prevention and control practices are strictly adhered to by all clinical staff, the chances of transmission are minimal.”
(Continue . . . )
Although Monkeypox is normally restricted to small outbreaks in Africa, in 2003 we saw a rare outbreak in the United States when a Texas animal distributor imported hundreds of small animals from Ghana, which in turn infected prairie dogs that were subsequently sold to the public (see MMWR Update On Monkeypox 2003).
By the time this outbreak was quashed, the U.S. saw 37 confirmed, 12 probable, and 22 suspected human cases. Among the confirmed cases 5 were categorized as being severely ill, while 9 were hospitalized for > 48 hrs; although no patients died (cite).
As mentioned, the smallpox vaccination provides some cross-protection against monkeypox infection, but a 2010 study in PNAS warned, there has been a Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo.
Routine vaccination against smallpox ceased in the United States in 1972, and worldwide by the end of that decade. Today more than half of the world's population is unvaccinated, a percentage that runs much higher in Africa.All of which makes Monkeypox one of those obscure infectious diseases we watch with considerable interest, as declining community immunity may one day permit this virus to spread in a more sustained manner.
