Avian Flu Diary: Nigeria CDC: Monkeypox Update Week 46

Credit Nigerian CDC

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It's been just over a month since the Nigerian CDC updated their Monkeypox Surveillance (see Nigeria CDC: Monkeypox Update Epi Week 41), and nearly three months since the first of 3 exported cases (2 to the UK, 1 to Israel) showed up outside of Nigeria.

Nigeria reported their first outbreak of Monkeypox in nearly 40 years in the fall of 2017, one which appeared to be about over in February. Until their September (Epi Week 37), update, Nigeria issued their last outbreak update in epi week 9 of 2018.

The Nigerian CDC has now issued an update for Epi Week 46 - current through Nov. 13th - which indicates that low levels of transmission continue in the country, and suggest a recent uptick in suspected cases (29 vs 10 in the last report).

Whether this increase is the result of more disease activity, or of better surveillance and reporting is impossible to say.

Due to a changing way that Key Indicators are being presented (see graphic below), direct comparisons to the previous updates are cumbersome.

In some reports, numbers reflect totals of confirmed cases only, while others combine confirmed and suspected. In other cases, totals are since Sept 2017, while others reflect only 2018 cases.

NIGERIA MONKEYPOX OUTBREAK REPORT

027
November 13, 2018

SUMMARY OF OUTBREAK INDICATORS FOR 2018 KEY INDICATORS

Nigeria continues to report sporadic cases of monkeypox since the beginning of the outbreak- September 2017

A total of nine new confirmed cases were recorded in 4 states (Bayelsa 4; Rivers – 2; Delta – 2; Oyo – 1) out of twenty-nine (29) new cases reported to the NCDC in the last one month

A total of 104 cases have been reported in 2018 from 19 States (Rivers, Akwa-Ibom, Bayelsa, Cross River, Delta, Ebonyi, Edo, Enugu, Imo, Kebbi, Lagos, Nasarawa, Oyo, Abia, Anambra, Bauchi, Plateau, Adamawa and the FCT)

Of the 104 cases reported, there are 38 confirmed cases, one probable case and one death

Rivers state and Bayelsa state in South-south Nigeria remain the most affected states

Males are more affected with a female to male ratio of 1: 3

The most affected age group in confirmed cases is 21-40 years (Median Age = 31).

Since the beginning of the outbreak in September 2017, 126 confirmed cases, four probable cases and seven deaths have been recorded

Genetic sequencing suggests multiple sources of introduction of monkeypox virus into the human population with some evidence of human to human transmission

Ongoing analysis of findings from monkeypox animal surveillance activities

(Continue . . . )

A little over a month ago (Oct 18th) the CDC issued a travelers' advisory for Monkeypox in Nigeria (see below):

Monkeypox in Nigeria

Alert - Level 2, Practice Enhanced Precautions

Key Points

An outbreak of monkeypox has been ongoing since September 2017 in Nigeria.

Monkeypox is spread through contact with an infected person or animal (alive or dead), or with material contaminated with the virus. It can also be spread through droplets when infected people cough, sneeze, or talk.

Travelers to Nigeria should protect themselves from monkeypox by washing hands often with soap and water, and avoiding contact with animals or people that may be sick.

What is the current situation?

As of September 2018, health officials in Nigeria have reported more than 100 confirmed cases of monkeypox, including multiple deaths. As of October 2018, three cases of monkeypox have been reported in travelers to the United Kingdom (2) and Israel (1), including one to GeoSentinel (a global travel surveillance network).

What is monkeypox?

Monkeypox is a rare disease that occurs throughout remote parts of Central and West Africa, often near tropical rainforests. It is spread through contact with the monkeypox virus from an animal or human (alive or dead) or with materials contaminated with the virus. Symptoms begins with fever, headache, muscle aches, swollen lymph nodes and exhaustion, and is followed by a rash. Patients are usually ill for 2-4 weeks. Monkeypox is fatal in as many as 10% of people who get it.

(Continue . . . )

Nigeria continues to struggle with a number of other infectious disease outbreaks, including Lassa Fever, Yellow Fever, and Cholera. That, combined with the Boko Haram conflict in the northeast, and ongoing political and societal challenges, likely hinders the CDC's ability to conduct surveillance in some parts of the country.

Fortunately, the West African Monkeypox virus is considered to be less virulent, and less easily transmitted, than its Central African counterpart (cite).

For a more detailed look at the Monkeypox virus in Africa, and a limited 2003 outbreak in the United States - you may wish to revisit this blog from last May.