In the fall of 2017, Nigeria saw their first confirmed Monkeypox outbreak in nearly 40 years, resulting in more than 200 confirmed and suspected cases. While that outbreak was reportedly quelled in February, a small number of isolated cases have continued to be reported over the past 6 months.
Fortunately, the West African Monkeypox virus is considered to be less virulent, and less easily transmitted, than its Central African counterpart (cite).Last September the UK saw two imported cases from Nigeria (see Eurosurveillance Rapid Comms: Two cases of Monkeypox imported to the UK) and a month later Israel: MOH Confirmed An Imported Monkeypox Case).
Nigeria apparently continues to see sporadic transmission of the Monkeypox virus, but hasn't released an updated Sitrep since January of this year (see Monkeypox Outbreak in Nigeria for Week 5).Today Singapore's Ministry of Health has announced the diagnosis and isolation of a traveler from Nigeria with Monkeypox. First the full statement, then I'll return with a postscript.
CONFIRMED IMPORTED CASE OF MONKEYPOX IN SINGAPORE
9th May 2019
The Ministry of Health (MOH) has confirmed one imported case of monkeypox infection in Singapore. The patient is a 38-year-old Nigerian national who arrived in Singapore alone on 28 April 2019, and was tested positive for monkeypox on 8 May. He is currently warded in an isolation ward at the National Centre for Infectious Diseases (NCID), and his condition is stable.
About the Patient
2. The patient stayed at a hotel at 21 Lorong 8 Geylang from 28 April and had attended a workshop at 3 Church Street on 29 and 30 April 2019. He developed fever, muscle ache, chills and skin rash on 30 April. He reported that he had remained in his hotel room most of the time between 1 and 7 May. He was conveyed to Tan Tock Seng Hospital by an ambulance on 7 May and referred to NCID on the same day.
3. The patient reported that prior to his arrival in Singapore, he had attended a wedding in Nigeria, where he may have consumed bush meat, which could be a source of transmission of monkeypox virus.
4. Monkeypox is a rare disease caused by a virus that is primarily transmitted to humans from animals. Infected persons would typically experience fever, headache, muscle ache, backache, swollen lymph nodes and skin rash. The disease is usually self-limiting, with most patients recovering within two to three weeks. In some cases, however, the virus can cause serious complications such as pneumonia, sepsis, encephalitis (brain inflammation) and eye infection with ensuing loss of vision. There have been reported mortality rates of 1% to 10% during outbreaks, with most deaths occurring in younger age groups.
5. Transmission of monkeypox principally occurs when a person comes into close contact with infected animals (typically rodents) through the hunting and consumption of bush meat.
6. Human-to-human transmission, while possible, is limited. A person is infectious only during the period when he has symptoms, particularly skin rash. Transmission typically occurs from close contact with the respiratory tract secretions or skin lesions of an infected person, or objects recently contaminated by an infected person’s fluids or lesion materials.
7. More information on the disease and its transmission is provided in Annex A.
8. Professor Leo Yee Sin, Executive Director of NCID, said, “The risk of community spread of monkeypox within Singapore is low. There is no evidence to date that human-to-human transmission alone can sustain monkeypox infections in the human population. On average, each infected person transmits the infection to less than one other person. This is much less infectious than the common flu. The chain of transmission can also be broken through contact tracing and quarantine of close contacts.”
Actions by MOH
9. While risk of spread is low, MOH is taking precautions. Based on MOH’s investigation and contact tracing thus far, 23 persons have been identified as close contacts of the patient. These include 18 participants and trainers who attended the same workshop, one staff at the workshop venue and four hotel staff who had close contact with the patient. Healthcare workers who were in contact with the patient had used personal protective equipment. MOH’s investigation and contact tracing operations are ongoing.
10. Close contacts of the patient have been assessed by NCID and offered vaccination, which can prevent the disease or reduce the severity of symptoms. As a precautionary measure, they will be quarantined and monitored for 21 days from their date of exposure to the patient. Those who develop symptoms will be treated at NCID. All other contacts who have a low risk of being infected are nevertheless put under active surveillance, and will be contacted twice daily to monitor their health status.
11. One workshop participant had left Singapore on 5 May 2019, before the patient was seen and diagnosed at the hospital. This workshop participant has reported to MOH that he was, and remains, well with no symptoms. Nonetheless as a precaution, MOH has informed the public health authority in his home country.
Advice for Public
12. MOH would like to advise travellers to areas affected by monkeypox in Central and Western Africa to take precautions, including:
Ministry of Health
- Maintain a high standard of personal hygiene, including frequent hand washing after going to the toilet, or when hands are soiled.
- Avoid direct contact with skin lesions of infected living or dead persons or animals, as well as objects that may have become contaminated with infectious fluids, such as soiled clothing or linens (e.g. bedding or towels) used by an infected person.
- Avoid contact with wild animals, and consumption of bush meat.
- Returning travellers from areas affected by monkeypox should seek immediate medical attention if they develop any disease symptoms (e.g. sudden onset of high fever, swollen lymph nodes and rash) within three weeks of their return. They should inform their doctor of their recent travel history.
9 May 2019
Last October in WHO: Monkeypox Update & Risk Assessment - Nigeria, we looked at advice from the World Health Organization, and some studies that raise concerns over the future path of the Monkeypox virus.
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 May of 2018.