Mpox: What you need to know about rampaging disease

As of Friday, Nigeria has confirmed 40 cases of Mpox, a viral disease recently declared a public emergency of international concern by the World Health Organisation (WHO).

Like the global health institutions, the Nigerian health authorities have expectedly reintroduced relevant measures to curtail its spread and provide care for those already infected. One of these measures was reintroducing health declaration forms at airports for people returning or visiting the country.

The Nigerian government also enforced increased border surveillance, distributing diagnostic protocols to port health services and putting people on higher alert at international airports, sea ports, and land borders.

The Coordinating Minister of Health and Social Welfare, Muhammad Pate, said these efforts were in response to the rapid spread of the disease in African countries where an outbreak has been declared.

Mr Pate said Nigeria intends to tackle the disease by deploying measures similar to those used during the COVID-19 pandemic.

However, the disease is less deadly and contagious compared to COVID-19.

He said these measures will be introduced alongside the activation of infectious disease centres in all 36 states and the Federal Capital Territory.

Confirmed cases of the disease in Nigeria were recorded across 19 states, including the FCT, from the year’s first month.

Five states currently lead the infection chart. Bayelsa tops the chart with five confirmed cases. Cross River, Enugu and Akwa Ibom have four cases each, and Benue has three cases. For suspected cases, Ogun tops the chart with 141 suspected cases, Lagos has 99 cases, Bayelsa has 94 cases, Ekiti has 47 and is followed by Osun which has recorded 45 suspected cases this year.

The number of cases in Nigeria is low when compared to countries in the Central African region, where thousands of cases have been recorded and hundreds of people killed by the disease. However, this does not eliminate the risk of Mpox in the country.

What is Mpox

Mpox, formerly known as monkeypox, is a viral disease related to the eradicated smallpox virus. It has been endemic in parts of Africa for decades since it was first detected in humans in the Democratic Republic of Congo in 1970.

For years, Mpox was predominantly detected in Central and West Africa. Clade I cases were concentrated in Central Africa, especially in the Democratic Republic of Congo, while Clade II cases were found mainly in Nigeria.

It is a contagious and deadly disease that spreads from animals to humans through direct contact with infected animals’ blood and bodily fluids, such as monkeys.

Human-to-human transmission is also possible through close contact such as touching, kissing or sex, as well as through contaminated materials like sheets, clothing and needles.

Recent outbreak

The recent Mpox outbreak has been in the Democratic Republic of Congo since November 2023 but recently spread rapidly to several other African countries including Burundi, Rwanda, Uganda and Kenya.

The Africa Centre for Disease Control and Prevention (Africa CDC) has recorded 3,641 confirmed cases with 622 deaths across 13 African countries this year.

The public health agency also said 19,222 suspected cases have been reported so far.

Sweden has also recorded one case of clade I, making it the first Mpox case outside Africa.

The Africa CDC Director, Jean Kaseya, recently warned of the virus’s rapid spread.

WHO Director-General Tedros Ghebreyesus also expressed deep concern, stating that the potential for further international spread is “very worrying.”

Both organisations have also consistently released funding to support responses in countries.

The Africa CDC said it had granted the African Union $10.4 million in emergency funding for its Mpox response, while the WHO has released $1.45 million from its contingency fund for emergencies.

In 2022, a less severe strain of the virus spread to over a hundred countries, primarily through sexual transmission.

This led the World Health Organisation (WHO) to declare it a public health emergency. Ten months later, the WHO announced the end of the emergency, stating that it had been brought under control.

What is different about this outbreak?

There are two main types of Mpox: Clade I and Clade II.

Clade II was responsible for a global outbreak that was declared a global health emergency from July 2022 to May 2023. This new outbreak, however, is caused by the “deadlier” Mpox Clade II virus. Also, a new variant of the Clade I virus, Clade 1b, was discovered in September 2023 in Congo.

According to WHO, Clade Ib is a more lethal strain of the virus. It is highly contagious and has spread to at least five other African countries unaffected by the last outbreak.

Why is this more dangerous?

Experts say mutations led to Clade Ib, which has since spread rapidly. This new variant has been labelled “the most dangerous yet” by scientists.

According to different studies, Clade I has a higher mortality rate of 1-10 per cent compared to Clade II, which is usually less than one per cent.

The Chief of Public Health, UNICEF Nigeria, Eduardo Celades, told PREMIUM TIMES that compared to Clade I and II, the new variant, Clade Ib, is considered to be deadlier and more contagious, spreading rapidly across African countries.

He said the rapid spread caused both WHO and the African CDC to raise an alarm about the outbreak and declare it a health emergency that required urgent attention.

Experts have noted that the current outbreak is the largest for Clade I to date, with a mortality rate estimated at around 4 per cent, consistent with previous reports for this strain.

The WHO Director-General also said: “We are not dealing with one outbreak of one clade; we are dealing with several outbreaks of different clades in different countries with different modes of transmission and different levels of risk.”

Vaccines

There are two key mpox shots, made by Denmark’s Bavarian Nordic and Japan’s KM Biologics. Bavarian Nordic vaccine reportedly costs $100 a dose, but the price of KM Biologics’ is unknown.

While the mpox vaccine has been available to 70 countries outside Africa, the arrival of the vaccine into the continent where thousands of people are infected, has been slow.

Health experts told Reuters that the vaccine has been difficult for many low-income nations due to its high cost. However, the struggle for access is worsened by the delay in WHO approval for international agencies to procure and distribute the vaccine to poor countries.

This has forced African governments and the African CDC to resort to seeking donations of vaccines from wealthier countries.

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Several WHO officials and scientists told Reuters that the delay in providing vaccine doses to Africa showed that lessons learned from the COVID-19 pandemic about global healthcare inequities have been slow to bring change.

They said WHO did not begin the process needed to give poor countries easy access to large quantities of vaccines through international agencies until this month.

Last Friday, the UN agency disclosed that it plans to relax some of its procedures to accelerate poor countries’ access to the mpox shots.

But health officials and experts said this could have begun years ago.

According to a member of the Africa CDC’s Mpox Emergency Committee, Helen Rees, the situation is unacceptable. She noted that in Africa’s battle to obtain vaccines during the COVID-19 pandemic, the continent is once again being neglected.

However, on Tuesday, the Africa CDC DG said the agency expects to receive a total of 380,000 doses of vaccine through donations from some of its international partners.

Nigeria has also received 10,000 vaccine doses from the US.

Preventive measures

Good hygiene is crucial to preventing the spread of the Mpox virus. Experts recommend regular hand washing with soap or alcohol-based hand sanitiser.

It is also best to avoid sharing items like towels, bedding, clothing, or utensils with others and to regularly clean and disinfect frequently touched surfaces, such as doorknobs, countertops, and phones.

Also, avoid unsafe sexual practices.

While reported cases of the disease are significantly low in Nigeria, UNICEF’s Eduardo Celades urged that citizens learn to identify the primary symptoms of the virus.

Some of the symptoms are fever, headache, muscle aches, backache, chills, fatigue, swollen lymph nodes, and sore throat. A rash usually appears one to five days after the first symptoms. It often starts on the face and then spreads to other parts of the body, including the genitals and anus.

Mr Celades said recognising the symptoms will help people identify when they might be infected, allowing them to seek medical care early and preventing further transmission to others.

WHO also suggested that uninfected people should avoid close contact with people suspected or diagnosed with the disease, while infected or recovering persons should self-isolate.