Monkeypox: The Re-emergence and Spread of a Forgotten Disease



    The largest documented outbreak of the rare monkeypox viral disease has afflicted Nigeria since 2017. As of April, more than 300 cases and multiple deaths have been reported. The majority of cases are males between 21 and 40 years oldSince 1970, prior to the Nigeria outbreak, only around 10 cases in West Africa had been reported. According to the U.S. Centers for Disease Control and Prevention (CDC), before 2017 the most recent case of human monkeypox recorded in Nigeria was in 1978. Experts cannot account for the rise in cases and geographic reach over the last ten years. The disease is prevalent in the Democratic Republic of the Congo (DRC) and previous outbreaks have occurred primarily in rural rainforest areas of the Congo basin and West Africa.

    In 2003, a total of 81 cases were confirmed in the United States, the first reported outside the African continent. Most of the patients in the U.S. were reported to have had contact with pet prairie dogs that were infected by African rodents that were imported into the country. In the last year alone, cases have been reported in the United Kingdom, Israel, and Singapore.


    What is Monkeypox?

    • Monkeypox was discovered in 1958 when two outbreaks of ‘pox-like’ symptoms were found in research monkeys, hence the name “monkeypox”


    • The first known human case of monkeypox was recorded in the DRC in 1970; in 1996–97, there was a major outbreak in the DRC


    • It is similar to smallpox, which was eradicated in 1980, although not as deadly; an average of 1 in 10 that are infected with monkeypox die


    • The virus is transmitted from wild animals, but it is still unclear whether from primates, rats, or other rodents


    • It can spread between humans, although not highly infectious


    • The symptoms begin with a fever and body rash spreads over the body. It also affects the eyes and can lead to blindness


    • There is no treatment or vaccine available, but a smallpox vaccine has proven effective and is being trial tested


    • There are Central and West African strains of the virus; the West African is milder and leads to fewer deaths

    United Kingdom and Israel

    In Sept 2018, the United Kingdom reported the first known cases of monkeypox outside of Africa since the U.S. outbreak in 2003. Two of the cases were detected in persons arriving from Nigeria. The third was a healthcare worker who cared for one of the two first cases.

    On 4 Oct 2018, a 38-year-old man suffered from a rash and fever in Jerusalem, Israel. The Israeli resident had just returned from Nigeria. On Sept 17 2018, during his last trip to Nigeria, he is said to have disposed of two rodent carcasses at his residence.


    On 9 May this year, the Ministry of Health of Singapore notified the World Health Organization (WHO) of one confirmed case of monkeypox. The patient is a Nigerian man who arrived in Singapore on 28 April. After developing symptoms, he was referred to the National Centre for Infectious Diseases (NCID) where he was isolated for further observation. On 8 May he tested positive for the monkeypox virus and is currently in stable condition. Fearful of its spread due to its close proximity and ferry traffic to Singapore, the island of Batam, Indonesia equipped all passenger ferries with body heat sensors to detect any individual with fevers on board. Airports in Indonesia are also conducting strict monitoring of body heat and being extremely vigilant with to people arriving from Singapore.

    Stockpiling … just in case

    There is no specific treatment or vaccine for monkeypox infection. However, the smallpox vaccine is shown to be 85% effective in preventing monkeypox infection, but it is not commercially available. A stockpile of smallpox vaccine is held by the WHO, France, Germany, Japan, New Zealand and the U.S. in case smallpox re-emerges. In preparation for further monkeypox outbreaks, researchers from CDC and Kinshasa University in the DRC are currently trialling a vaccine in the DRC.

    A dead disease?

    The discontinuation of smallpox vaccination is in part considered the culprit for the re-emergence of monkeypox. However, greater interaction between wildlife and humans caused by deforestation increased migration, and the continued consumption of bushmeat is also considered a cause. Therefore, the best way to not be infected is to reduce exposure by limiting contact with rodents and primates; limiting direct exposure to blood and meat of animals; and the thorough cooking of meat prior to eating, particularly bushmeat. The WHO is advocating for further restrictions on the animal trade or banning the movement of small African mammals and monkeys to slow the expansion of the virus outside Africa.

    Furthermore, Andrea McCollum, an epidemiologist at CDC and an expert in poxviruses, told the Telegraph that “one of the problems is that there are no experts in these countries because there has been a lapse in the number of cases over the last 30 to 40 years. A lot of the experts from the smallpox era are just not around anymore”.

    Image: Noella / Pixabay (link)

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