29 May, 2022|Abuja - Public Health Advisory on Monkeypox
Monkeypox (MPX) is a rare viral zoonotic infectious disease (i.e., an infection transmitted from animals to humans) that is endemic in areas in and near tropical rainforests in Central and West Africa. It is caused by the Monkeypox virus which belongs to the same Orthopoxvirus genus and Poxviridae family of viruses as the Variola virus (Smallpox virus), the Vaccinia virus (used in smallpox vaccine for eradication programme), and the cowpox virus (used in earlier generations of smallpox vaccines) and some other viruses. There are two types (clades) of the MPX virus: the West African and the Central African clade. Available data suggests human disease with the Central African clade is more severe than with the West African clade
The exact reservoir of the MPX virus is still unknown although rodents are suspected to play a part in transmission. So far, the virus itself has been identified in wild animals in Africa only twice (from a type of squirrel and a type of monkey in the Democratic Republic of Congo and Cote d’Ivoire respectively). Rodents from West Africa (rats, dormice, and squirrels) being sold in a store in the United States contributed to a 2003 outbreak.
The virus can spread both from animal-to-human (which is the first (spill-over) event preceding the detection of cases in humans), and from human-to-human. Animal-to-human transmission may occur by direct contact with the blood, body fluids, the skin or mucosal lesions of infected animals (e.g., monkeys, squirrels, and rodents). This can happen through a bite, scratch, handling of, or eating inadequately cooked or other products of infected bushmeat. Human-to-human (person-to-person) transmission occurs when a person comes into contact with the virus from an infected human, or materials contaminated with the virus such as clothing, beddings. As a consequence, household members or healthcare workers are at greater risk of infection. The virus enters the body through broken skin (even if not visible), the respiratory tract, or the mucous membranes of the eyes, nose, or mouth. Human-to-human transmission may also occur through aerosols/droplets following prolonged face-to-face or close contact. The East African clade is better than the West African clade in human-to-human transmission.
Symptoms of the illness include fever, headache, body aches, weakness, swollen lymph nodes (glands) and a rash. After about 1 to 3 days of fever, the rash erupts, beginning on the face and then spreading to the body with the face and palms/soles being mostly affected. They can also occur in and around the genitals which is why contact during sex is one mode of transmission. It is mostly a self-limiting illness that often lasts for 2−4 weeks.
To prevent MPX, members of the public are urged to practise infection prevention and control measures that have proven to limit the spread of MPX infection. This includes:
• Avoid contact with animals that could harbour the virus including sick or the dead animals in areas where MPX has been confirmed
• Avoid contact with any material that has been in contact with a sick animal.
• Avoid unnecessary physical contact with persons infected with MPX
• Isolate potentially infected animals from other animals
• Practice frequent handwashing with soap and water especially after caring for or visiting sick people
• Ensuring all animal food products are properly cooked before eating
• Use of appropriate protective clothing and gloves while handling sick animals or their infected tissues and during slaughtering procedures
• Report all cases with the associated symptoms mentioned above to the nearest health facility for care, and/or call NCDC toll free line on 6232
Healthcare workers are further advised to:
• Always practice standard care precautions (including droplet precautions) when caring for patients, regardless of their presumed diagnosis
• Wash hands with soap and water after contact with patients and/or their environment
• Maintain a high index of suspicion for MPX, especially for patients presenting with fever and vesicular/pustular rash in all parts of the country at this time.
• During triage, use precautionary measures such as placing a surgical mask over the nose and mouth of suspected patients and covering any exposed skin lesions with a sheet or gown
• Isolate all patients suspected of having MPX as soon as possible
• Wear personal protective equipment (gloves, gown, and masks) before close contact with suspected cases and dispose of properly
• Correctly disinfect all contaminated equipment (including bedding) using bleach unless otherwise indicated and dispose of all waste properly
• Report all cases to the State Epidemiologist/LGA Public Health Department immediately, or call NCDC toll free line on 6232
• Samples taken from humans for investigation of the MPX virus should be handled by trained staff and sent to the Nigeria Centre for Disease Control
• Provide psychosocial support to all patients. Refer to the section on Guideline for Psychosocial Management of Patients in Isolation contained in the Interim National Guidelines for MPX (https://ncdc.gov.ng/themes/common/docs/protocols/96_1577798337.pdf)
• RESPECT PATIENTS' PRIVACY always:
o Do not photograph a patient or any part of their body without their knowledge and consent.
o Do not take a patient’s photograph with the patient’s face in it. If unavoidable, ensure to conceal the patient's face before using the image.
o Do not share photographs taken on the social media
Veterinarians are advised to:
• Consider all mammals susceptible to MPX and be aware of how the disease transmits from animal to animal.
• Veterinarians should use infection control precautions to protect themselves, staff, clients, as well as other animal patients in the clinic, when treating animals with suspected MPX.
• Look out for symptoms such as a cough, history of fever, conjunctivitis, lack of appetite, respiratory signs, and rash.
• Practice proper hand hygiene after all contact with a sick animal and with contaminated surfaces.
• Use the complete personal protective equipment when examining animals with suspected monkeypox
• Handle used patient-care equipment in a manner that prevents contamination of skin and clothing
• Ensure that procedures are in place for cleaning and disinfecting contaminated environmental surfaces.
Pet owners/hunters/wildlife rangers are advised to:
• All suspected animals should be isolated and reported to the nearest veterinary authority
• All pet owners should observe personal hygiene practice such as the washing of hands with soap and water
• Control rodent
• Animals affected include monkeys, gorillas, rodents, and squirrel
• Anyone who has been exposed to monkeypox should avoid contact with animals’ particularly monkeys, rodents, and squirrel
• All animal healthcare providers should use personal protective equipment (PPE) during contact with an animal suspected to have monkeypox.
• Stop using non-human primates for animal shows
• Non-human primates (monkey, chimpanzee, and gorilla) should not be housed in the residential area.
Signs to look out for in monkeys and apes
• Pox lesions (rash and ulcers) over the entire body and mucosal surfaces (e.g., mouth) and can be seen on the face, limbs, palms, soles, and tail.
• In severe cases, coughing, nasal discharge, difficulty in breathing, swollen faces, and mouth ulcer.
About the NCDC
The Nigeria Centre for Disease Control is the country’s national public health institute, with the mandate to lead the preparedness, detection and response to infectious disease outbreaks and public health emergencies. The Bill for an Act to establish NCDC was signed into law in November 2018, by President Muhammadu Buhari. The mission for the NCDC (2017-2021) is ‘To protect the health of Nigerians through evidence-based prevention, integrated disease surveillance and response activities, using a One Health approach, guided by research and led by a skilled workforce’.
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Dr. Ifedayo Adetifa
DG, Nigeria Centre for Disease Control