Historical Review

Monkeypox is a viral zoonotic infectious disease that is transmitted from animals to humans. It occurs sporadically, especially in remote areas in most central and west African countries near tropical rainforests. Monkeypox occurs when a person comes in contact with the virus from another person, animal, or contaminated material.

Being a global pandemic, Nigeria is one of the countries in Africa where the monkeypox disease has become endemic.

After experiencing its first and second monkeypox incidents in 1971 and 1978, Nigeria experienced another outbreak between September 2017 till December 2019 where over 176 confirmed cases and 9 deaths were recorded from 18 states.

So far in the year 2022, 478 suspected cases with 175 confirmed cases and 5 deaths have been recorded.

Overall, since the re-emergence of monkeypox in September 2017, 990 suspected cases have been reported from 35 states in the country. Of these 985 suspected cases, 403 (40.4%) were confirmed from 30 states. Thirteen (12) deaths have been recorded since September 2017 in nine states.

Monkeypox in Africa and the Rest of the World

As of 9^th August 2022, there have been 31,799 confirmed cases of monkeypox reported from more than 83 countries globally, especially from countries with no historical record of monkeypox. These countries are mainly in Europe (17,850/31,799; 56%) and America (13,438/31,799; 42%) regions. Other regions reporting cases include the African Region (381/31799, 1.2%). (See table)

The World Health Organization (WHO) on 23^rd July 2022 declared the present multi-country outbreak of monkeypox a public emergency. It also highlighted the risk of further international spread, although the risk of interference with migration remains relatively low at the moment.

In Africa, two new Africa Union (AU) Member States (Liberia and Sudan) reported confirmed cases. A total of 896 new cases (65 confirmed and 846 suspected) and 28 new deaths of monkeypox have been reported from Cameroon, the Democratic Republic of Congo (DRC) Ghana, Liberia, Nigeria, and Sudan. Cumulatively, 2,927 cases (2,627 suspected cases and 381 confirmed cases) with 104 deaths (CFR: 3.6%)

Liberia: On 25^th July 2022, the National Public Health Institute of Liberia (NPHIL) reported 2 confirmed cases of Monkeypox in Maryland county of the country.

Sudan: On 28 July 2022, the Sudan Federal Ministry of Health (MoH) reported the first case of monkeypox in West Darfur State, Sudan. The initial case was a 16-year-old student whose sample tested positive at the National Institute of Public Health, Stak West Darfur. The African CDC has engaged Sudan’s Minister of Health for more information on this event.

It is important to note that majority of African reporting cases are from the Central and Western African regions with Nigeria and DRC accounting for 84% of all confirmed cases reported. The majority of the cases were reported between the months of June and July 2022.

In developed countries such as the United States of America (9,491), The United Kingdom (2,914), The Netherlands (959), Germany (2,982), Spain (5,162 with 2 deaths), France (2,423), Belgium (546), Portugal (710), Italy (599), Austria (175), Denmark (126), Israel (166), Sweden (123), and Switzerland (347) have all recorded over One Hundred (100) cases of monkeypox.

In comparison to selected developed countries, Nigeria, with its high population, has a low monkeypox incidence rate when compared to selected developed countries of the world with lower populations.

Although monkeypox is generally known to have been transmitted from animals to humans especially when there is contact with an infected fluid; in developed countries such as The United Kingdom and the United States of America, some cases have been identified through sex, especially among homosexual and bisexual individuals.

It is important to understand that the transmission of monkeypox does not necessarily limit itself to men who engage in homosexual acts, but also to anyone who has had close contact with a person who is infectious.

How Can Monkeypox be Avoided/Prevented?

Monkeypox can be avoided or prevented by:

• Limiting close contact with people who have suspected or confirmed cases of monkeypox, or infected animals.
• Cleaning and disinfecting the surrounding environment for contaminated fluids
• Regularly keeping one updated about the status of the disease in one’s local area
• Stop eating bush meats, especially monkeys and Gambian bush rat
• Use protection during sexual intercourse (especially men having sex with other men)

How to Protect Others from Monkeypox if Infected

Depending on how serious the symptoms are, it is important to seek medical advice on how one needs to be catered to once they are infected with the virus. If there is a need to isolate at home, do not go out. Protecting others from contracting the virus should be a possibility by:

• Isolating in a separate room
• Using a separate bathroom, or cleaning the bathroom after each use
• Cleaning frequently touched surfaces with soap and water and/or a household disinfectant and avoiding sweeping/vacuuming (this might disturb virus particles and cause others to become infected)
• Using separate utensils, towels, bedding, and electronics
• Doing your own laundry (lift bedding, clothes, and towels carefully without shaking them, put materials in a plastic bag before carrying it to the washing machine, and wash them with hot water > 60℃)
• Opening windows for good ventilation
• Encouraging everyone in the house to wash their hands regularly with soap and water or an alcohol-based hand sanitizer.