Nigeria’s dysfunctional and underfunded health care system is on trial once again. After the recovery from the recent outbreaks of Lassa fever and meningitis that claimed hundreds of lives, the country is facing another public health challenge in an outbreak of monkeypox.
While meningitis and Lassa fever are two familiar diseases that the country deals with seasonally, monkeypox poses a different type of challenge altogether because of its relative novelty in this part of the world and the lack of sufficient knowledge about it. For example, the World Health Organisation says, “Doubts persist on the natural history of the virus and further studies are needed to identify the exact reservoir of monkeypox virus and how it is maintained in nature.” But Nigeria has to come up with a robust response to contain the disease.
Monkeypox, the outbreak of which was first reported in Bayelsa State, is described as a rare viral zoonotic disease – an infectious disease that spreads between animals and humans – with symptoms in humans similar to those seen in the past in smallpox patients, although in a milder form. Just like the Ebola Virus Disease, a deadly viral infection that invaded Nigeria and most parts of West Africa three years ago, the origin of monkeypox has been traced to the Democratic Republic of Congo, where human infection was first identified in 1970. Since then, cases have been reported in remote villages of West Africa and essentially in the Congo Basin.
Like a typical viral infection, it has no known cure; neither has any vaccines been developed for it. Though the vaccines used for smallpox are known to have about 85 per cent efficacy in monkeypox, these vaccines are no longer under production since smallpox was pronounced eradicated by the World Health Assembly on May 8, 1980. This makes adoption of preventive measures a matter of utmost importance. Fortunately, it has been described as a self-limited disease, with the symptoms lasting from 14 to 21 days. The evolution of the rash from lesions to fluid-filled blisters followed by crusts occurs in 10 days. It takes about three weeks for the crusts to completely disappear, says WHO.
To effectively combat monkeypox, it is necessary to understand the nature of the disease. It is defined by the appearance of rash all over the body of the patient, often starting from the face and then spreading down to other parts of the body. It affects mostly the face, palms of the hand and soles of the feet. Although called monkeypox, transmission from animal to man is not limited to monkeys, but also occurs from the handling of other infected animals such as the Gambian giant rats, striped mice, prairie dog (in the United States), rodents and squirrels, etc.
The human-to-human or secondary transmission, according to WHO, results from direct contact with infected respiratory track secretions, skin lesions of an infected person or objects recently contaminated by patient’s fluids or lesion materials. Transmission also occurs via droplet respiratory particles requiring prolonged face-to-face contact, thus putting household members of active cases at greater risks of infection.
It is generally believed that, unlike smallpox, a deadly disease that is credited with a fatality rate sometimes higher than 30 per cent, the fatality rate of monkeypox could be as low as one per cent, and as high as 10 per cent. However, in an outbreak reported in the Republic of Congo between January and March this year, seven people died out of 19 cases, an alarming 36.84 per cent fatality rate.
Since it was first reported in Bayelsa about two weeks ago, the disease has since spread to seven states so far, according to the Nigerian Centre for Disease Control, bringing the number of suspected cases as of Tuesday to 31. This has been made possible because of the movement of people from one part of the country to another. It will therefore not be out of place to advise people to limit their movements to those that are absolutely necessary.
At this stage, what is very important is enlightenment of the citizenry by the appropriate health authorities. Efforts should be made to isolate any patient identified with monkeypox to limit the spread, which could come from close contact with people. Nigerians should be told that it is dangerous to keep patients with symptoms at home. High level of personal hygiene is also recommended for everybody. Simple things such as the frequent washing of hands with soap should not be discounted. The US Centres for Disease Control and Prevention says washing of hands should be mostly with clean, running water. It is also important to note that, if people must eat bush meat, it has to be properly cooked.
Besides, just like in the case of Ebola, health workers are advised to always wear their protective gear while dealing with patients or handling samples from the patients. WHO advises that such workers should consider being immunised against smallpox. On the part of the government, the level of surveillance should be stepped up and whenever any case is identified, efforts should be made to ensure that possible contacts with the patient is traced and monitored.
Beyond the preventive measures, the issue of the absence of vaccines for diseases such as monkeypox is a challenge that should be taken up by Nigerian scientists and researchers. It is unfortunate that, just as was the case with the outbreak of Ebola, the country has to wait for foreigners to develop vaccines for tropical diseases such as meningitis, Lassa fever and others that periodically cause thousands of avoidable deaths within the country and beyond. Government and private organisations have to step up efforts in the funding of research and the different research institutes in the country should be revitalised to be able to serve the people better.
