MONKEY POX VIRUS HITS BAYELSA STATE | ALL YOU SHOULD KNOW ABOUT THE MONKEY POX VIRUS

It's in the news that a deadly virus is currently spreading fast, and the general public have been asked to stay alert. As the virus is reported to have infected about 10 person's in Bayelsa State.

It was gathered that a medical doctor and 10 persons, who came down with the monkey pox had been quarantined in an isolation centre created at the Niger Delta University Teaching Hospital (NDUTH) Okolobiri, Yenagoa Local Government Area.

The isolation centre was reportedly created by the Nigerian Centre for Disease Control (NCDC) and the epidemiological team of the state's Ministry of Health to stop the spread of the virus.

Monkey pox is similar to smallpox but milder. symptoms include headache, fever, swollen lymph nodes, tiredness, backache and chills. After about 3 days, the patient develop rashes starting from the face to other part of the body....

The state Commissioner for Health Prof. Ebitimitula Etebu, who confirmed the development said samples of the virus had been sent to the World Health Organisation Laboratory in Dakar, Senegal for confirmation.

He described monkey pox as a viral illness caused by a group of viruses that include chicken pox and small pox, adding that the first case was noticed in the Democratic Republic of Congo and subsequently it had outbreaks in West African region.

Explaining that the virus has the Central African and the West African types, the commissioner said the West African type is milder and has no records of mortality.

"Recently in Bayelsa State we noticed a suspected outbreak of monkey pox. It has not been confirmed. We have sent samples to the World Health Organisation (WHO) reference laboratory in Dakar, Senegal. When that comes out we will be sure that it is confirmed. But from all indications, it points towards it", he said.

He said as the name implied, the virus was first seen in monkey, but could also be found in all bush animals such as rats, squirrels and antelopes.

He said: "The source is usually all animals. It was first seen in monkeys and that is why it is called monkey pox. But every bush animals like rats, squirrels, antelopes are involved. So, the secretions from particularly dead animals are highly contagious

Etebu listed the symptoms of monkey pox severe headache, fever, back pains amongst other symptoms adding that most worrisome of all the signs were rashes bigger than those caused by chicken pox.

He said the rashes are usually frightening and usually spread to the whole body of an infected persons.

On Bayelsa case, he said: "We noticed the first index case from Agbura where somebody was purported to have killed and eaten a monkey and after that the people who are neighbours and families started developing these rashes.

"We have seen cases from as far as Biseni. We invited the Nigerian Centre for Disease Control together with our own epidemiological team from the Bayelsa Ministry of Health. We have been able to trace most of the people who have come in contact with the patients.

"I think so far we have 10 patients and we have created an isolation centre at the NDUTH and most of them are on admission and we are following up the 49 cases that we are suspecting might come down with the illness. As a state we are taking car of all the expenses of all the isolated cases.

"The disease has an incubation period and it is also self-limiting in the sense that within two to four weeks, you get healed and it confers you with immunity for life.

"We have mobilised virtually every arsenal at our disposal in terms of sensitizing the general public and making them aware by radio programmes, jingles and fliers. So the Nigerian Centre for Disease Control has mobilised fully to Bayelsa state. We are on top the situation.

"The only thing I will tell the general public is to observe hand hygiene and ensure they don't come in contact with dead animals, their secretions. The disease is airborne too. So when you come down with it is very infectious.

"People should wash their hands whenever they go in or come out of their houses. If they come in touch with animals, they should ensure that they wash their hands. They should be very vigilant. People should report any similar cases.

"A lot of people have come down with the symptoms but they are hiding in their houses. If they hide, there is the propensity for the infection to spread.

"It is better to quarantine them and treat so that we can interrupt the spread of the disease. People should be calm and they shouldn't get frightened. The state has distributed personal protective equipment to workers and they are using it".

All you should know about the Virus! 

Monkeypox is a rare viral zoonosis (a virus transmitted to humans from animals) with symptoms in humans similar to those seen in the past in smallpox patients, although less severe. Smallpox was eradicated in 1980.However, monkeypox still occurs sporadically in some parts of Africa.

Monkeypox is a member of the Orthopoxvirus genus in the family Poxviridae.

The virus was first identified in the State Serum Institute in Copenhagen, Denmark, in 1958 during an investigation into a pox-like disease among monkeys.

Outbreaks

Human monkeypox was first identified in humans in 1970 in the Democratic Republic of Congo (then known as Zaire) in a 9 year old boy in a region where smallpox had been eliminated in 1968. Since then, the majority of cases have been reported in rural, rainforest regions of the Congo Basin and western Africa, particularly in the Democratic Republic of Congo, where it is considered to be endemic. In 1996-97, a major outbreak occurred in the Democratic Republic of Congo.

In the spring of 2003, monkeypox cases were confirmed in the Midwest of the United States of America, marking the first reported occurrence of the disease outside of the African continent. Most of the patients had had close contact with pet prairie dogs.

In 2005, a monkeypox outbreak occurred in Unity, Sudan and sporadic cases have been reported from other parts of Africa. In 2009, an outreach campaign among refugees from the Democratic Republic of Congo into the Republic of Congo identified and confirmed two cases of monkeypox. Between August and October 2016, a monkeypox outbreak in the Central African Republic was contained with 26 cases and two deaths.

Transmission

Infection of index cases results from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. In Africa human infections have been documented through the handling of infected monkeys, Gambian giant rats and squirrels, with rodents being the major reservoir of the virus. Eating inadequately cooked meat of infected animals is a possible risk factor.

Secondary, or human-to-human, transmission can result from close contact with infected respiratory tract secretions, skin lesions of an infected person or objects recently contaminated by patient fluids or lesion materials. Transmission occurs primarily via droplet respiratory particles usually requiring prolonged face-to-face contact, which puts household members of active cases at greater risk of infection. Transmission can also occur by inoculation or via the placenta (congenital monkeypox). There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population.

In recent animal studies of the prairie dog-human monkeypox model, two distinct clades of the virus were identified – the Congo Basin and the West African clades – with the former found to be more virulent.

Signs and symptoms

The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 16 days but can range from 5 to 21 days.

The infection can be divided into two periods:

the invasion period (0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle ache) and an intense asthenia (lack of energy);

the skin eruption period (within 1-3 days after appearance of fever) where the various stages of the rash appears, often beginning on the face and then spreading elsewhere on the body. The face (in 95% of cases), and palms of the hands and soles of the feet (75%) are most affected. Evolution of the rash from maculopapules (lesions with a flat bases) to vesicles (small fluid-filled blisters), pustules, followed by crusts occurs in approximately 10 days. Three weeks might be necessary before the complete disappearance of the crusts.

The number of the lesions varies from a few to several thousand, affecting oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (eyelid) (20%), as well as the cornea (eyeball).

Some patients develop severe lymphadenopathy (swollen lymph nodes) before the appearance of the rash, which is a distinctive feature of monkeypox compared to other similar diseases.

Monkeypox is usually a self-limited disease with the symptoms lasting from 14 to 21 days. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and severity of complications.

People living in or near the forested areas may have indirect or low-level exposure to infected animals, possibly leading to subclinical (asymptomatic) infection.

The case fatality has varied widely between epidemics but has been less than 10% in documented events, mostly among young children. In general, younger age-groups appear to be more susceptible to monkeypox.

Diagnosis

The differential diagnoses that must be considered include other rash illnesses, such as, smallpox, chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish it from smallpox.

Monkeypox can only be diagnosed definitively in the laboratory where the virus can be identified by a number of different tests:

enzyme-linked immunosorbent assay (ELISA)

antigen detection tests

polymerase chain reaction (PCR) assay

virus isolation by cell culture

Treatment and vaccine

There are no specific treatments or vaccines available for monkeypox infection, but outbreaks can be controlled. Vaccination against smallpox has been proven to be 85% effective in preventing monkeypox in the past but the vaccine is no longer available to the general public after it was discontinued following global smallpox eradication. Nevertheless, prior smallpox vaccination will likely result in a milder disease course.

Natural host of monkeypox virus

In Africa, monkeypox infection has been found in many animal species: rope squirrels, tree squirrels, Gambian rats, striped mice, dormice and primates. Doubts persist on the natural history of the virus and further studies are needed to identify the exact reservoir of the monkeypox virus and how it is maintained in nature.

In the USA, the virus is thought to have been transmitted from African animals to a number of susceptible non-African species (like prairie dogs) with which they were co-housed.

Prevention

Preventing monkeypox expansion through restrictions on animal trade

Restricting or banning the movement of small African mammals and monkeys may be effective in slowing the expansion of the virus outside Africa.

Captive animals should not be inoculated against smallpox. Instead, potentially infected animals should be isolated from other animals and placed into immediate quarantine. Any animals that might have come into contact with an infected animal should be quarantined, handled with standard precautions and observed for monkeypox symptoms for 30 days.

Reducing the risk of infection in people

During human monkeypox outbreaks, close contact with other patients is the most significant risk factor for monkeypox virus infection. In the absence of specific treatment or vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus. Surveillance measures and rapid identification of new cases is critical for outbreak containment.

Public health educational messages should focus on the following risks:

Reducing the risk of human-to-human transmission. Close physical contact with monkeypox infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.

Reducing the risk of animal-to-human transmission. Efforts to prevent transmission in endemic regions should focus on thoroughly cooking all animal products (blood, meat) before eating. Gloves and other appropriate protective clothing should be worn while handling sick animals or their infected tissues, and during slaughtering procedures.

Controlling infection in health-care settings

Health-care workers caring for patients with suspected or confirmed monkeypox virus infection, or handling specimens from them, should implement standard infection control precautions.

Healthcare workers and those treating or exposed to patients with monkeypox or their samples should consider being immunized against smallpox via their national health authorities. Older smallpox vaccines should not be administered to people with comprised immune systems.

Samples taken from people and animals with suspected monkeypox virus infection should be handled by trained staff working in suitably equipped laboratories.

Key facts

Monkeypox is a rare disease that occurs primarily in remote parts of Central and West Africa, near tropical rainforests.

The monkeypox virus can cause a fatal illness in humans and, although it is similar to human smallpox which has been eradicated, it is much milder.

The monkeypox virus is transmitted to people from various wild animals but has limited secondary spread through human-to-human transmission.

Typically, case fatality in monkeypox outbreaks has been between 1% and 10%, with most deaths occurring in younger age groups.

There is no treatment or vaccine available although prior smallpox vaccination was