Everything you need to know about Mpox in Nigeria 2024

Mpox, commonly called monkeypox, is a viral infectious disease similar to smallpox, caused by an orthopoxvirus termed monkeypox virus (MPXV).

MPXV was first identified in 1959 in lab monkeys in Denmark. The virus has been endemic to central and west African regions, with the first human confirmed case in 1970: a 9-year-old child from the Democratic Republic of Congo. Over 40 years after the first case, several cases were recorded from Africa annually, with the number surpassing 10,000 in subsequent years.

Understanding Mpox in Nigeria

The first case of Mpox in Nigeria was recorded in 1971. No cases were recorded in Nigeria from 1978 until a case was confirmed by NCDC in Bayelsa State in 2017. In July 2022, WHO declared Mpox a public health emergency of international concern. Nigeria has reported multiple outbreaks of Mpox, with the most recent in August 2024. In 2023, Nigeria was one of the African countries with the highest number of reported Mpox cases.

As of November 17, 2024, 998 total confirmed cases of Mpox have been recorded by WHO in Nigeria, with 137 new cases in 2024. This disease has a fatality rate of up to 11%. The risk of infection is reported to be higher in people with reduced immunity: HIV-positive individuals, pregnant women, people with STIs, other disease conditions, and children. MPVX is confirmed through diagnostic lab testing using swabs/scabs, blood samples, and tissue samples via PCR tests, immunoassay tests, and tissue culture.

Mpox Symptoms

Mpox symptoms vary with the severity of the infection; they appear after an incubation period of 6–21 days. Cases of asymptomatic Mpox have also been recorded.

The symptoms include inflammatory skin bumps/papules, headache, fever, sore throat, fatigue, back pain, muscle aches, joint pain, and swollen lymph nodes. Mpox can also lead to complications, which include pneumonia, encephalitis, respiratory distress, myopericarditis, corneal infection resulting in loss of vision, and sepsis.

How Mpox Spreads

Mpox virus can be transmitted from animals to humans via bites or contact with an infected animal through routes such as body injury, mucus membranes in the nose or intestines, body fluids, or skin lesions. 

Subsequently, the virus can spread between humans via contact with infected persons through the same routes, commonly via sexual interactions.

Mpox Prevention and Control

Infection with this virus can be prevented and controlled through the following practices:

1. Getting vaccinated: Vaccination against smallpox has been proven to be 85% effective in preventing monkeypox. CDC recommends vaccination with two doses of JYNNEOS for people at risk of mpox to protect against small pox and Mpox. The vaccine is FDA-approved, and it’s expected to protect against all clades of mpox. The second dose is given 4 weeks after the first dose.
2. Avoid contact with sick animals, mostly wild mammals.
3. Avoid direct contact with infected species and any objects they have been in contact with.
4. Isolating infected animals and humans from other remaining populations.
5. Thoroughly cooking all animal products before consumption.
6. Good hygiene
7. Use of PPEs and implementation of standard infection control precautions by health workers.
8. Educating individuals about the disease and its prevention.
9. Safe, protected sex.

Seeking Medical Care for Mpox

Currently, no FDA-approved treatment for mpox has been documented. However, health practitioners manage the symptoms through:

1. Prescribing medications such as painkillers/analgesics and antihistamines.
2. Topical creams are also prescribed to reduce itching.

Other ways to manage the condition include taking oatmeal baths, staying hydrated, and maintaining good hygiene.

Latest Updates on Mpox in Nigeria

Globally, as of March 16, 2023, the WHO had reported 86,496 laboratory-confirmed cases of mpox and 111 deaths in 110 countries. Of the 1,420 cases of mpox reported in Africa as of March 16, 2023, Nigeria alone recorded 57.1% (812) of the confirmed cases and eight fatalities recorded in the continent.

In Nigeria, according to a situation report by the NCDC as of September 2024, 4997 suspected cases have been reported from 36 states and FCT, with 1164 confirmed cases (23.3%) from 35 states and FCT with seventeen (17) deaths. From September 2017 to date. According to UN news, Nigeria received 10,000 doses of the mpox vaccine in August 2024, making Nigeria the first African country to obtain MPVX vaccine.

NCDC’s Response to the Mpox Outbreak in Nigeria

Due to the 2017 monkeypox outbreak in Nigeria, the Nigeria Center for Disease Control (NCDC) created a surveillance Outbreak, Response, Management, and Analysis System, which helped in the timely detection and complete reporting of cases, and this resulted in improved prevention and control of the virus. During a press conference in August 2024, NCDC boss Dr. Jide Idris confirmed that 

1. The NCDC has intensified surveillance across Nigeria to swiftly detect and respond to new cases.
2. Port Health Service Officials have been put on high alert across all ports and borders in the country for the virus. Also, diagnostic tools have been distributed to these locations for screening of suspected cases.
3. Contact tracing and monitoring have also been established for confirmed cases to prevent further spread.
4. The organization will continue to provide healthcare workers and the public with updated guidance on Mpox infection prevention and control measures.
5. The public and private hospitals have been notified about the monkeypox, and a list of isolation/management centers across the six geopolitical zones and reference laboratory networks have been sent to them. These centers include the National Reference Lab (NRL), Central Public Health Laboratory (CPHL), Nigeria Institute of Medical Research (NIMR), Lagos University Teaching Hospital (LUTH), ACEGID, University of Nigeria Teaching Hospital (UNTH), and University of Port Harcourt Teaching Hospital (UPTH).

Addressing Mpox stigma and discrimination

Most individuals with Mpox recover completely with proper management of the condition; The only thing they are left with is a bit of scarring from the skin bumps. Monkeypox is usually a self-limited disease, and most conditions resolve in around 3-4 weeks after the onset of symptoms. Patients do not risk infecting others after all crusts are desquamate. Therefore, it’s pointless to stigmatize and discriminate against people that have been infected or are undergoing treatment for Mpox.

Educating individuals on the condition and training health workers on how to relate to and manage infected individuals will go a long way in reducing any form of stigma and discrimination regarding Mpox.

References

1. Centers for Disease Control and Prevention. (2023). Monkeypox: Information for healthcare professionals. https://www.cdc.gov/poxvirus/monkeypox/index.html 
2. Alakunle E, Moens U, Nchinda G, et al. Monkeypox virus in Nigeria: infection biology, epidemiology, and evolution. Viruses 2020;12:1257.
3. Ogoina D, Iroezindu M, James HI, et al. Clinical Course and Outcome of Human Monkeypox in Nigeria. Clin Infect Dis. 2020;71(8):e210-e214. doi:10.1093/cid/ciaa143.
4. https://thesun.ng/ncdc-confirms-39-monkeypox-cases-in-nigeria-2/?amp
5. Falcinelli SD, Chertow DS, Kindrachuk J. Integration of global analyses of host molecular responses with clinical data to evaluate pathogenesis and advance therapies for emerging and reemerging viral infections. ACS Infect Dis. 2016; 2, 787-79.

The article was curated by Aisha Ahmad, a Clinical Physiologist at Federal Teaching Hospital Katsina. You can contact Aisha via her social media handles LinkedIn, Instagram and Facebook.