By Mary Hearty

With the emerging reported cases of monkeypox even in non-endemic countries, the World Health Organization (WHO) has urged the public to be on the alert for signals related to patients presenting with symptoms of the disease which include an abnormal rash that progresses in sequential stages over all affected areas of the body, that may be associated with fever, enlarged lymph nodes, back pain and muscle aches.

According to the health organization, these individuals could possibly present to various community and healthcare settings including but not limited to primary care, fever clinics, sexual health services, infectious disease units, obstetrics and gynecology, urology, emergency departments and dermatology clinics.

Therefore, increasing awareness among potentially affected communities, as well as health care providers and laboratory workers, is essential for identifying and preventing further secondary cases and effective management of the current outbreak, WHO notes.

The countries that are not endemic for the monkeypox virus but are having reported cases include: Germany, Italy, Netherlands, Portugal, Spain, Sweden, United Kingdom and United States of America.

Whereas, endemic countries in Africa that have reported cases of monkeypox are: Cameroon (where it was first detected on 15 December, 2021) 25 cases, Central African Republic 6 cases, Democratic Republic of Congo 1238 cases and Nigeria 46 cases.

Other endemic countries in Africa that have not yet reported human cases are: Benin, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Republic of the Congo, Sierra Leone, and South Sudan.

According to WHO, endemic monkeypox disease is normally geographically limited to West and Central Africa. The identification of confirmed and suspected cases of monkeypox without any travel history to an endemic area in multiple countries is atypical.

Consequently, this poses a great concern to other endemic and non-endemic African countries as WHO predicts that more cases of the zoonotic virus will be reported as surveillance expands in those regions.

“There is an urgent need to raise awareness about monkeypox and undertake comprehensive case finding and isolation (provided with supportive care), contact tracing and supportive care to limit further onward transmission,” WHO emphasizes.

Endemic monkeypox is a zoonosis virus transmitted to humans from animals, has very similar symptoms to those seen in smallpox patients, although it is clinically less severe.

The virus is transmitted from one person to another by close contact with lesions, fluids, respiratory droplets and contaminated materials such as bedding.

The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days; and eating inadequately cooked meat and other animal products of infected animals is considered a possible risk factor.

Although, WHO notes that monkeypox is usually self-limiting but may be severe in some individuals, such as children, pregnant women or persons with immune suppression due to other health conditions.

At the moment, further public health investigations are ongoing in non-endemic countries that have identified cases, including extensive case finding and contact tracing, laboratory investigation, clinical management and isolation provided with supportive care.

Any patient with suspected monkeypox, WHO notes that they should be investigated and if confirmed, isolated until their lesions have crusted, the scab has fallen off and a fresh layer of skin has formed underneath.

Also, WHO states genomic sequencing, where available, have been undertaken to determine the monkeypox virus clade in this outbreak, noting that human infections with the West African clade appear to cause less severe disease compared to the Congo Basin clade, with a case fatality rate of 3.6% compared to 10.6% for the Congo Basin clade.

Vaccination for monkeypox, where available, is also being deployed to manage close contacts, such as health workers. WHO calls for experts to discuss recommendations on vaccination.