THE World Health Organisation (WHO) has called on media not to use imagery and language that is stigmatising to key populations and Africans in their reportage on the ongoing monkeypox pandemic.
The call comes in the midst of media reports that seem to be apportioning blame in the rise of monkeypox infections to sexual activities linked to the LGBTI community. Initial monkeypox reports also carried images of black Africans with monkeypox even though the first case was reported in the United Kingdom in May 2020.
Speaking to Journalists during a virtual media dialogue that was organised by Internews, Dr Ottim Patrick Cossy Ramadan, and the World Health Organisation Health Emergency Officer said there was no monkeypox vaccine at the moment and this puts everyone at risk of getting the diseases.
Below are some of the take home nuggets from Dr Ramadan’s presentation on Monkeypox.
History of the Monkeypox
Monkyepox is a viral zoonotic disease because it originates from animals and it can be transmitted from animas to humans. It was first isolated in animals in the 1950S. The first documented human case was in 1970. The virus has been there largely in African mostly in the Tropical Rainforest in Central Africa and Western Africa. The diseases is characterised by fever, rash and have a range of illness. It can range from a mild asymptomatic disease to a very severe one where deaths can occur.
Monkeypox Infection Scenarios
For Monkeypox, we are looking at two scenarios of infection. There is the primary infection and this arises when we have the interaction between humans and animals. These can range from rodents as well as wild animals that have been identified to be reservoirs of the virus. Contact with these animals and contaminated animals products will result in initial infection or the primary infection. Once the person who has come into contact with a contaminated animal or animal product develops the symptoms, he is now infectious and is able to infect other humans.
Now we move onto Human to Human infection. This primarily occurs when we come into contact with a person who is sick especially when the rashes are there and there is the fluids coming from the rash, that result in secondary transmission. The more the person who is sick comes into contact with several other people, it amplifies infection. There are also a few documented cases of mother to fetus transmission of monkeypox. However, the mode of transmission is largely contact and this contact can be in different types of social settings where contact happens.
Monkeypox Symptoms
Incubation period: (15-21 days)
Monkeypox has an incubation period of Five (15) to 21 days. During this incubation period, the person has no symptoms. The person has been exposed and picked the virus at this stage but still there won’t be any symptoms to show.
Febrile Stage: (1-4 Days)
This is now the indication that the person is now starting the prodromal phase or the febrile phase. The person starts with high fever. The phase lasts between one (1) to four (4) days. Fever, swelling of the lymph nodes usually around the neck and also in the armpits. A person also experiences headache, chills sour throat, malaise, and fatigue. This phase is very difficult to differentiate because we have a number of clinical conditions such as Malaria, Typhoid and many more that present with these symptoms expect with the swelling of the lymph nodes which is not very common but it does occur with a number of things even infections.
Rash Stage (2-4 Weeks)
At this stage, the rash starts occurring. It starts from the mouth, face and then spreads to the other body. There are so many viruses that also cause rash but the brash of the Moneypox is different. One of the defining things to note is that you get rashes also on the soles of the feet and in the palms of the hands which is not common with the other types of rashes and viruses. This rash stage is the most infectious stage because of the fluids that come out of the rashes after it breaks and it contains a lot of viruses. This phase can last for two to four weeks with the person in that phase.
Recovery (Days to two weeks)
This is when the person start recuperating and the rashes and all symptoms start disappearing.
Transmission Pattern of the monkeypox
1.) Sporadic transmission: In Africa, we are seeing typically two distinct patterns of transmission: The first one is what we have had before where we have had sporadic transmission in remote areas and communities. This is because there is spill over from the wild or other rodents and animals that come in contact with the different communities and in some instances, people hunt for food in the wild and this is being seeing largely in the Congo, the Central Africa Republic, Cameroon and the Democratic Republic of Congo (DRC).
2.) Slow person to person transmission: There has been slow person to person transmission in rural and peri-urban areas. We have seen this mostly in West Africa in Nigeria and Ghana. We now want to understand better what is driving this slow human to human transmission. We have panned that there should be proper epidemiological investigations to be able to identify some of the drivers and factors behind this pattern of transmission.
Monkeypox Complications:
Should we be worried about monkeypox? Yes we should! Apart from the rash, monkeypox results in the infection of the glassy part of the eye what we call the Cornea which is very important for vision. Corneal infection can result in loss of vision. There are also secondary bacterial infections that may arise due to monkeypox. You have the body of a person being covered in wounds and bacteria can enter the body through any of the wounds. You also have Abscess and airway obstruction, pneumonia, bacterial infection of the blood (Sepsis), inflammation the brain (encephalitis), miscarriage, death.
Monekypox Vaccination
We know that the Monkeypox virus shares the genetic structure with the smallpox which was eradicated. The 2nd Generation and Third Generation smallpox vaccines may be effective against the monkeypox. One of them (MVA-BN) has been approved for prevention of monkeypox. However, doses are not readily available. Mass Vaccination is not recommended for monkeypox at this time. Targeted vaccination in the context of Pre-Exposure Prophylaxes for individuals at high risk and post exposure prophylaxes for contacts is highly recommended. In Africa at the moment despite us being the third in terms of the disease burden, we have not vaccinated any person in Africa. We are working with countries to get ready and to prepare to develop the necessary regulatory approval in the event that the vaccines become available.
