Introduction to Monkeypox: An Emerging Global Concern
Africa has produced a fair share of devastating diseases; however, the African community has been reported to be resilient to pandemics due to harsh weather, herd immunity, and repeated exposure to infectious organisms that stimulate the immune system (Frazzoli et al., 2023). Common diseases with similar symptoms to some pandemics have resulted in people being misdiagnosed or not going in for a checkup until it is too late; the most common are malaria and COVID-19, which share symptoms such as fever, breathing difficulties, tiredness, and acute-onset headache (Hassan et al., 2020).
Monkeypox is a viral disease caused by an orthopoxvirus that causes isolated cases of a human disease in Africa that resembles smallpox. According to the Centres for Disease Control and Prevention, the monkeypox virus (MPXV) belongs to the same virus family as smallpox. USA Today (2024) reports that the virus was first identified in 1958 and given the name monkeypox, not because infections are spread by monkeys, but because it was first found in that particular animal. However, in recent years, it has been renamed “mpox” to avoid the stigma associated with monkeys.
There are two types of mpox, according to the European Centre for Disease Prevention and Control (2024): Clade I, which is endemic in Central Africa and has subclades Ia and Ib, and Clade II, which is endemic in West Africa and has subclades IIa and IIb. Since the WHO classified mpox as a PHEIC (Public Health Emergency of International Concern) in 2022 due to the worldwide outbreak, the disease has posed a serious threat to Africa. As of 2024, 15 countries had confirmed cases of mpox, with 32 deaths reported. The Democratic Republic of the Congo (n = 5,610), Burundi (n = 853), and Nigeria (n = 78) have accounted for the majority of these cases. However, because some African countries lack the diagnostic capacity to test for mpox, a sizable number of suspected cases go untested and are never confirmed.
Know How It Spreads, Recognize the Signs
Masirika et al. (2024) describe two classic routes of mpox virus transmission. The primary route of transmission is through being bitten by or cooking infected animals such as rodents, giant pouched rats, small mammals (such as sun and rope squirrels), and primates (such as monkeys), all of which have been linked to Clade I viruses on multiple occasions. Clade I mpox has minimal human-to-human spread, though the zoonotic reservoir of MPXV is unknown (Moore et al., 2023).
In contrast to earlier outbreaks, the current Mpox epidemic displays distinct features, with direct human contact serving as the mode of Mpox virus transmission (Gao et al., 2024). Clade IIb (the clade that caused the global mpox outbreak in 2022) is linked to human-to-human transmission, and there have also been cases of sexual contact leading to genital and anorectal lesions, which usually follow lesions at the site of infection (Masirika et al., 2024). However, nonsexual human-to-human transmission of Clade I mpox virus has been documented.
Similar to smallpox, the mpox virus typically has an asymptomatic incubation period of 5–21 days. Following this, a number of symptoms may manifest, such as fever, rash, sore throat, lymphadenopathy, secondary bacterial infections, respiratory distress, bronchopneumonia, gastrointestinal involvement, dehydration, sepsis, and corneal infection that could result in blindness (Ogunleye et al., 2024).
The most typical prodromal symptom is fever and rash, which is characterised by skin lesions at various sites (face, torso, arms, legs, genitals, scalp, palms, soles of feet, mouth, and eyes) and a body temperature ranging from 101.3 to 104.9 °F. According to Wang and Lun (2023), fever was the earliest symptom in the study of cases of monkeypox in the Congo; however, in the clinical review of cases of monkeypox in Nigeria, 65.7% of the patients had a rash as their initial symptom, and 34.3% had a fever. Research has shown that the manner in which a person was exposed influences both illness progression and symptom onset.
Transmission can be avoided by thoroughly cleaning and disinfecting surfaces, as well as by washing your hands after handling potentially contaminated objects. Avoiding unprotected contact with wild animals, especially those that are ill or dead, including their meat and blood, can lower your chance of contracting mpox from animals. Any food containing meat or animal parts should be cooked completely before consumption in areas where animals are infected with the virus (Travers & UN News, 2024).
Monkeypox: A New Challenge to Africa’s Smallpox Victory
Monkeypox and smallpox symptoms are very similar and difficult to distinguish because of the similar prodromal period and rash distribution. So far, the enlarged lymph nodes associated with monkeypox are a key distinguishing feature between the two. Nonetheless, the World Health Organisation has identified the following illnesses as needing to be distinguished from monkeypox: syphilis, bacterial dermatosis, measles, smallpox, and severe chickenpox (Tarín-Vicente et al., 2022).
There are still gaps in our knowledge of the natural history, dynamics of transmission, and risk factors of mpox in Africa. In particular, the extent of clade I and II mpox sexual transmission in Africa, the ways in which it manifests itself differently from classical mpox, the interaction between zoonotic and human-to-human transmissions, and the function of co-infections (Kuppalli et al., 2024).
Fortunately, current vaccinations and antiviral drugs can effectively stop the virus from spreading and, in most cases, reduce its severity, so Mpox is unlikely to be the next pandemic, also known as Disease X. The majority of mpox cases resolve on their own within a few weeks of supportive care, but antiviral therapy, such as Tecovirimat (TPOXX), can alleviate the severity of symptoms; Jynneos is the most effective vaccine available for preventing mpox infection (Fernandes, 2024). In all affected African countries, where over 10 million doses are estimated to be needed, medical countermeasures like vaccines and therapeutics are still lacking, according to Kuppalli et al. (2024). The continent’s supply of these doses is limited to 2.6–3.6 million, mostly from global donations.
In any case, the Centres for Disease Control and Prevention (2024) report that bilateral health funds have been allocated to support Mpox responses in mostly infected areas of Central and Eastern Africa, with the U.S. government being the largest global health donor. More than $2.65 billion in bilateral health funding was allocated in the fiscal year 2023 alone. Since March 2024, the CDC and USAID have jointly contributed an additional $20 million USD to support the response to the clade I mpox pandemic in Central and Eastern Africa. These interventions will be crucial to controlling the outbreak and reaching the 10 million dose target by 2025, along with increasing testing, vaccination, availability of trained personnel, and surveillance.
References
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Centers for Disease Control and Prevention (CDC). (2024). FACT SHEET: United states response to the clade I mpox outbreak in several african countries. CDC Newsroom. https://www.cdc.gov/media/releases/2024/s0822-mpox-outbreak.html
European Centre for Disease Prevention and Control. (2024). Risk assessment for the EU/EEA of the mpox epidemic caused by monkeypox virus clade I in affected african countries. Rapid Risk Assessment. https://doi.org/10.2900/087147
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