Monkeypox can spread everywhere, if neglected

New article published in the magazine Sciences by Nigerian scholars provides perspective on the consequences of neglecting a disease, anywhere, such as monkeypox. As an orthopoxvirus, monkeypox virus (MPV) causes monkeypox (MPX), a zoonotic disease spread by some animals and humans.

MPXV was discovered in 1958 during an outbreak at an animal facility in Copenhagen, Denmark. The first human cases were found in the Democratic Republic of the Congo (DRC) in 1970. This disease is now endemic to Africa and spreads mainly from animal reservoirs, although occasionally human-to-human transmission has been documented.

Prior to the 2022 outbreak, human cases of MPV were first reported in the United States (US) in 2003. The spread occurred from prairie dogs infected with rodents imported from Ghana. MPX injuries have also been reported in Singapore and Israel. However, all infections were self-limiting and did not lead to a large-scale outbreak.

In early May 2022, a British resident who had traveled to Lagos and Delta State in Nigeria, where monkeypox is considered endemic, was reported to have monkeypox. After a rash appeared in Nigeria on 29 April, the individual returned home to the UK on 4 May. During the second half of May 2022, more cases were reported in countries outside the endemic area. Portugal reported 14 cases of monkeypox on May 18. The Spanish government has confirmed seven cases as of May 18. The United States confirmed its first case of monkeypox in 2022 on the same day, while Canada reported 13 suspected cases. As a result of human-to-human transmission, MPX has become prevalent in many non-endemic countries. More than 61,000 cases of monkeypox have been confirmed in 104 so far non-endemic countries under the current outbreak. The majority of these cases have been reported in adult males aged 38 and over. It was estimated that the world monkeypox outbreak in 2022 had a reproductive number of 1.29 during the initial stage.

Monkeypox virus has two gene clades – Clyde I (formerly called the Congo Basin clade) and Clyde II (formerly the West African clade). Clade II is classified into two subcategories – IIa and IIb. Clade I causes a severe form of the disease with a fatality rate of 10% (CFR). Since its first discovery in Africa, MPV infection has been documented in several other African countries.

Since 2022, human infections with MPX have been reported in many non-endemic countries such as Australia, Asia, Europe, America, Ghana, Benin and South Africa. Infection is mainly caused by Clade II of MPV, which is made more transmissible due to 50 single nucleotide polymorphisms (SNPs).

More extensive epidemiological studies are warranted to better understand animal reservoirs of MPV and to better control the disease. Evidence indicates that the epidemiological aspects of human MPV infection in Africa have changed over the past three decades.

Recently, Clade I infections and deaths are increasing in the Democratic Republic of the Congo, raising concern about its magnitude and frequency. However, only about 10% of cases have been clinically confirmed. Hence, the actual burden of disease remains elusive. Nigeria has faced a similar situation since its resurgence in 2017 – with the spread of Clade II.

There is disparity in the provision of attention and participation in prevention and treatment strategies in African and non-African countries. The apparent selective attention given to non-African countries despite the long-standing and persistent human transfusions of human MPV in Africa highlights global inequalities in health care access and awareness. Furthermore, engagements regarding insufficient preventive, investigative and therapeutic research are also evident in the previous response to the MPV outbreak in Africa.

In order to reduce MPV infection in endemic areas and prevent its spread elsewhere, a collaborative effort is warranted—aiming to develop a global plan to identify MPV reservoirs and their hosts, to better understand the epidemiology and transmissibility of the virus, and to develop at an affordable price. Vaccines and medicines. Endemic countries should be supported by providing adequate infrastructure. Efforts should also be directed towards educating the public and communities about the disease and creating appropriate awareness regarding individual roles in preventing the spread of the virus.

The spread of MPV is a reminder that infectious diseases cannot be isolated in one region or country, and defensive measures must be taken to protect everyone, regardless of their regional differences. This calls for a collaborative effort by all countries to find solutions at national levels through appropriate use of resources. In addition, endemic areas must also deploy strategies to appropriately use their resources for disease mitigation – to control disease independently and contribute to global disease control.