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Keeping the monkey in the box

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ON THE RISE— Monkeypox

By May 20 2022, monkeypox was akin to wildfire as cases were, like an abnormal curve, rising and rising again.

To make matters worse, a disease which those in the west thought was the exclusive of Africa broke ‘artificial’ boundaries, with the United Arab Emirates (UAE) becoming the first Gulf state to record a case of monkeypox, which the World Health Organisation (WHO) describes as a viral zoonosis— that is, a virus transmitted to humans from animals— with symptoms very similar to those seen in the past in smallpox patients, although it is clinically less severe. The disease is caused by the monkeypox virus, which belongs to the orthopoxvirus genus of the Poxviridae family.

Apart from UAE, the Czech Republic and Slovenia registered their first cases on May 19 this year, joining 18 other countries that had, by then, detected the virus outside its usual African base.

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Outbreaks of the virus have been found in Europe, Australia and America.

The symptoms often include fever and rash—but the infection is usually mild.

In the UAE, health officials announced a case had been detected in a traveller who had been to West Africa.

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Just on Sunday this week, the Massachusetts Department of Public Health in the United States (US) announced two cases of monkeypox in two adult men who had close contact with one another.

It also indicated that initial testing was completed late Saturday at the State Public Health Laboratory in Jamaica Plain; with confirmatory testing entrusted in the hands of the US Centres for Disease Control and Prevention (CDC).

“Current data from CDC indicate that there have been 49 cases of monkeypox virus this year in US residents; this includes the first identified case in Massachusetts which was confirmed on May 18. There have been no deaths in the US or globally related to this outbreak and patients generally recover fully in two to four weeks. Although many of the early cases were associated with international travel, recent cases are not. Gay and bisexual men and other men who have sex with men make up a large proportion of the cases identified to date.

“However, anyone who has been in close contact with someone who has monkeypox is at risk. While the virus does not spread easily between people, people can spread the infection once they develop symptoms. Transmission occurs through direct contact with body fluids and monkeypox sores, by touching items that have been contaminated with fluids or sores (clothing, bedding, etc.), or less commonly, through respiratory droplets following prolonged face-to-face contact,” the department says in the statement.

According to US-based epidemiologist Catherine Brown, vigilance is key to defeating the disease.

“It is very important to be aware of the symptoms of monkeypox and to be vigilant. Individuals with concerning rashes should contact their healthcare provider,” she said.

It is a view which WHO shares.

“We encourage you all to increase the surveillance of monkeypox to see where transmission levels are and understand where it is going,” WHO’s Director for Global Infectious Hazard Preparedness, Sylvie Briand, said at a conference recently.

The outbreaks may not be normal but remain containable, she added.

Outside Africa, there are now 237 confirmed and suspected cases of monkeypox and health authorities around the world have announced plans to contain the virus.

Germany says it has ordered up to 40,000 doses of Imvanex vaccine – used to treat smallpox, but also effective against monkeypox – to be ready in case the outbreak worsens.

Anyone already vaccinated with a smallpox vaccine years ago as part of a global bid to eradicate the disease should have existing immunity, German health officials said. But they added that the older treatment has more side effects so is not suitable for fighting monkeypox today.

As efforts are being made in other countries to contain the outbreak, public health expert Maureen Chirwa said there is a need for the Ministry of Health in Malawi to raise public awareness on signs and symptoms of the disease.

“We have had several diseases we, as a country, have been handling lately and, through experience, we have had lessons learned.

“Of course, the country is responding very well to emerging diseases but, I think, we need to do more, in terms of awareness, so that people can be able to identify the disease,” she said.

Malawi Health Equity Network Executive Director George Jobe, while hailing the government for putting in place requisite measures in readiness for any outbreak, said there is a need for assurance that the country has medication for the disease to avoid panic when cases are detected.

“We are recommending that the government should have medication for the disease. It can have medication for, say, 100 people so that the country can ably treat any case that might be reported,” Jobe said.

The sentiments are being raised at a time there have been false alarms in Malawi.

This week, the Ministry of Health dispelled the notion that a monkeypox case in a human was registered in Chiradzulu District recently.

There were reports to the effect that Malawi’s monkeypox patient succumbed to the disease on Friday, June 10 2022.

Secretary for Health Charles Mwansambo said investigations health experts conducted indicated that the patient in question had Varicella disease— which affects the skin, brain, liver and lungs— and not necessarily monkeypox .

Mwansambo further indicated that the patient had not travelled outside the country; neither had he been in contact with any known case of monkeypox.

“Through the Public Health Reference Laboratory at the Community Health Sciences Unit in Lilongwe, the ministry will proceed to process samples from the case to guide the definitive diagnosis,” he said.

This, in effect, means Malawi has had a lucky escape— no one knows for how long.

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