Mitigating the Impact of Infectious Diseases:

Addressing the Monkeypox (Mpox) Outbreak

By

Dr. Vivian Nguyan Shaahu

Senior Lecturer & Consultant Community/Public Health Physician

College of Health Sciences, Benue State University/Benue State
University Teaching Hospital, Makurdi

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 Monkeypox
Prevention and
Control

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 OUTLINE
• Introduction
• Epidemiology (distribution in terms of
time, person and place)
• Transmission
• Clinical features
• Treatment
• Strategies for effective prevention and
control of Mpox and other infectious
diseases Credit: Am J Trop Med Hyg./ Reynolds et al.,

• Activities of the Benue State Public 2013

Health Emergency Operations Center

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 INTRODUCTIO
N  An infectious, zoonotic disease
caused by the Mpox virus
 Characterized by a severe rash
 Typically self-limiting, but can
lead to severe illness or death
 Death occurs in about 11% of
cases, mostly in younger age
group
 Mpox virus is a species of the
genus Orthopoxvirus in the
family Poxviridae (as cowpox &
smallpox)
 Waning immunity to smallpox
Credit: WHO/ M. V.
Szczeniowski
(eradicated in 1980 and
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 INTRODUCTION: Mpox Virus
Characteristics
 Distinct subtypes in two clades:
 Central African clade, prevalent
in Central African Republic, the
DRC and other countries
 virus in this clade causes more
severe illness and case fatality
up to 11%
 West African clade, found in
Nigeria, Côte d’Ivoire, Liberia
and Sierra Leone
Credit: The Centers for Disease Control
 causes less human-to-human
and Prevention (CDC), USA
transmission, less severe illness,
and death in up to 6% of cases
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 EPIDEMIOLOGY (I)

 First identified as an illness

of non-human primates. The
virus is also found in rodents
 In humans, was first
identified in 1970 in the
Democratic Republic of
Congo (DRC)
 DRC routinely reports a high
number of cases: more
than 1,000 suspected cases
Credit: Exp Anim / C. Milhaud, et al.,
1969 per year since 2005
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 EPIDEMIOLGY (ii)

 Since 2016,
human Mpox
confirmed in:
 Central African
Republic
 Democratic
Republic of
Congo
 Liberia
 Nigeria
 Republic of the
Congo
(Brazzaville)
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 Sierra Leone 7
 EPIDEMIOLGY (iii)
 2018-22, confirmed cases among Nigeria travelers
reported in:
 Israel
 Singapore
 United Kingdom
 USA
 Over 120 countries reported Mpox between Jan 2022 – Aug
2024
 Over 100 000 laboratory-confirmed cases
 Over 220 reported deaths among confirmed cases
 This unpredicted appearance of Mpox in non-endemic regions
highlights its epidemic potential and global public health threat
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 TRANSMISSION: ZOONOTIC

 Mpox occurs primarily around rainforests of West

and Central Africa
 The natural host of mpox is not known
 Many species of small rodents and non-human
primates are susceptible to mpox virus
 Following the eradication of smallpox, Mpox virus
emerged as the most significant orthopoxvirus in
humans
(smallpox, cowpox and Mpox virus belong to the
same genus & family)
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 TRANSMISSION: Animal-to-human

 Human infection has occurred

from handling infected
animals: giant pouched rats,
rope squirrels, and monkeys
 Infection results from direct contact
with the blood, bodily fluids, or
external lesions of infected animals
 Eating inadequately cooked
meat of infected animals is a
Credit:
possible risk factor
123rf
 For most human infections, the
source is not known
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 Animal Species in Africa Found to Host
Mpox virus
Gambian pouched rat Dwarf dormouse Sun squirrel
Cricetomys gambianus
* Graphiurus murinus * Heliosciurus sp.*

Rope squirrel Colobus monkey Sooty mangabey

Colobus sp. ** Cercocebus atys **
Funisciurus sp.*

* Credit: The Centers for Disease

Control and Prevention (CDC), USA
** Credit: 123rf
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 TRANSMISSION: Human-to-human

 Human-to-human transmission results

from close contact with infected
respiratory droplets, skin lesions, or
contaminated objects
 Health care workers and household
members of active cases are at
higher risk of infection
 As human-to-human transmission is
limited, most outbreaks consist of only
a few cases within families

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 CLINICAL FEATURES (i)
 Incubation period is usually 6-13
days, with range 5-21 days
 Infection progresses in two
phases:
 invasion period (0-5 days)
characterized by fever,
headache, lymphadenopathy,
back pain, myalgia and fatigue;
and
 characteristic rash appearing in
stages, 1-3 days after onset of WHO/ M. V.

fever, beginning on the face

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Szczeniowski
11
 CLINICAL FEATURES (ii)

 Rash lesions evolve from macules

(lesions with a flat base) to papules
(raised firm lesions) to vesicles (filled
with clear fluid) to pustules (filled with
yellowish fluid), followed by crusts
 Rash affects
 the face in 95% of cases
 the palms and soles of the feet (75%)
 oral mucous membranes (70%)
 genitalia (30%) Credit: CDC/ B. W. J.
Mahy

 the conjunctivae and cornea (20%)

 It may take three weeks for crusts to
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 CLINICAL FEATURES (iii)

 Lesions range from a few to

several thousand and are often
painful
 Severe lymphadenopathy
(swollen lymph nodes) is a
distinctive feature of mpox
and generally develops before
the rash Swollen lymph
 Mpox usually lasts 3 to 4 nodes
Credit: CDC/ B. W. J.
Mahy
weeks
 Severe illness occurs more
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 Differential
 Mpox canDiagnoses
resemble other infectious
illnesses with fever and rash, such
as:
 varicella (chickenpox)
 measles
 smallpox (now eradicated)
 Other conditions to rule out:
 bacterial skin infections, scabies,
syphilis and medication allergies
 Early considerations include other
WHO/ M. V.
Szczeniowski
febrile illnesses (especially during
outbreaks)
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 Clinical Features of Mpox and Differential
Diagnosis
Symptoms Mpox Chickenpox Measles

Fever Fever > 38 °C Fever to 39 °C High fever to 40.5

Rash after 1-3 Rash after 0-2 °C, Rash after 2-4
days days days
Rash Macules, Macules, Non-vesicular rash
appearance papules, papules, in different stages
vesicles, pustules vesicles, present
present at the in several
same stage on stages
any area
Rash Slow, 3-4 weeks Rapid, appear in Rapid, 5-7 days
development crops over several
days
Rash Starts on head; Starts on head; Starts on head
distribution more dense on more dense on and spreads;
face and limbs; body; absent on may reach
appears on palms palms and soles hands and feet
and soles
Note: Smallpox was eradicated in 1980. Clinically, smallpox is very similar to monkeypox.
Classic
However, lymphadenopathy Lymphadenopathy Itchy rash
was not present in smallpox. Koplik
Smallpox was more spots
contagious
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 LABORATORY DIAGNOSIS

 Mpox can be confirmed in the laboratory

 The best specimens are from lesions/rash
(skin, fluid, or crust)
 The virus can be best identified with
nucleic acid tests by PCR. Antigen and
antibody detection methods are not
specific
 Specimens from persons and animals
should be handled by trained staff,
wearing personal protective equipment
Credit: Am. J. Trop. Med.
and working in suitably equipped
Hyg. / McCollum, 2017 laboratories
 Procedures for safe storage and
transport of samples must be followed
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 TREATMENT
 The goal is to take care of the rash,
manage pain & prevent complications
 Case management is based on
symptom-specific, supportive
care
 First generation vaccinia
vaccines used to prevent
smallpox also largely protected
vaccinees from mpox
 In 2019, a newer vaccinia
vaccine for smallpox was also
approved for prevention of Mpox
in adults
 Further vaccination and
WHO/ M. V.
Szczeniowski
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 STRATEGIES FOR PREVENTION & CONTROL
1. Surveillance
 Countries at risk should include Mpox in their
integrated disease surveillance & response
system
 The goal is to detect and immediately
respond to any suspected case of Mpox
 Develop case definitions: e.g. a suspected
case:
 an acute illness with fever > 38 °C, intense
headache, lymphadenopathy, back pain,
myalgia & intense fatigue followed 1-3 days
later by a progressively developing rash on
the face and spreading to the body, palms of
hands and soles of feet
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 2. Infection Prevention & Control among
Health Care Workers (HCW)
 HCWs MUST ALWAYS practice standard,
contact and droplet precautions when
caring for patients or handling
specimens
 wash hands before & after caring for a
patient, touching surroundings or
handling specimens
 wear appropriate PPE (gowns, gloves,
masks, goggles and boots)
 ensure isolation of patient in hospital or
home
 ensure proper waste disposal and
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 3. Reducing Risk of Transmission
 Public health education on measures to
reduce exposure:
 understand the risk of handling or
consuming wild animals and avoid contact
with wild animals
 wear gloves and other protective clothing to
handle or slaughter animals
 avoid close contact with patients during
human Mpox outbreaks
 Any person in contact with or taking care of a
person with Mpox should:
 avoid close contact
 wear gloves and other protective equipment
 always wash hands before and after caring
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for or visiting sick persons
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 MPOX: OUTBREAK
RESPONSE
 Each suspected or confirmed case of
Mpox requires immediate response
 Report all case information to health
authorities
 Initiate outbreak coordination
 Put in place laboratory confirmation, contact
tracing, active search, rumour tracking, and
enhance surveillance
 Initiate community education & risk
communication
 Institute infection prevention and control
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measures in all situations
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 IMPLICATIONS FOR GLOBAL
PREPAREDNESS AND DISEASE
 WHO and partners are workingCONTROL
to
improve understanding and control of
Mpox
 One Health approach (integrated, unifying
approach that aims to sustainably balance & optimize
the health of people, animals & ecosystems)
 Early detection and diagnostics
 clinical knowledge
 laboratory capacity
 Better capacity for disease control
 coordinating global expertise
 vaccines and treatments
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 BENUE STATE SITUATION REPORT: HIGHLIGHTS OF
EPIDEMIOLOGICAL WEEK 41 (13 OCTOBER, 2024)

 Total of 23 suspected Mpox cases were reported between

29 February and 13 October, 2024
 First confirmed case in the State was on 31 March, 2024
 Since then, five laboratory confirmed cases were recorded
as at the date of this report
 Zero confirmed cases among HCWs
 Zero number of deaths in confirmed cases
 Two visits by NCDC to the State (28 June and 22 July
2024) to interview positive cases
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 Summary of Suspected Mpox Cases : Distributed by LGAs

S/N LGA No of Suspected Cases

1 Ushongo 4
2 Katsina-Ala 4
3 *Makurdi (3) 11
4 *Gwer West (1) 1
5 Okpokwu 1
6 Gwer East 1
7 *Gboko (1) 1

*Confirmed cases

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 Response Activities of BSPHEOC: Summary by Pillars
Surveillance
 Five contacts of first confirmed case were line-listed & followed up
 Contacts of second confirmed case also line-listed & followed up
 Training of community volunteers by the Nigerian Red Cross
Case management
 No case on admission presently
Risk communication
 Pillar to lead cascading critical information to the State mobilization
officers (SMOs) and Town announcers on Mpox awareness
 Mpox awareness creation ongoing & integrated with other diseases
response (Lassa fever)
Laboratory
• Laboratorians trained on sample collection, packaging & transportation
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 Next Steps
• Benue State PHEOC is on Alert Mode for Mpox
• Intensify support response mechanisms at the LGAs
• Continuous strengthening of risk communication activities
• Enhance sensitization of health care workers on Mpox
• Active case search in health facilities and communities by
DSNOs and community informants
• Adapt and translate Mpox jingles into the local dialects

Epidemiological Week 41 Report was Prepared by:

Dr Asema Msuega State Epidemiologist
Mr Julius Swende State DSNO
Mrs Joy Akume Mpox FP
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 KEY
MESSAGES

 Mpox is an emerging
disease
 Mpox can be seen in
endemic countries or
anywhere in the world
 Report any suspected
case
 Take all precautions to
prevent spread
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