The Sunday Mail
Health authorities are on the alert for monkey-pox, although we are not one of the African rain forest countries where the disease is endemic and have yet to record a case of the 2022 global spread.
But over the last week, Zambia and South Africa have recorded cases, one each, and the latter’s health authorities are fairly sure there must be more since the confirmed case was a man who has not travelled, so must have been infected directly or indirectly by someone who had. Mild cases may not throw up symptoms that cause the patient alarm or even notice.
But it is also necessary to put the disease into perspective. It has been around in the endemic African countries for a long time, although until smallpox was eradicated in 1977, was confused with that very similar but far more contagious and lethal disease and even in more recent times has been confused with chickenpox, an unrelated infection from a different group of viruses but also presenting superficially similar symptoms.
Smallpox vaccine is 85 percent effective against monkey-pox so the huge global effort of the 1960s and 1970s to eradicate smallpox must have come close to eradicating monkey-pox in humans. Regrettably unlike smallpox it infects rodents and some other animals, so since the end of smallpox vaccination in 1980 monkey-pox cases have been slowly rising.
The present global outbreak has so far added about 4 600 confirmed cases, including the Zambian and South African pair, to the 1 583 cases confirmed in seven African countries in the endemic zone so far this year, mostly in the Democratic Republic of Congo.
This is probably less than the number of headlines.
The headlines arise from where the global cases have occurred: Spain 1105, United Kingdom 910, Germany 676, Portugal 348, France 330, Canada 280, Netherlands 211, United States 201, Italy 127, and Belgium 78.
The other 340 or so cases are scattered across around 20 countries. But that batch of western European and North American countries has generated the headlines.
Of course the conspiracy theorists have crawled out from under their rocks and infected social media with inaccurate information and false theories, so once again on health issues people need to follow the experts.
The endemic countries have seen, this year, 1 366 in the Democratic Republic of Congo, about 86 percent of the African cases and reflecting the fact, rarely reported in the press, that the DRC has been combating a slowly growing number of cases for decades. Central African Republic, which also has the Congo variant has seen 25 cases this year, not all confirmed, and Republic of Congo 9.
The Congo variant is more severe than the West African variant that affects the rest of the endemic African countries and which is the one seen in the 22 global outbreak. Nigeria heads the West African endemic countries with 146 new cases this year taking the total since the present outbreak was first recorded in that country in 2017 to around 400.
Nigeria, although being a densely populated country, has an effective programme that identifies infections and follows them up so copes well. That is why with a far larger population and some animal hosts, it has a far lower infection rate than say Britain.
Cameroon is third in West Africa with 31 cases, Liberia with four and Sierra Leone with two make up the rest of the endemic country cases for this year. The countries within the West African rain forest might be the home of the virus but they have learned how to deal with it as a matter of routine, another reason for treating the present outbreak with concern, but not panic.
Monkey-pox is actually a bad name for the virus, but it got the name since the first scientist who identified the virus found it in a batch of laboratory monkeys in Denmark in 1958.
The more common hosts are rodents, the Gambian pouched rat, dormice and African squirrels, and these are thought to be the natural reservoir although it does spread to non-human primates and has even been found in US prairie dogs. This year almost all cases in endemic and non-endemic countries have been human to human.
Many of the measures we use to combat the vastly more contagious Covid-19 are precisely the ones recommended to control any spread of monkey-pox: masking, high levels of personal hygiene and just being careful who you hug and sit in a crowd with. And then if you have flu symptoms or a rash that forms blisters see a health centre.
While the old smallpox vaccines worked, they are no longer available but by 2019 a specific monkey-pox vaccine had been developed.
It is not being used presently although some public health experts are brooding about using it to ring-fence an infection so the virus is blocked from spreading.
Meanwhile, most people in Africa from their late 40s onward were vaccinated against smallpox so probably have some protection.
The World Health Organisation monitors the disease but has not declared any global emergency.
The West African health departments have shown it can be kept under control by ensuring people know the symptoms, medical staff can accurately diagnose a patient, and the patients can be kept isolated at home or hospital until they are better.
Zimbabwe could do the same if cases occurred here and as one highly effective public health measure is the earliest possible diagnosis, the Ministry of Health and Child Care is right to make sure everyone is aware of the potential risk and is prepared.
