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Nigeria had the largest outbreak of monkeypox. What could we learn from this?

Researchers at the Carlos III Health Institute have obtained the first draft of the complete sequence of the virus that causes monkeypox (Monkey Pox).

Researchers at the Carlos III Health Institute have obtained the first draft of the complete sequence of the virus that causes monkeypox (Monkey Pox).

Photo: Kiko Huesca

The first time a case of monkey pox in humans was in 1970, in the Democratic Republic of Congo (Africa). Over the years, some cases continued to be detected in different countries of the continent. In 2017, Nigeria experienced one of the largest outbreaks of monkeypox, as it is also known. There were 115 confirmed cases, more than 262 suspected cases, and seven associated deaths.

However, it is likely that you have only heard about this disease during the last few weeks, when European health authorities, as well as the media, began to report unusual outbreaks in Europe. Until this week, according to the World Health Organization (WHO), 131 cases of monkeypox had been reported in 17 countries, mostly European, but also in Pakistan, Israel, Canada, the United States and Australia. It is the first time that it is presented on several continents simultaneously. (You can read: What you should know in case the “monkey pox” reaches Colombia)

The monkeypox, recalls the WHO, is characterized by fever, headache and muscle pain, as well as lack of energy during the first five days. But a characteristic feature are rashes on the skin and mucous membranes that appear in the first three days.

Unlike many, who have never seen a case of monkeypox, Dr. Christian Happi, a physician and PhD from the University of Ibadan, in Nigeria, knows much more about this disease. From this country he directs the African Center of Excellence for the Genomics of Infectious Diseases (Acegid, for its acronym in English), where he has also focused his research on other infectious diseases such as malariathe HIVthe ebola and the covid-19. For him, although Western countries must be vigilant, that there is an outbreak of this smallpox should not cause panic, as there is a clear path to contain it.

What could a country like Colombia learn from the Nigerian experience? The viewer talked with him.

Some of the countries in the West are a little alarmed by the outbreak of monkeypox. Do you really think there is reason to worry?

The answer would be yes and no. Yes, in case they do nothing to contain it, because then there is reason to worry. And no, because if you really work hard and seek advice from countries that have experience in managing the monkey poxNo cause for alarm.

Unlike SARS-CoV-2, the virus that gives rise to the coronavirus, we have known about monkeypox for half a century. But is there anything we don’t know about this virus? Any unanswered questions?

We used to know that monkeypox was spread through contact: by having contact with an infected person or by coming into contact with fluid from that person. But, with this new experience, we are seeing a dimension not seen before, which is possibly sexually transmitted. So there is something that we would still be learning.

What tools have been successful in controlling monkeypox in Africa?

In the first place, and based on the experience that Africa has had with monkey pox, the key is to isolate the cases. Contacts should then be monitored and these contacts vaccinated against smallpox if necessary. That is what has been done. It is worth remembering that, in Africa, it has been very rare to see cases where transmission occurs from one country to another, from one region to another. These are usually very localized outbreaks and are often contained in the environment in which they occur.

And in what sense is monkeypox still a challenge in the region?

I don’t think we have any challenges in Africa in containing monkeypox. Often when we have outbreaks in the region, it is because humans have come into contact with the environment and with the animal population that is infected. That’s where communicable diseases keep coming from: from animals to humans, which end up becoming transmission from one human to more groups of humans. So I think the real challenge is in nature: in that, eventually, a human is exposed to it and from there several of us get sick. At that point is the real challenge.

Nigeria was the latest country to report a large outbreak of monkeypox. How challenging was this situation and what lessons can be learned from that moment?

The great outbreak of monkeypox was in Nigeria in 2017. This means that almost 40 years passed between this outbreak and the last time a case of monkeypox was recorded in this country. So what can be learned? What the authorities did at that time was identify the cases and isolate them. Then follow the contacts of those cases and create a smallpox vaccination ring around those contacts.

And, in that sense, do you think that a mass vaccination against smallpox will be necessary?

I think that if there is ever to be a need for mass vaccination, it should be in Europe and in Western countries, because smallpox vaccination stopped around the 1970s. This may mean that their population is at greater risk. However, I don’t think this is the case for Africa, because smallpox is part of the vaccination that is given to children when they grow up.

Are you afraid that the case of what happened with the coronavirus vaccines will be repeated? That they are monopolized by the countries with the highest income, such as Europe and the United States, and they begin to be scarce in Africa?

If that becomes the case, so be it. It is something that could happen eventually. But again, I would say that here in Africa we are not talking about the same problem with monkeypox, it is a bit different. People here have developed some immunity to monkeypox, so if Europe and North America want to steal all the vaccines, I don’t think that translates into high mortality or morbidity in Africa. If that happens, we have to get by without the vaccines, manage that situation, and navigate it like we always have. But, of course, I think it would be good if this did not happen, if experience told us that it is important to be fair. Ultimately, this is a problem that needs to be tackled globally, as a global health community, and done holistically. It must be remembered that as long as you have not treated and protected your neighbor, the consequences can be returned to you.

Africa reported the first case of monkeypox in 1970. And as you mentioned, it had a relatively recent outbreak, in 2017, in Nigeria. However, international authorities and the media have only started to talk about it now, when it is reported in Europe. Do you see any injustice in this?

Yes, and I’ve said it before: there is a double standard in how public health information is reported. And that double standard is actually responsible for the fact that many diseases that can become epidemics or pandemics have not been addressed or do not receive attention. If in the face of an epidemic – and I am not necessarily talking about monkeypox, but any disease – the media do not focus their attention on it, they do not make noise, coming from the country that comes from, there will not be a solution to these problems. But what you see is that when outbreaks occur in low- and middle-income countries, the Western media doesn’t care about these diseases. And it is a problem because, once again, no solution is sought for them, which gives them the possibility of being transmitted to Europe or the West. So I do think that having a double standard in how illnesses are covered is a major public health issue globally.

Smallpox (the common one) is the only disease that we have been able to eradicate since 1980, they even stopped applying vaccines. Is it possible that the monkeypox virus has evolved to fill that niche left by smallpox?

I couldn’t say, because I’m not sure there is a relationship. But what I do think is that what is important, and urgent, is to understand what is happening with the outbreak that is spreading across Europe and North America. That’s what’s important. So instead of panicking, you have to address the situation and take the necessary health measures that I have mentioned to control it: isolation, surveillance of cases and focus on containing the outbreak. You have to break the cycle and its transmission, that’s what’s important.

Do you see any particular difference in the European outbreak versus outbreaks that have emerged in Africa before?

Well, something unusual is that the recent outbreak is occurring in people who have not received the smallpox vaccine, so they are more vulnerable.

Finally, how should the health systems of the countries be strengthened in the face of this outbreak of monkeypox?

The basic thing is that they continue with the surveillance. At present it is difficult to know exactly how diseases move, because they do not need a passport or visa to enter countries, they simply arrive with people. So the important thing is that all countries and systems are alert. Again, we have to work as a global community and try to see how we can prevent massive spread. But I’m not really worried, because it’s not a disease like coronavirus, which is airborne. Monkeypox is a disease that requires more contact, so I am not concerned about its ability to transmit and therefore spread. It is important to avoid panic. Act, but avoid panic.

Source: Elespectador

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