Feature

Monkeypox: A viral infection causing global concern

It can spread from animals to humans, person to person –Profs Babalola, Ezeibe

The outbreak, a global health emergency, says WHO

Monkeypox, a viral infection, manifests a week or two after exposure with fever and other non-specific symptoms. It produces a rash with blisters that can last for a couple of weeks, according to medical experts. In this report, Isioma Madike, traces the origin, current outbreak, and how it can be tamed

An ongoing outbreak of monkeypox, a viral disease, was confirmed in May. The disease was first traced to Monkey from where it derived its name. The variola virus, the causative agent of smallpox, is also in this class. Of the two types in humans, the West African type is said to cause a less severe disease than the Central African (Congo basin) type. Monkeypox may spread from infected animals by handling infected meat or via bites or scratches. Human- to-human transmission, according to experts, can also occur through exposure to infected body fluids or contaminated objects, by small droplets, and possibly through the airborne route.

The recent occurrence is believed to have started from Lagos and Delta states. People, medical experts say, can spread the virus from the onset of symptoms until all the lesions have scabbed and fallen off with some evidence of spread for more than a week after lesions have crusted. They have said that diagnosis can be confirmed by testing a lesion for the virus’s DNA.

Incidentally, there is no known cure yet. This may be the reason the World Health Organisation recently declared it a public health emergency while warning of another threat to society. WHO has also said that monkeypox is not as contagious as some other infections because it requires close contact with someone who has it to be contaminated. Dr. Rotimi Adesanya, Head, Medical services, College Medical Centre, Federal College of Education (Technical), Akoka, listed monkeypox as a member of the virus called orthopoxvirus, which is a double-stranded DNA virus. The family, Adesanya said, includes the smallpox (variola), vaccinia, and cowpox virus.

He also said that monkeypox is a viral infection that causes a rash and is spread by very close contact with someone with it. Most people, the doctor said, recover within a few weeks. However, there may be mild symptoms, which may occur without any known signs, he said. The classic presentation of fever and muscle pains, followed by swollen glands, with lesions all at the same stage, has not been found to be common to all outbreaks though. But, cases, Adesanya said, may be severe, especially in children, pregnant women or people with suppressed immune systems.

He told this reporter that monkeypox is usually transmitted to humans by the bite of an infected animal, or by touching an infected animal’s blood, body fluids, or fur. It’s also possible to catch the disease, according to him, by eating undercooked meat from an infected animal. Carriers, he also said, include rodents such as rats, mice, and squirrels.

He said: “The disease is usually limited to central and West Africa or to travelers to these regions. Human- to-human transmission rates generally have been limited. Transmission via droplet respiratory particles usually requires prolonged face-to-face contact, which puts household members and other close contacts of active cases at greater risk. “There are rashes, lesions or sores, particularly in areas that are hard to see such as the genitals, anus or anal area or on the face, arms and legs.

There are also ulcers, lesions or sores in the mouth as well as fever, headache, muscle aches, backache, swollen lymph nodes, chills and/or exhaustion.” He did not stop there but said that treatment may consist of immediate vaccination with the smallpox vaccine because monkeypox is so closely related to smallpox and thus cross-protective. The doctor also said that treatment with an antiviral drug or human immune globulin has been done. He added: “In general, the prognosis for monkeypox is good to excellent as most patients recover. Monkeypox symptoms usually clear within 2-4 weeks without treatment. In recent times, the mortality rate has been between 3-6%, mostly among young children and immunocompromised individuals.

“Treatment may consist of immediate vaccination with the smallpox vaccine because monkeypox is so closely related to smallpox and thus cross-protective. Treatment with an antiviral drug or human immune globulin has been done. In general, the prognosis for monkeypox is good to excellent as most patients recover.”

A Professor of Veterinary Medicine and Clinical Virology at the Michael Okpara University of Agriculture, Umuahia, Abia State, Maduike Ezeibe, has also called monkeypox a skin infection that leads to inflammation of the skin (dermatitis) and fever. This, he said, can be complicated to become life threatening. “It is a zoonotic disease which means it affects both animals and human beings. So, veterinary doctors and other professionals who work on or with animals are more at risk of contracting the infection. The virus spreads by contact between infected animals or infected persons and susceptible persons.

“So, to avoid contracting the infection, people should avoid contact with live animals (especially wild animals) and infected persons. Those who must handle live animals or infected persons should be provided with protective clothes and they should thoroughly wash and disinfect their hands after handling any animal or suspected persons. “For now, there is no vaccine to protect against the disease but if a person gets infected with the disease, being a viral disease (like HIV/AIDS and COVID-19), can be cured with Medicinal Synthetic Aluminum Magnesium Silicate (MSAMS).

“Mechanism of the Nigerian Nanomedicine is to mop viruses and abnormal (infected/tumor) cells by the already known opposite charges electrostatic attraction. Science does not know race. That Nigerian Institute of Medical Research (NIMR) has refused to announce results of the trial we conducted on HIV/AIDS cannot change that age long principle.

“For them to have put it in writing that they have been working with the MSAMS is enough proof that Nigeria has invented a broad spectrum antiviral/ antitumor medicine. “So, we can cure any viral disease. While HIV and the COVID-19 virus are positively charged Pox viruses have negative charges. Nigerian medicine has both positive ends and negative ends. All these facts can be cross checked from literature. Our medicine uses its negative ends to mop HIV and COVID-19 virus while it uses its positive ends to mop monkeypox virus and abnormal (cancer and infected) cells.

“Do you see what Nigeria is losing because those in charge of confirming scientific claims have chosen to withhold results that show that Nigerian scientists can do what other countries cannot do? If the claim was false they would have announced their results. “Global outbreak of one viral disease after the other is an opportunity for Nigeria to benefit economically and diplomatically but some people insists on denying over 200 million Nigerians such a huge benefit because they do not like the face of an inconsequential individual,” he said.

Former President, Guild of Medical Directors (GMD), Professor Olufemi Babalola, has also emphasised that monkeypox is caused by monkeypox virus, a member of the orthopoxvirus genus in the family Poxviridae. According to Babalola, monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks, adding that severe cases can occur.

In recent times, he said, the case fatality ratio has been around 3–6 per cent, meaning that out of every one hundred people who contract the disease, 3-6 people would die. The professor also confirmed that monkeypox is transmitted to humans through close contact with an infected person or animal (such as rats), or with material contaminated with the virus (such as rat faeces or urine on food to be consumed). Obviously, monkeys, he said, acts as a reservoir for the virus but are not affected by the disease. Complications from monkeypox, Babalola says, include secondary skin infections, pneumonia, confusion, and eye problems.

In the past, according to him, about one to 10 per cent of people with monkeypox have died. It is important to note that death rates in different settings may differ due to a number of factors, such as access to health care, he added. He said these figures may be an overestimate because surveillance for monkeypox has generally been limited in the past. He also said that in the newly affected countries where the current outbreak is taking place, there have been no deaths to date. He said: “Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding and spread commonly among men, who have sex with men, particularly in the West. “It is a viral zoonotic disease that occurred primarily in tropical rainforest areas of central and West Africa. But it has now spread to several countries in Europe, Asia and the Americas. It is endemic in Nigeria, other West African countries, central Africa and the Congos. An antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of monkeypox. “The clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection, which was declared eradicated worldwide in 1980. However, it is less contagious than smallpox and causes less severe illness. It typically presents clinically with fever, rash and swollen lymph nodes and may lead to a range of medical complications.

“Vaccines used during the smallpox eradication programme also provided protection against monkeypox. Newer vaccines have been developed of which one has been approved for prevention of monkeypox. However, Nigeria does not have any stockpile of smallpox vaccine at the moment.” Since September 2017, Nigeria has continued to report sporadic cases of monkeypox. But, on May 26, a monkeypox National Emergency Operations Centre (EOC) was activated in response to the risk assessment conducted, which put Nigeria at high risk for an outbreak.

By May 29, Nigeria, according to the Nigeria Centre for Disease Control (NCDC), recorded a total of 21 confirmed cases with one death in nine states and the FCT. Some experts have said that environments can become contaminated with the monkeypox virus, for example when an infectious person touches clothing, bedding, towels, objects, electronics and surfaces. Someone else who touches these items can then become infected. It is also possible to become infected, according to the experts, from breathing in skin flakes or viruses from clothing, bedding or towels.

This route is what they called fomite transmission. Although asymptomatic infection has been reported, it is not clear whether people without any symptoms can spread the disease or whether it can spread through other bodily fluids. Pieces of DNA from the monkeypox virus have been found in semen, but it is not yet known whether infection can spread through semen, vaginal fluids, amniotic fluids, breast milk or blood. Research is said to be underway to find out more about whether people can spread monkeypox through the exchange of these fluids during and after symptomatic infection. As of May, public health authorities have aimed to target resources and education to affected groups, but avoid stigma which could discourage people with symptoms or who have been exposed from seeking help. Rights groups have also issued statements advising media to avoid stigmatising marginalised groups such as men who have sex with men. On May 20, WHO convened an emergency meeting of independent advisers to discuss the outbreak of monkeypox and assess the threat level.

Initial assessments expressed the expectation of the outbreak to be contained and of low impact to the general population in affected countries. Its European chief, Hans Kluge, expressed concern that infections could accelerate in Europe as people gather for parties and festivals over the summer. On June 1, a WHO statement acknowledged that undetected transmission had occurred for some time, and called for urgent action to reduce transmission. By June 14, it announced plans to rename the monkeypox virus in order to combat stigma and racism surrounding the disease.

A meeting convened on June 23, determined that the outbreak did not constitute a Public Health Emergency of International Concern for the time being, but that decision was overturned by a later meeting on July 23. A few days after that, WHO declared the global monkeypox outbreak a public health emergency of international concern (PHEIC) as it said that public health measures taken failed to stem the disease’s spread. Human monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo in a 9-monthold boy in a region where smallpox had been eliminated in 1968.

Since then, most cases have been reported from rural, rainforest regions of the Congo Basin, particularly in the Democratic Republic of the Congo and human cases have increasingly been reported from across Central and West Africa. Since then, human cases of monkeypox have been reported in 11 African countries: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone and South Sudan.

However, the true burden of monkeypox is not known. For example, in 1996–97, an outbreak was reported in the Democratic Republic of the Congo with a lower case fatality ratio and a higher attack rate than usual. A concurrent outbreak of chickenpox (caused by the varicella virus, which is not an orthopoxvirus) and monkeypox was found, which could explain real or apparent changes in transmission dynamics in this case. Since 2017, Nigeria has experienced a large outbreak, with over 500 suspected cases and over 200 confirmed cases and a case fatality ratio of approximately three per cent.

Today, it has become a disease of global public health importance as it not only affects countries in West and Central Africa, but the rest of the world. In 2003, the first monkeypox outbreak outside of Africa was in the United States of America and was linked to contact with infected pet prairie dogs. These pets had been housed with Gambian pouched rats and dormice that had been imported into the country from Ghana.

This outbreak led to over 70 cases of monkeypox in the U.S. Monkeypox has also been reported in travelers from Nigeria to Israel in September 2018, to the United Kingdom in September 2018, December 2019, May 2021 and May 2022, to Singapore in May 2019, and to the United States of America in July and November 2021. Also in May, multiple cases of monkeypox were identified in several non-endemic countries. Studies are currently underway to further understand the epidemiology, sources of infection, and transmission patterns. Global health experts hope the decision will spark a more coordinated international response, further research into the disease, and the ramping up of vaccine production.

 

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