Monkey pox: Risk factors, Signs and Symptoms

Monkeypox, a rare viral zoonosis  is a virus transmitted to humans from animals with symptoms in humans similar to those seen in...

Wednesday, 11 October 2017

Monkey pox: Risk factors, Signs and Symptoms

Monkeypox, a rare viral zoonosis  is a virus transmitted to humans from animals with symptoms in humans similar to those seen in the past in smallpox patients, although less severe. Smallpox was eradicated in 1980.However, monkeypox still occurs sporadically in some parts of Africa.
Monkeypox is a member of the Orthopoxvirus genus in the family Poxviridae.
The virus was first identified in the State Serum Institute in Copenhagen, Denmark, in 1958 during an investigation into a pox-like disease among monkeys.
Monkey pox: Risk factors, Signs and Symptoms

Its risk factors include animal bites and scratches from infected animals (mainly African rodents or monkeys) or from other rodents (like prairie dogs) that have had contact with African animals infected with the virus. Recent studies have shown that several species of mammals can be infected with monkeypox, even though the species had never been associated with the virus in their normal environment. Person-to-person transfer, although infrequent, can be reduced or prevented by avoiding direct physical contact with the patient and having the patient's caregivers wear gloves and face masks.

SIGNS AND SYMPTOMS OF MONKEY POX

  1. Fever
  2. Sweating
  3. Malaise
  4. Cough
  5. Nausea
  6. Shortness of breath
  7. Rashes with papules and pustules on the face and chest and other body areas
  8. Swelling of lymph nodes

Basic monkey pox facts

Below are the basic facts about monkey pox:
Basic monkey pox facts

  • Monkeypox is a viral disease that produces pox lesions on the skin and is closely related to smallpox but is not nearly as deadly as smallpox was.
  • The history of monkeypox is new (1958), and the first human cases were diagnosed and differentiated from smallpox in the early 1970s.
  • Monkeypox virus causes monkeypox. The majority of cases are transmitted from animals (rodents) to humans by direct contact. Person-to-person transfer, probably by droplets, can occur infrequently.
  • Risk factors for monkeypox include close association with African animals (usually rodents) that have the disease or caring for a patient who has monkeypox.
  • During the first few days, symptoms are nonspecific and include fever, nausea, and malaise. After about four to seven days, lesions (pustules, papules) develop on the face and trunk that ulcerate, crust over, and begin to clear up after about 14-21 days, and lymph nodes enlarge. There may be some scarring.
  • The diagnosis of monkeypox is often made presumptively in Africa by the patient's history and the exam that shows the pox lesions, however, a definitive diagnosis is made by PCR, ELISA, or Western blotting tests that are usually done by the CDC or some state labs. Definitive diagnosis is important to rule out other possible infectious agents like smallpox.
  • Treatment may consist of immediate vaccination with smallpox vaccine because monkeypox is so closely related to smallpox. 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. The prognosis may decrease in immunocompromised patients, and patients with other problems such as malnutrition or lung disease may have a poorer prognosis.
  • Monkeypox is preventable as long as people avoid direct contact with infected animals and people. Vaccination against smallpox seems to afford about an 85% chance of avoiding the infection. There is no commercially available vaccine specifically for monkeypox.
  • Research is ongoing to study antivirals, genetics, and rapid tests for monkeypox.

How to prevent Monkey pox

The Nigerian Centre for Disease Control, NCDC in a statement on Thursday gave preventive measures on how to avoid the virus.
How to prevent Monkey pox

The measures include: avoiding contact with squirrels, rats and monkeys., especially animals that are sick or found dead in areas where monkeypox occurs; always wash hands with soap and water after contact with animals or when caring for sick human relatives or soiled beddings.

“Health care workers are strongly advised to practice universal precautions while handling patients and/or body fluids at all times. They are also urged to be alert, be familiar with the symptoms and maintain a high index of suspicion. All suspected cases should be reported to the Local Government Area or State Disease Surveillance and Notification Officers,” the statement read.

The Executive Officer, NCDC, Chikwe Ihekweazu, also advised that health workers must continue to manage their patients without fear.
“As long as universal infection prevention and control practices are strictly adhered to by all clinical staff, the chances of transmission are minimal,” he said.

Although there is no specific medicine to treat the disease, when intensive supportive care is provided most patients recover fully.

All about monkey pox

The Minister of Health, Isaac Adewole, has called on Nigerians to stop eating dead animals, bush meat, particularly monkeys, as the Nigerian health authorities has launched measures to curb the spread of monkeypox, following suspected cases of the disease in Bayelsa State and other states. In a press statement by the ministry on Thursday, 5th October 2017, Mr. Adewole assured Nigerians that the health ministry was working on re the spread of the disease.
All about monkey pox

Noticeable symptoms of the disease include headache, fever, back pains and in advanced cases, rashes bigger than those caused by chicken pox.
The minister urged anyone with the symptoms to immediately report to the nearest health facility, while advising health workers to maintain a high index of suspicion and observe safety precautions. He also warned that there is no known treatment or preventive vaccines, hence people should be at alert and avoid crowded places as much as possible.

He further outlined measures being taken to include placing health facilities in Bayelsa on alert, having patients suspected of the disease quarantined, and providing supportive treatments being offered to the victims.

The minister said investigation is still on-going and that health partners were working with the ministry on the reported outbreak. The Nigeria Centre for Disease Control, NCDC team in Bayelsa state are also supporting the state government in curbing the spread of the disease, he said.

Monkeypox, a viral disease, broke out in Yenagoa, Bayelsa capital and about 11 persons have been placed under medical surveillance. An isolation centre was created by NCDC and the epidemiological team of the state’s Ministry of Health to control the spread of the virus. About 49 other persons who had been in contact with the persons infected with the virus are also being tracked by health experts.
The Bayelsa State Commissioner of Health, Ebitimitula Etebu, who had earlier confirmed suspicion of the disease, said samples of patients had been sent to a laboratory in Dakar, Senegal for confirmation.

He described monkeypox as a viral illness caused by a group of viruses that include smallpox and chicken pox.  “Recently in Bayelsa, we noticed a suspected outbreak of monkeypox. Although it has not been confirmed, we have sent sample to World Health Organisation reference laboratory in Dakar, Senegal. When that comes out, we will be sure that it is confirmed. But from all indications, it points towards it,” he said. Mr. Adewole also confirmed that samples from victims had been sent to WHO referral laboratory in Dakar. He, however, called for calm as monkeypox is mild and has no record of mortality.

Also, the Nigerian Centre for Disease Control, NCDC in a statement on Thursday gave preventive measures on how to avoid the virus. The measures include: avoiding contact with squirrels, rats and monkeys., especially animals that are sick or found dead in areas where monkeypox occurs; always wash hands with soap and water after contact with animals or when caring for sick human relatives or soiled beddings. “Health care workers are strongly advised to practice universal precautions while handling patients and/or body fluids at all times. They are also urged to be alert, be familiar with the symptoms and maintain a high index of suspicion. All suspected cases should be reported to the Local Government Area or State Disease Surveillance and Notification Officers,” the statement read.

The Executive Officer, NCDC, Chikwe Ihekweazu, also advised that health workers must continue to manage their patients without fear.
“As long as universal infection prevention and control practices are strictly adhered to by all clinical staff, the chances of transmission are minimal,” he said.
Although there is no specific medicine to treat the disease, when intensive supportive care is provided most patients recover fully.

Friday, 6 October 2017

Facts about Monkey pox

Monkey pox

 

1. Double stranded DNA virus (Zoonotic)

  • Family poxviridae, Genus orthopoxvirus
  • Family of pox viruses includes other viruses like chicken pox or the eradicated small pox.

2. History

  • 1958: First identified in laboratory monkey kept for research
  • 1970: First human case was identified in DR Congo
  • 1985: First isolation in nature, in an ailing rope squirrel in DR Congo
  • 2003: First human infection outside Africa documented in USA

3. Transmission

  • From infected animals or humans
  • Following contact with body fluids/materials of animals or infected humans
  • Following bite, scratch or even bush meat preparation
  • Entry via broken skin or mucosa (skin, respiratory tract, mucus membrane eye, nose, mouth).
  • Shared utensils, bed, room etc increase risk of transmission

4. Incubation period

  • Seven to fourteen days commonly but could extend from five to twenty-one days.

5. Signs and symptoms

  • Similar to small pox but milder
  • Fever, chills, drenching night sweats, headache
  • Muscles aches (backache), Exhaustion-Lymph-nodes swell up (absent in small pox)

6. Case definition

  • Designed to detect single cases followed by immediate response and control efforts: Fever followed by rash (vesicular/pustular) with rash on palm, soles and face or 5 various-like scars
  • Designed for use in the context of disease surveillance to elaborate on burden in endemic areas: Individual with vesicular/pustular eruptions with at least one of the symptoms: fever preceding eruptions, lymphadenopathy and/or pustules/crust on the palms of the hands or sole of the feet

7. After 1-10 days

  • Centrifugal rash: Rash macule-papule-vesicles-pustules-umbilical-then crusted (scab)

8. Case fatality

  • One to ten percent die from this infection

9. Prevention

  • Small pox vaccine (for at-risk workers) which can be given up to 14 days post exposure
  • Hygiene (Hand washing) with soap and water or alcohol based sanitizer
  • Avoid ill or dead animals’ suspects or their materials
  • Isolation of suspects or identified cases
  • Use personal protective equipment when caring for patients (for health workers)

10. Treatment and vaccine

  • There are no specific treatments or vaccines available for monkey pox infection, but outbreaks can be controlled. Vaccination against smallpox has been proven to be 85% effective in preventing monkey pox in the past but the vaccine is no longer available to the general public after it was discontinued following global smallpox eradication.

Monkey pox outbreak in Bayelsa, Nigeria

Fear has gripped the residents of Yenagoa, the capital of Bayelsa State, following an outbreak of viral epidemic known as Monkey Pox in the state, with report that 10 persons are already infected.Authorities in the state were said to be tracking 49 persons alleged to have come in contact with the infected persons. The victims, according to sources, have been quarantined in an isolation centre created at the Niger Delta University Hospital, NDUTH, Okolobiri, in Yenagoa Local Government Area of the state.The isolation centre was reportedly created by the Nigerian Centre for Disease Control, (NCDC), and the epidemiological team of the state’s Ministry of Health at the ourbreak of the epidemic.
Monkey pox outbreak in Bayelsa, Nigeria

The NCDC and the epidemiological team, it was learned, were tracking 49 other individuals, said to have come in contact with the infected persons. The state Commissioner for Health, Professor Ebitimitula Etebu, while confirming the development, said samples of the virus had been sent to the World Health Organisation, WHO, laboratory in Dakar, Senegal, for confirmation.
He described Monkey Pox as a viral illness caused by a group of viruses that include chicken pox and small pox, noting that the first case was noticed in the Democratic Republic of Congo and subsequently it had outbreaks in the West African region.Explaining that the virus had the Central African and the West African types, the commissioner said the West African type was milder and had no records of mortality, saying “recently in Bayelsa State, we noticed a suspected outbreak of Monkey Pox.
“It has not been confirmed. We have sent samples to the World Health Organisation, WHO, reference laboratory in Dakar, Senegal. When that comes out we will be sure that it is confirmed.”

He said the virus was first seen in monkeys, but can also be found in all bush animals such as rats, squirrels and antelopes.His words: “The source is usually all animals. It was first seen in monkeys and that is why it is called Monkey Pox. But every bush animals like rats, squirrels, antelopes are involved. So, the secretions from particularly dead animals are highly contagious.
”He listed the disease’s symptoms to include severe headache, fever, back pains among others. According to him, “most worrisome of all the signs are rashes bigger than those caused by chicken pox, which is usually frightening and usually spread to the whole body of infected persons.
The Commissioner said: “We noticed the index case from Agbura, where somebody was purported to have killed and eaten a monkey and after neighbours and family members started developing these rashes.“We have seen cases from as far as Biseni. We invited the Nigerian Centre for Disease Control together with our own epidemiological team from the Bayelsa Ministry of Health. We have been able to trace most of the people who have come in contact with the patients.
“I think so far we have 10 patients and we have created an isolation centre at the NDUTH and most of them are on admission; we are following up on the 49 cases that we are suspecting might come down with the illness.
As a state, we are taking care of all the expenses of all the isolated cases. The disease has an incubation period and it is also self-limiting in the sense that within two to four weeks, you get healed and it confers you with immunity for life.“We have mobilized virtually every arsenal at our disposal in terms of sensitizing the public and making them aware by radio programmes, jingles and fliers. So the Nigerian Centre for Disease Control has mobilised fully to Bayelsa State. We are on top the situation.
“The only thing I will tell the public is to observe hand hygiene and ensure they don’t come in contact with dead animals or their secretions. The disease is airborne too. So when you come down with it is very infectious.“People should wash their hands whenever they go in or come out of their houses. If they come in touch with animals, they should ensure that they wash their hands.
They should be very vigilant. People should report any similar cases.“A lot of people have come down with the symptoms, but they are hiding in their houses. If they hide, there is the propensity for the infection to spread. It is better to quarantine them and treat so that we can interrupt the spread of the disease.
“People should be calm and they shouldn’t get frightened. The state has distributed personal protective equipment to workers and they are using it accordingly.”













Culled from The Vanguard
FEAR, yesterdaygripped residents of Yenagoa, the capital of Bayelsa State, following an outbreak of viral epidemic known as Monkey Pox in the state, with report that 10 persons are already infected.Authorities in the state were said to be tracking 49 persons alleged to have come in contact with the infected persons. The victims, according to sources, have been quarantined in an isolation centre created at the Niger Delta University Hospital, NDUTH, Okolobiri, in Yenagoa Local Government Area of the state.The isolation centre was reportedly created by the Nigerian Centre for Disease Control, NCDC, and the epidemiological team of the state’s Ministry of Health at the ourbreak of the epidemic. A patient of Monkey Pox The NCDC and the epidemiological team, it was learned, were tracking 49 other individuals, said to have come in contact with the infected persons.Commissioner reactsThe state Commissioner for Health, Professor Ebitimitula Etebu, while confirming the development, said samples of the virus had been sent to the World Health Organisation, WHO, laboratory in Dakar, Senegal, for confirmation. He described Monkey Pox as a viral illness caused by a group of viruses that include chicken pox and small pox, noting that the first case was noticed in the Democratic Republic of Congo and subsequently it had outbreaks in the West African region.Explaining that the virus had the Central African and the West African types, the commissioner said the West African type was milder and had no records of mortality, saying “recently in Bayelsa State, we noticed a suspected outbreak of Monkey Pox. “It has not been confirmed. We have sent samples to the World Health Organisation, WHO, reference laboratory in Dakar, Senegal. When that comes out we will be sure that it is confirmed.” Index caseHe said the virus was first seen in monkeys, but can also be found in all bush animals such as rats, squirrels and antelopes.His words: “The source is usually all animals. It was first seen in monkeys and that is why it is called Monkey Pox. But every bush animals like rats, squirrels, antelopes are involved. So, the secretions from particularly dead animals are highly contagious. ”He listed the dicease’s symptoms to include severe headache, fever, back pains among others.According to him, “most worrisome of all the signs are rashes bigger than those caused by chicken pox, which is usually frightening and usually spread to the whole body of infected persons. The Commissioner said: “We noticed the index case from Agbura, where somebody was purported to have killed and eaten a monkey and after neighbours and family members started developing these rashes.“We have seen cases from as far as Biseni. We invited the Nigerian Centre for Disease Control together with our own epidemiological team from the Bayelsa Ministry of Health. We have been able to trace most of the people who have come in contact with the patients. “I think so far we have 10 patients and we have created an isolation centre at the NDUTH and most of them are on admission; we are following up on the 49 cases that we are suspecting might come down with the illness. Immunity for life“As a state, we are taking care of all the expenses of all the isolated cases. The disease has an incubation period and it is also self-limiting in the sense that within two to four weeks, you get healed and it confers you with immunity for life.“We have mobilised virtually every arsenal at our disposal in terms of sensitising the public and making them aware by radio programmes, jingles and fliers. So the Nigerian Centre for Disease Control has mobilised fully to Bayelsa State. We are on top the situation. “The only thing I will tell the public is to observe hand hygiene and ensure they don’t come in contact with dead animals or their secretions. The disease is airborne too. So when you come down with it is very infectious.“People should wash their hands whenever they go in or come out of their houses. If they come in touch with animals, they should ensure that they wash their hands. They should be very vigilant. People should report any similar cases.“A lot of people have come down with the symptoms, but they are hiding in their houses. If they hide, there is the propensity for the infection to spread. It is better to quarantine them and treat so that we can interrupt the spread of the disease. “People should be calm and they shouldn’t get frightened. The state has distributed personal protective equipment to workers and they are using it accordingly.”

Read more at: https://www.vanguardngr.com/2017/10/10-infected-49-surveillance-monkey-pox-hits-bayelsa/

Monkey pox: The new pox in town

According to W.H.O., monkeypox is a rare viral zoonosis (a virus transmitted to humans from animals) with symptoms in humans similar to those seen in the past in smallpox patients, although less severe. Smallpox was eradicated in 1980. However, monkeypox still occurs sporadically in some parts of Africa.
Monkeypox is a member of the Orthopoxvirus genus in the family Poxviridae.
The virus was first identified in the State Serum Institute in Copenhagen, Denmark, in 1958 during an investigation into a pox-like disease among monkeys.
Monkey pox
 
Human monkeypox was first identified in humans in 1970 in the Democratic Republic of Congo (then known as Zaire) in a 9 year old boy in a region where smallpox had been eliminated in 1968. Since then, the majority of cases have been reported in rural, rainforest regions of the Congo Basin and western Africa, particularly in the Democratic Republic of Congo, where it is considered to be endemic. In 1996-97, a major outbreak occurred in the Democratic Republic of Congo.
In the spring of 2003, monkeypox cases were confirmed in the Midwest of the United States of America, marking the first reported occurrence of the disease outside of the African continent. Most of the patients had had close contact with pet prairie dogs.
In 2005, a monkeypox outbreak occurred in Unity, Sudan and sporadic cases have been reported from other parts of Africa. In 2009, an outreach campaign among refugees from the Democratic Republic of Congo into the Republic of Congo identified and confirmed two cases of monkeypox. Between August and October 2016, a monkeypox outbreak in the Central African Republic was contained with 26 cases and two deaths.

Transmission

Infection of index cases results from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. In Africa human infections have been documented through the handling of infected monkeys, Gambian giant rats and squirrels, with rodents being the major reservoir of the virus. Eating inadequately cooked meat of infected animals is a possible risk factor.
Secondary, or human-to-human, transmission can result from close contact with infected respiratory tract secretions, skin lesions of an infected person or objects recently contaminated by patient fluids or lesion materials. Transmission occurs primarily via droplet respiratory particles usually requiring prolonged face-to-face contact, which puts household members of active cases at greater risk of infection. Transmission can also occur by inoculation or via the placenta (congenital monkeypox). There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population.
In recent animal studies of the prairie dog-human monkeypox model, two distinct clades of the virus were identified – the Congo Basin and the West African clades – with the former found to be more virulent.

Signs and symptoms

The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 16 days but can range from 5 to 21 days.
The infection can be divided into two periods:
  • the invasion period (0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle ache) and an intense asthenia (lack of energy);
  • the skin eruption period (within 1-3 days after appearance of fever) where the various stages of the rash appears, often beginning on the face and then spreading elsewhere on the body. The face (in 95% of cases), and palms of the hands and soles of the feet (75%) are most affected. Evolution of the rash from maculopapules (lesions with a flat bases) to vesicles (small fluid-filled blisters), pustules, followed by crusts occurs in approximately 10 days. Three weeks might be necessary before the complete disappearance of the crusts.
The number of the lesions varies from a few to several thousand, affecting oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (eyelid) (20%), as well as the cornea (eyeball).
Some patients develop severe lymphadenopathy (swollen lymph nodes) before the appearance of the rash, which is a distinctive feature of monkeypox compared to other similar diseases.
Monkeypox is usually a self-limited disease with the symptoms lasting from 14 to 21 days. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and severity of complications.
People living in or near the forested areas may have indirect or low-level exposure to infected animals, possibly leading to subclinical (asymptomatic) infection.
The case fatality has varied widely between epidemics but has been less than 10% in documented events, mostly among young children. In general, younger age-groups appear to be more susceptible to monkeypox.

Diagnosis

The differential diagnoses that must be considered include other rash illnesses, such as, smallpox, chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish it from smallpox.
Monkeypox can only be diagnosed definitively in the laboratory where the virus can be identified by a number of different tests:
  • enzyme-linked immunosorbent assay (ELISA)
  • antigen detection tests
  • polymerase chain reaction (PCR) assay
  • virus isolation by cell culture

Treatment and vaccine

There are no specific treatments or vaccines available for monkeypox infection, but outbreaks can be controlled. Vaccination against smallpox has been proven to be 85% effective in preventing monkeypox in the past but the vaccine is no longer available to the general public after it was discontinued following global smallpox eradication. Nevertheless, prior smallpox vaccination will likely result in a milder disease course.

Natural host of monkeypox virus

In Africa, monkeypox infection has been found in many animal species: rope squirrels, tree squirrels, Gambian rats, striped mice, dormice and primates. Doubts persist on the natural history of the virus and further studies are needed to identify the exact reservoir of the monkeypox virus and how it is maintained in nature.
In the USA, the virus is thought to have been transmitted from African animals to a number of susceptible non-African species (like prairie dogs) with which they were co-housed.

Prevention

Preventing monkeypox expansion through restrictions on animal trade
Restricting or banning the movement of small African mammals and monkeys may be effective in slowing the expansion of the virus outside Africa.
Captive animals should not be inoculated against smallpox. Instead, potentially infected animals should be isolated from other animals and placed into immediate quarantine. Any animals that might have come into contact with an infected animal should be quarantined, handled with standard precautions and observed for monkeypox symptoms for 30 days.
Reducing the risk of infection in people
During human monkeypox outbreaks, close contact with other patients is the most significant risk factor for monkeypox virus infection. In the absence of specific treatment or vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus. Surveillance measures and rapid identification of new cases is critical for outbreak containment.
Public health educational messages should focus on the following risks:
  • Reducing the risk of human-to-human transmission. Close physical contact with monkeypox infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.
  • Reducing the risk of animal-to-human transmission. Efforts to prevent transmission in endemic regions should focus on thoroughly cooking all animal products (blood, meat) before eating. Gloves and other appropriate protective clothing should be worn while handling sick animals or their infected tissues, and during slaughtering procedures.

Controlling Infection In Health-Care Settings

Health-care workers caring for patients with suspected or confirmed monkeypox virus infection, or handling specimens from them, should implement standard infection control precautions. Healthcare workers and those treating or exposed to patients with monkeypox or their samples should consider being immunized against smallpox via their national health authorities. Older smallpox vaccines should not be administered to people with comprised immune systems.
Samples taken from people and animals with suspected monkeypox virus infection should be handled by trained staff working in suitably equipped laboratories.

WHO response

WHO supports Member States with surveillance, preparedness and outbreak response activities in affected countries.


Culled from  WHO Media Centre