While South Africa has not yet recorded any cases of monkeypox, the National Institute for Communicable diseases said it is confident the country can handle any outbreak.

The  World Health Organisation (WHO)  said that 12 countries where the virus is not endemic reported 93 laboratory-confirmed cases since mid-May.  There are also investigations into 28 suspected cases.

According to WHO, monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms very similar to those seen in the past in smallpox patients, although it is clinically less severe. 

The monkeypox virus, which belongs to the orthopoxvirus genus of the Poxviridae family, causes the infection. There are two groups of monkeypox virus: the West African clade and the Congo Basin (Central African) clade. 

It is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets, and contaminated materials such as bedding. The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days. Eating inadequately cooked meat and other animal products of infected animals is a possible risk factor.

Symptoms include an unexplained acute rash, headache, Acute onset of fever (>38.5oC), Lymphadenopathy (swollen lymph nodes), Myalgia (muscle and body aches), back pain, and asthenia (profound weakness).

Implications of outbreak for South Africa

According to the World Health Organisation, monkeypox endemic countries are Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.

The NICD says 145 monkeypox cases from Australia, Austria, Belgium, Canada, Canary Islands, France, Germany, Israel, Italy, Netherlands, Portugal, Spain, Sweden, Switzerland, the UK, and the US,  have been confirmed. 

But it said the implications for South Africa is the risk of importation of cases is a reality, as was learned from the COVID-19 pandemic.

“Lessons learned from COVID-19 have illustrated that outbreaks in another part of the world can quickly become a global concern,” said NICD Executive Director Prof Adrian Puren. 

Puren encourages travellers to endemic countries to avoid contact with sick animals that could harbour the monkeypox virus, such as rodents, marsupials, and primates. They should also avoid eating or handling wild game.

Travellers must report any illness to a healthcare professional. Information about recent travel, attendance of mass gathering events, and contact with any known cases would be required, said Puren.

Risk is continually assessed

“The NICD can test for monkeypox as the Centre for Emerging, Zoonotic and Parasitic Diseases (CEZPD) has a diagnostic polymerase chain reaction (PCR) in place and electron-microscopy capacity,” said Dr. Jacqueline Weyer from the Special Viral Pathogens Division at the CEZPD.

Dr. Weyer said the NICD would continually assess the risk for local introduction and transmission in collaboration with the National Department of Health and the WHO in line with the International Health Regulations.

According to Dr. Rosamund Lewis, Head of the smallpox secretary in WHOs Emergencies Programme, monkeypox has been around for at least 40 years. 

“But this is the first time we are seeing cases across many countries simultaneously, in people who have not travelled to the endemic regions in Africa,” she said.

Dr. Lewis said that the distinction between smallpox and monkeypox was the swollen lymph nodes. 

“If a child had swollen lymph nodes, it was more likely to be monkeypox than smallpox.   We’re also seeing more cases where the rash begins in the genital area,  which is not new and has always been there. Sometimes it’s also possible that it stays there and does not spread to the rest of the body.” 

Stigma and discrimination

The  WHO said cases were seen mainly amongst men who have sex with men (MSM) seeking care in primary care and sexual health clinics.

Since the outbreak, men who are part of the LGBTQIA+ community have faced discrimination. Andy Seal, an advisor with the HIV, Hepatitis, and STI  programme, debunked the myth that monkeypox is a gay disease.

“Anybody can contract Monkeypox through close contact. We know as well in WHO that when we want to be responsive to an emergency or to an outbreak, in addition to really working with the experts and tracking the epidemiology, we need to work with communities from the beginning,” said Seal. 

Seal reiterated that although monkeypox can spread through sexual contact, it is not a sexually transmitted disease.

“Many diseases spread through sexual contact. You can get a cough or a cold through sexual contact, but it doesn’t mean it’s a sexually transmitted disease. Typically you need an exchange of vaginal fluids or semen that has an element of contagion to transmit the disease. Close personal contact is sufficient”, said Seal.

Reporting needs to improve

“Sometimes, the reporting can come with misinformation, stigma, and discrimination. Not only about the MSM community but perhaps also unintentionally suggesting that this is an African disease by only using images of black skin.

Dr. Lewis added that public health professionals investigating the outbreak are just describing what they are seeing and learning.

“It’s not about discrimination or stigma but rather identifying where the first cases are found and how that can assist in contact tracing and the investigation. Where is it spreading now and how is it spreading are questions we ask ourselves in the middle of an outbreak investigation”, said Dr. Lewis. 

Maria Von Kurkov, the technical lead on Covid-19 and a programme that looks at various diseases and zoonosis, said the  WHO  is working to detect cases in countries that do not typically have it.

“We have been working with ministries of health and other countries to look for people who have rashes. We have been looking in dermatology clinics, emergency departments, infectious disease clinics, and sexual health clinics,” she said.

Von Kurkov said raising awareness and expanding surveillance will help stop human-to-human transmission, which is possible in non-endemic countries.

“We really as a global community have another opportunity to do this right because there are some parallels with Covid-19 and vaccines access”, said Von Kurkov. – Health -e News