The outbreak of monkeypox in Africa is causing global concern, with thousands of confirmed cases and fears of a global pandemic. Cheryl Walter, senior lecturer in biomedical sciences, presents the challenges and steps required to contain the disease
At least 450 people died during an initial outbreak in the Democratic Republic of the Congo and since then the disease has spread to regions in central and eastern Africa and last week Sweden announced the discovery of the first case of smallpox outside of Africa.
In light of the alarming increase in cases of monkeypox, the Centers for Disease Control and Prevention in Africa took an unprecedented step and declared the outbreak raging in African countries as a public health emergency at the continental level. A day later, the World Health Organization declared the outbreak a global health emergency.
These steps were taken after a virulent mutation of the disease spread rapidly to 16 countries, and cases were reported in six new countries within 10 days.
Since the beginning of 2024, there have been 15,132 confirmed cases of monkeypox in Africa. Some of the affected countries are Burundi, Cameroon, Congo, Ghana, Liberia, Nigeria, Rwanda, Democratic Republic of Congo, South Africa, Uganda and Kenya.
Virologist Cheryl Walter, Senior Lecturer in Biomedical Sciences, University of Hull in the UK, explains some of the reasons why monkeypox outbreaks are so worrying.
How many strains of monkeypox are there and which ones should we be concerned about?
The monkeypox virus is one of the species of the smallpox viruses, like smallpox and cowpox, characterized by a rash followed by bumps on the skin. In monkeypox, the bumps fill with fluid and eventually suffocate. As we have learned from diseases like COVID-19, viruses change genetically and mutations occur rapidly.
Monkeypox virus is not a different virus, although poxviruses tend to mutate much more slowly than other viruses, such as HIV. HIV changes about every three times the virus replicates.
There are two strains of monkeypox - clade I and clade II. You can think of them as two big branches on a tree.
Until about five-six years ago, these clades were not so diverse.
something has changed. These branches are growing and the leaves on the branches are multiplying. In fact, we have new subclades for both clade I and clade II, so two new branches have been added.
Clade II is much less dangerous with a mortality rate of about 0.1%. In other words, about one in a thousand died.
Scientists now see thousands of cases of clade I reported in 16 African countries and a mortality rate of between 3% and 4%. This means that three or four people out of every hundred die. Many of the cases are children.
Let's compare again to COVID-19. A global emergency has been declared from January 30, 2020 to December 31, 2021, with an estimated fatality rate of 1.2%.
Monkey pox is a relatively little studied virus. Until recently there were several single confirmed cases each year. It appeared mainly in tropical rain forest areas in central and western Africa. There was very little opportunity for the virus to adapt to a human host.
We do not understand if genetic changes make the virus spread more easily and if the circulating variants are more dangerous.
We know that the virus changes and moves between many people. Viruses can only mutate when they pass through a host such as a human.
The more people it passes through, the more opportunities it has to change and become perhaps more virulent or more contagious.
Now that the virus is passing through many people, there are many such opportunities.
How does the disease spread to new areas?
The virus spreads through contact such as sharing dishes, plates, towels and bedding.
Women and children are disproportionately affected by skin-to-skin contact because they are in close proximity to each other every day. Children play in schools and kindergartens and touch objects and each other all the time.
The viruses also spread easily when people live in crowded, low-income areas and cannot isolate themselves because they have to go out to earn a living.
The two other reasons monkeypox virus spreads so quickly are its long incubation period and vague symptoms.
The incubation period usually ranges from five to 21 days. A person can become infected with monkeypox during this period and travel to another country and infect others with the disease.
The initial symptoms are vague and include swollen glands, fever and a general feeling of tiredness. It is estimated that 10% of people infected with monkeypox are asymptomatic.
Only when the rash appears may it turn out not to be a cold, flu or COVID-19.
To add to this challenge, when children get these rashes they may be confused with chicken pox or one of the other childhood illnesses.
What emergency measures should be taken to ensure that the outbreak does not become a global pandemic?
There are several things that put health agencies in Africa at a disadvantage in trying to contain the virus.
There are very few resources to fight this disease and the lack of vaccines is a major problem. The Centers for Disease Control and Prevention in Africa estimate that there are only 200,000 doses available to African countries compared to a requirement of at least 10 million.
However, there is still much that can be done.
tests: This is the most important tool in this fight. We need to know where these cases are and who in the affected community has contracted monkeypox. We also need to use this data to track the number of infected people. We can do this through simple rapid tests - using a nose and/or throat swab that can be done in the community and get results within 30 minutes.
Public information: In the previous worldwide outbreak of the monkeypox virus, many accusations were made in the media against sex workers and men who have sex with men. As a result, people may think that it is only a sexually transmitted disease. This is not true.
Now women and children are infected with the virus, so the communities must be informed of the symptoms to look for and what actions to take.
Vaccines: Because monkeypox is very similar to smallpox, the smallpox vaccine can be used. However, there is very little stock and we cannot produce smallpox vaccines quickly enough. The World Health Organization called on companies that produce vaccines to quickly approve and distribute them.
These and other measures need to be taken urgently to curb this epidemic before it could become a global epidemic.
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