Despite a recent decline in mpox cases in Nigeria, rising incidence of the virus across Africa poses a significant threat to the country, especially given the current unavailability of vaccines in the country amid global shortage, experts warn.
The latest data from the Nigeria Centre for Disease Control (NCDC) shows a drop in suspected mpox cases from 102 to 51 in the last four weeks, up until August 11, 2024. These cases were reported across 18 states and 26 Local Government Areas (LGAs).
However, this decline does not mitigate concerns, as the rest of Africa is experiencing a surge in mpox cases, with the Democratic Republic of Congo (DRC) being the hardest hit. In just a few days, the DRC saw a sharp increase in cases, from 16,000 to 16,800, and a rise in deaths from 548 to over 570.
The current outbreak is being driven by a more contagious and dangerous strain of the virus, known as clade 1, which has a mortality rate of 3.6%, according to the World Health Organization (WHO). Neighbouring Cameroon has also reported cases of the severe clade 1 virus, raising fears of its potential spread into Nigeria.
Adaobi Onyechi, a public health expert has expressed concern about Nigeria’s vulnerability, citing the country’s porous borders and dense population as significant risk factors for importing the more virulent strain. Onyechi emphasized that the recent decline in cases should not lead to complacency. “Nigeria must ramp up awareness, public education, and surveillance efforts, which are currently still weak,” she said.
Onyechi also highlighted the need for increased access to the smallpox vaccine, which offers some protection against mpox. She warned that Nigeria’s low vaccination rates put the country at greater risk of a more severe outbreak.
The NCDC announced the expected arrival of 10,000 doses of the Jynneos vaccine, which is effective in preventing mpox after two doses. However, when contacted on Tuesday, both the NCDC and the National Primary Health Care Development Agency (NPHCDA) have expressed uncertainty about when these vaccines will arrive.
“We don’t know when the vaccines will arrive,” an NPHCDA official said.
The Africa CDC has reported a continent-wide shortage of vaccines, with only 200,000 doses available out of the 10 million needed. This raises concerns over vaccine access and equity, especially considering that during the 2022 global mpox outbreak, vaccines were widely available in Europe and the United States but scarce in Africa.
Currently, two vaccines licensed by the U.S. Food and Drug Administration (FDA) are available for preventing mpox: Jynneos, a two-dose vaccine, and ACAM2000, an older smallpox vaccine that can also be used to prevent mpox. However, outside of clinical trials, these vaccines have not been made available in the DRC or other African countries, where the disease has been endemic for decades.
In addition to this vaccine shortage, there aren’t approved antiviral treatments for mpox currently. However, health authorities advise that patients can be administered antiviral drugs like cidofovir or tecovirimat. These drugs are approved to treat other viral infections like smallpox.
So far in Nigeria, 19 states and the Federal Capital Territory have recorded at least one confirmed mpox case across 30 LGAs in 2024. Since September 2017, a cumulative total of 4,603 suspected cases have been reported from 36 states and the FCT, with 1,125 confirmed cases (24.4%).
Across Africa, at least 34 countries are either reporting infections or are considered at high risk, according to the Africa CDC. In addition to the DRC, cases are now being reported in countries like Burundi, Kenya, Rwanda, and Uganda, where mpox infections had previously been rare or nonexistent. The situation in the DRC is particularly alarming, with the 2024 figures already matching the total for the entire year of 2023, and cases emerging in previously unaffected provinces.
About mpox
Mpox is a rare viral zoonotic infectious disease ( disease of animals transmitted from animals to humans) that is endemic in several African countries including the tropical rainforests of Central and West Africa. The exact reservoir of the virus is still unknown although rodents, squirrels and monkeys are suspected to play a part in transmission.
The World Health Organization declared the latest mpox outbreak in Africa a “public health emergency of international concern” a category that was also used for Ebola and Covid-19 outbreaks.
The Mpox virus can spread both from animal to human and from human to human. Animal-to-human transmission may occur by direct contact with the blood, body fluids, skin or mucosal lesions of infected animals (e.g., monkeys, squirrels, and rodents). This can happen through a bite, scratch, handling of, or eating inadequately cooked or other products of infected bushmeat. Human-to-human (person-to-person) transmission occurs when a person comes into contact with the virus from an infected human, or materials contaminated with the virus such as clothing and bedding.
Sign and Symptoms
Symptoms of the illness include fever, headache, body aches, weakness, swollen lymph nodes (glands) and a rash. After about 1 to 3 days of fever, the rash erupts, beginning on the face and then spreading to the body with the face and palms/soles being mostly affected. They can also occur in and around the genitals which is why contact during sex is another mode of transmission.
Prevention
To prevent the spread of Mpox, the NCDC strongly urges members of the public to adhere to proven infection prevention and control measures. These practices are essential in limiting the transmission of the Mpox virus. This includes: Avoid contact with animals that could harbour the virus including sick or dead animals in areas where MPX has been confirmed
Avoid contact with any material that has been in contact with a sick animal. Avoid unnecessary physical contact with persons infected with MPX. Isolate potentially infected animals from other animals. Practice frequent handwashing with soap and water especially after caring for or visiting sick people;
Ensuring all animal food products are properly cooked before eating, and Use of appropriate protective clothing and gloves while handling sick animals or their infected tissues and during slaughtering procedures.
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