In this interview with Sade Oguntola, Dr. Moses Adewumi, a Reader in the Department of Virology, and Deputy Director, Biomedical Research Centre at the College of Medicine located in the University College Hospital, discusses the implications of the mpox spreading throughout Nigeria as well as the best ways to prevent it.
WHAT is monkey pox, and what is the difference between the monkey pox now ravaging countries like the DRC and the cases we are seeing in Nigeria?
Monkey pox, now referred to as mpox, is a viral infection of humans and animals, caused by one of the pox-like disease viruses similar to cowpox and smallpox. A comparable manifestation of the pox virus is typical rash with raised bumps or blisters on the skin. However, when a person has mpox, the rash usually starts on the face and subsequently spreads to the trunk, legs and other body regions.
The first case of mpox was reported in Denmark in 1958 among monkeys kept as study subjects. It was called ‘monkey pox’ for precisely that reason. The DRC reported the first human case of mpox about 1970. Research has shown that we have two major clades or groups of mpox viruses. Mpox is a DNA virus, hence with less capacity to mutate like SARSCoV-2 and HIV, which are both RNA viruses.
In the DRC and the other East African countries, we initially had the clade 1 virus; we had the clade 2A and 2B viruses during its outbreak in Nigeria. The class 2B is also present in a number of countries.
What is the difference between clade I and clade II mpox viruses? Do they both cause serious infections? Are the signs and symptoms the same, or does one spread faster than the other?
There are areas where each clade mostly circulates, although circulation of viruses is not bound by boundaries. Specifically, the more virulent Mpox clade I, circulates in Central African countries including DRC, while the less severe clade 2 circulates in West African countries including Nigeria. Their genetic makeup makes a difference. Even while we discuss one that causes a milder infection, early this year, a variety that also causes a milder infection was discovered in the Congo Democratic Republic. That indicates that you could not become aware of your infection until it has progressed, if you have that variation.
Also, the clade 1 in DRC occurred primarily among children and adolescents, but the clade 2 was reported among different age groups in Nigeria. Again, when you talk about different clade, studies in Nigeria on the 2017 to 2019 mpox outbreak showed that we had more cases among men than the women.
As a virologist, do you see Nigerians at risk of the variant of mpox that is sexually transmissible in humans as reported in the DRC and some other countries?
It was only recently identified that this virus may spread through sexual contact. A lapse in viral surveillance has occurred. Although its transmission from animal to human was initially believed by researchers, human-to-human transmission was also found throughout time. We eventually learnt that blood fluids, such as pus from an mpox patient’s rash, are how the disease is spread in people. Moreover, the DRC’s discovery of mpox’s human-to-human transmission through sex occurred during the 2017–2019 outbreak. This implies that the mpox clade II can be sexually transmitted, much like Clade I.
However, it is a fact that viruses have no boundary. Anybody can transfer the virus from one place to another. It is for this reason that WHO declares mpox a public health emergency of international concern. The WHO issued a statement along these lines in 2022. The WHO considers it to be the highest alert level. That indicates to us that we should be ready for the virus because it could appear anywhere at any time. We are discussing cases in the Congo Democratic Republic today, but according to WHO, they can occur anywhere and at any moment, so we should be ready. Therefore, we share the same level of danger as many other African nations.
Can mpox also be transmitted from mother to child through pregnancy, during childbirth, or breastfeeding? Does it have other modes of transmission?
When it is confirmed, then we can talk about the possibility of its transmission from one person to another. Now we know that it gets transmitted sexually, and we also know that it can spread through bodily fluids. These have been confirmed. However, there is a possibility of its vertical transmission, which is from mother to child. But more research is ongoing to understand fully all its modes of transmission.
Are there effective vaccines for mumps?
What is adapted for it is the smallpox vaccine; the third-generation smallpox vaccine has been approved for use. It has been confirmed to be at least 85 percent effective.
Many deaths have been recorded from mpox. Why does it kill, and under what situations does it kill?
Infections can either be mild, moderate, or severe. But there is a concern, particularly now because rates of death from mpox have increased. Recorded deaths from mpox in the past eight months of this year exceed that in the same period last year. This indicates that the virus has successfully infected humans because both the death and transmission rates are rising. Every country must thus be sure to step up their efforts before the number of casualties from it rises even higher. We wish to avoid going through what we went through during COVID-19.
For viruses, some people are more at risk of their casualties for different reasons. Are there groups of people that are more at risk of mpox?
This includes people working or getting in contact with animals that are reservoirs or carriers of the mpox. Also, health workers in the hospital environment are at risk. What it means is that if you have just one case on admission on the ward, everyone around such an individual is at risk. For every index case, everyone, including family members around such an individual, is at a higher risk of contracting the infection. Because of this, we recommend taking basic precautions if you are around someone who is infected with mpox, whether at work or at home. We also discuss the importance of following basic precautions in the lab and handling all samples used for analysis as though they were infectious.
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Are there diseases in our community that open the way for mpox to easily infect the body?
Studies during the last mpox outbreak, even in Nigeria, showed a relationship between mpox and HIV infection. Any infection that compromises our immune system will increase the chances of getting infected by other pathogens, including mpox.
The deadliest strain of mpox is spreading in multiple African countries; what caused the emergence of that particular mpox?
Mpox is a DNA virus that does not mutate as fast as the RNA viruses. It is a zoonotic infection coming from animals to humans. However, the virus adapts to the host over time, and human-to-human transmission of the virus has begun. That indicates to us that the virus has adapted to humans. Viruses are extremely intelligent; they adapt to maximise their host system’s potential for infection and replication. As a result, it appears that the virus has now successfully infected humans and has the ability to multiply. As a result, the pathogenesis has improved, which explains why there are more accounts of its spread. Surveillance and case reporting have increased. We weren’t hunting for them, so we weren’t reporting as much in the past.
Also, the virus, as it mutates, becomes more pathogenic, making its rate of transmission and infectivity higher. Those are the happenings in the virus, making more people infected. Through travels, this new variant in the DRC and other East African countries can get to other places.
The WHO has encouraged all nations to start monitoring the virus because, fortunately, there is less migration into and out of the Congo Democratic Republic. There’s a good probability it will be sent somewhere by the time it reaches nations like Nigeria, where there is a constant flow in and out.
How can individuals in the public differentiate mpox from chickenpox, smallpox, and other members of the pox family?
Smallpox has been eradicated, but like I mentioned earlier, it is the smallpox vaccine that is now being used for mpox. When it comes to mpox, the main symptom for the layperson to watch out for is that the rash begins on the face and moves down the body. There is usually about 21 days presentation in which within five days of contracting the virus, the rash begins on the face. Also, individuals report a very intense headache, fever or raised body temperature, swelling of lymph node, body aches, and lack of energy. Essentially, what distinguishes mpox from other illnesses like chickenpox is the type of rash and the area of the body where it first appears. A layperson will find it challenging to distinguish between different types of rashes; thus, the recommendation is to visit the hospital as soon as you notice any rash, especially if it starts on your face.
What other things can we do as Nigerians to protect ourselves from mpox?
The best defence against infection is still good hygiene, which includes frequently washing your hands with soap and water, avoiding contact with rodents and bush animals, wearing personal protective equipment when working with human samples in the lab, and avoiding contact with people who have rashes and their bodily fluids. The crust and all of the pus from the rash are contagious. Actually, prevention is preferable to treatment. Infected individuals should eat healthily and take their medication as prescribed. The majority of those afflicted live; it is treatable. We also have mpox vaccinations. Nigerians can get it. The most important thing is to keep ourselves from coming into contact. When a virus infects a person, you can never be sure what will happen because every person is different in how they react. We want to avoid this; therefore, please take all precautions to ensure that it is avoided rather than being too exposed. Because you can never fully determine the consequences it may have in the body after it enters the system, even with treatment. Insufficient research has left a great deal of gaps in our understanding of mpox.