EUROPEAN JOURNAL OF MEDICAL AND EDUCATIONAL TECHNOLOGIES https://www.ejmets.com ISSN: 2732-4109 (Online) To cite this article: Oladoye MJ. Monkeypox: A Neglected Viral Zoonotic Disease. European Journal of Medical and Educational Technologies 2021; 14(2): em2108. https://doi.org/10.30935/ejmets/10911 Review Article ___________________________________________________________ Monkeypox: A Neglected Viral Zoonotic Disease Moyinoluwa Joshua Oladoye 1,2* 1 Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria 2 Slum and Rural Health Initiative Research Academy, Nigeria * Corresponding author: Moyinoluwa Joshua Oladoye E-mail: [email protected] ORCID: 0000-0003-0300-1474 Received: 1 January 2021 Accepted: 16 February 2021 ABSTRACT Over the years, the nations of the world have been plagued with several infectious diseases outbreak. With the continuous rise in the number of emerging and re-emerging infectious diseases such as monkeypox, it is high time we drew lessons and insights from past outbreaks to guide and effectively prepare for possible future outbreaks. Monkeypox, popularly known as the most important orthopoxvirus infection, is a viral zoonotic disease prevalent in Central and West Africa. There are 2 known genetic clades of the monkeypox virus reported so far, the Western African and the Central African clades. The human monkeypox though originated from Africa has grown to be a global concern with cases reported in the United States, United Kingdom, Israel, and Singapore. It is distinctively characterized by lymphadenopathy and systemic rash symptoms. Monkeypox has a low fatality rate (0-11%) with the highest rates occurring in children and young persons who were not part of the smallpox vaccinated population. Report suggests that consumption of bush meats could be a potential risk factor in the transmission of the infection or caring for an infected patient. Several factors have been responsible for the weak surveillance system of monkeypox including the current COVID-19 pandemic that has put more pressure on the fragile healthcare systems and infrastructures of most countries. This paper aims to guide global health policymakers on the impending danger of neglecting this disease. The discourse is concluded with the recommendation of strategies to effectively strengthen the disease surveillance system in combating this public health threat. Keywords: monkeypox, smallpox, orthopox, epidemiology, COVID-19 INTRODUCTION prevalent in Central and West Africa. The orthopoxvirus genus also comprises three other species that are Monkeypox is a viral disease of public health importance pathogenic to humans; they are variola virus, cowpox virus caused by monkeypox virus, a member of orthopoxvirus and vaccinia virus [2]. Monkeypox is a closely related disease genus of the family of Poxviridae. It was first isolated in to smallpox but with a striking distinguishing feature of an Denmark from vesico-pustular lesions of infected early lymphadenopathy. In the western hemisphere, human cynomolgus monkeys in 1958 [1]. The monkeys were monkeypox was first isolated in 2003 and has recently imported from Singapore. According to the World Health experienced an upsurge in the African clime where it is Organization, it is the most important orthopoxvirus predominantly found since 1970 [3]. This can be associated infection in humans. It is a viral zoonotic disease that is most © 2021 by the authors; licensee EJMETS by Bastas, UK. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/). Oladoye / Monkeypox: A Neglected Viral Zoonotic Disease with the increasing interaction between humans and carrier Table 1. Comparison of sex distribution and clinical features animals of the monkeypox virus. Other factors have proven observed in persons with monkeypox between two countries (n for to be responsible for this such as ecosystem degradation Nigeria=122; n for United States=30) [20,22] NIGERIA UNITED and increased human-to-human rate of transmission [3]. CHARACTERISTIC (%) STATES (%) The response to the COVID-19 pandemic has taught SEX Female 31 40 countries invaluable lessons about the possible effects of Male 69 60 future disease outbreaks that could cause such havoc on CLINICAL Rash 100 83 lives and livelihoods. In the light of the current pandemic FEATURES that has put more pressure on the fragile healthcare systems Fever 88 73 of most countries, there is a need to look at strategies that Lymphadenopathy 69 47 can help to strengthen the monkeypox disease surveillance Sore throats 58 33 Headache 79 33 system. It is therefore imperative to put structures in place in preparedness for a possible future outbreak of monkeypox. Territory inclusive), an increase to the 11 states initially This paper discusses the available data on monkeypox, reported in 2017 [19-21]. This report confirms that the male addresses the challenges of the disease surveillance system to female ratio is 3:1, suggesting a higher prevalence in the hindering the eradication of this public health threat and male gender [19]. The male gender is more affected than the finally proffers recommendations to policymakers. female as shown in Table 1. REVIEW The largest reservoirs of the virus are rodents, squirrels and Epidemiology giant pouched rats which serve as a source of nutrition in Monkeypox has experienced an increased incidence in the some parts of the world [18]. The disease is primarily last two decades since its first human case discovery in 1970 transmitted by direct contact with infected reservoir with high prevalence reported in Nigeria, DRC, Liberia, animals. Monkeypox has a low fatality rate (0-11%) which Cameroon, Gabon, Sudan, Sierra Leone, Republic of the makes it less severe than smallpox (30-50%). The highest Congo and the Central African Republic [4-9]. In recent years, rates occur in children and young persons who were not part the sudden incidence in countries like the United States, of the smallpox vaccinated population. United Kingdom, Singapore, and Israel have been reportedly In 2003, monkeypox cases were reported from six states linked with the African origin of the disease [10-13]. during the United States outbreak [22]. The infection was There are 2 known genetic clades of monkeypox virus found to have been transmitted by pet prairie dogs reported so far, the Western African and the Central African suggested to have contracted the virus from small mammals clades. The Central African clade has a higher case fatality shipped into the US from Ghana [23]. These infected rate (11%) than the Western African clade(<1%) with an mammals were kept near prairie dogs that were later sold as additional human-to-human transmission seen in the pets. Central African clade [14]. The West African clade isolates In September 2018, human monkeypox experienced have been reported in Nigeria, Liberia, Sierra Leone, Ivory another international spread when two travelling Nigerians Coast and USA while the Central African clade isolates were diagnosed of the infection in the United Kingdom [10]. originate from the Republic of Congo, Cameroon, Gabon, A third case was later reported in a healthcare worker who Sudan and the DRC [14-17]. contracted the disease from one of the first two. This is the According to the World Health Organization, it is commonly major evidence available for the human-to-human found in young persons under the age of 40 or 50 years transmission present in monkeypox. (varies with country) due to cessation of smallpox In October 2018, Israel reported an imported case of vaccination following the eradication of the disease in 1980. monkeypox from her resident who arrived from Nigeria [12]. Report reveals that most monkeypox cases occur in A similar case was recorded in 2019 when a Nigerian population under the age of 40 with a median age of 31 travelled to Singapore. This explains the role travelers play years [18]. Asides from the age distribution, the gender in the spread of infectious diseases epidemics in new distribution of the disease has also been studied. In Nigeria regions globally. as a case study, monkeypox cases have been recorded in 26 states out of the 36 states of the country (the Federal Capital 2 / 6 European Journal of Medical and Educational Technologies 2021; 14(2): em2108 European Journal of Medical and Educational Technologies Aetiology Percentages were calculated individually for each characteristic based on the number of patients with Monkeypox is caused by Monkeypox virus (MPXV), a available data. member of the orthopoxvirus group of viruses. It is a double- stranded DNA virus. Research suggests the evolutionary Diagnosis nature of the monkeypox virus [24]. Samples are best taken from the skin lesions such as The incidence of human infection of monkeypox is hinged pustules, vesicles and dry crusts after which they are stored on certain risk factors. The most important factor is the in a dry, sterile tube and kept cold. Skin biopsy is a good discontinuation of smallpox vaccination campaign which alternative for sample collection. Arriving at a definitive has resulted in waning cross-protective immunity [18]. This diagnosis proves quite challenging in the presence of has made the younger age group the most susceptible to differentials with common symptom of systemic rash illness the infection. Another central factor attributed to the as seen in measles, bacterial skin infections, scabies,