About monkeypox outbreak

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By LT. COL Dr Henry Kyobe

At the beginning of this week, in an editorial, the International Society of Infectious Diseases lifted the lid on the threat of mpox (formally called monkeypox) epidemic as an emerging public health issue happening in Democratic Republic of Congo (DRC) and sounded an “alarm bell to Africa and the world”.  

There is ongoing mpox transmission in 23 out of 26 provinces in DRC with 8,734 infections,  and 408 deaths.

The editorial raised serious concerns about the changing dynamics of transmission and the high number of deaths particularly among children, as well as the disease’s effects on the socio-economic spheres. Of the dead in DRC, 85% are children.

The ongoing mpox epidemic in Congo, with concomitant transmission taking place in South Africa and 27 other countries globally, and the risk of severe disease among HIV patients and children, seems to have entered in a new phase that threatens public health stability in the region.

The emergence of cases in North Kivu province, and specifically in Goma, close to major trade routes with Uganda, threatens a cross-border transmission into Uganda, which may happen in weeks.

And as we have seen with other diseases, the rapid spread from one region to another, and specifically infected individuals drifting towards urban populated areas where health services are presumed to be superior to rural settings.

Entry into cities amplifies transmission and creates challenges in control. Mpox is a disease of the skin that manifests as several skin pustules (small boils) that may combine to form bigger clusters of boils that may get re-infected with community bacteria.  

This may happen in one or more parts of the body and can involve the whole body. In many cases, this may be self-limiting, but for individuals at risk of severe disease, this can result in death.

Transmission is through physical contact with an infected person or an infected animal reservoir.

The mpox infection can cause complications that involve eyes and sight, nervous system, the heart and others associated with mucosal (mouth, rectal, genital, and urethral areas of the body), and uncontrolled viral spread due to moderate or severe immunocompromise, particularly in advanced or unsuppresed HIV infection.

The HIV patients whose virus is not adequately suppressed by ARV treatment (those with HIV virus still detectable in blood), infants and children of age under 15 years are at higher risk of severe disease may lead to death.

Additionally, pregnant women are at risk of severe disease including pregnancy loss, foetal death and maternal death.  

The evidence from the Congo shows that human-to-human transmission is primarily associated with casual or commercial sexual activity in urban settings related to travel and trade.

And this tends to be in poor, densely populated areas with a high number of bars that are sustaining the local sex industry. Additionally, transmission among children is driven by school clusters where transmission rapidly occurs to affect several children.

Transmission in schools is ignited through a single introduction by a single child with an active infection.

Except for supportive care to avert  blood infection (septicamia) and possible end organ damage that may arise, there is no definitive treatment.

The World Health Organisation has recommended compassionate vaccination, specifically for individuals at risk of severe disease.

This said, even where transborder mpox transmission is anticipated, given Uganda’s track record in robust response to public health emergencies, this will be dealt with precision and success.  

To retain this national capacity, as usual the the public needs to understand the transmission dynamics, the at-risk population categories as well as appreciate the value of early detection and reporting.

According to a disease control expert, adherence to public health measures is the most important line. Uganda has capacity to test and confirm mpox both at Uganda Virus Research Institute Entebbe and at the National Public Health Laboratories in Butabika.

Similary, Bwera Government Hospital has been designated to for potential early call response, should any spill-over happen into Uganda.

For the Government, and Ministry of Health, all will be done to ensure that early detection and diagnosis are undertaken, appropriate clinical care for those infected especially those at high risk of severe disease and death, and will work with partners locally and globally to ensure reactive vaccination is undertaken for those that are at high-risk of severe disease and death.  

As indicated earlier, to achieve this, the public will need to work and adhere to the Ministry of Health recommendations as they will updated from time to time until the mpox threat as a public health issue is no more.

The writer is a senior military officer, consultant epidemiologist, and incident commander in Ministry of Health.