The document provides background information on monkeypox virus, including its transmission between animals and humans, signs and symptoms, diagnosis, treatment and prevention. It discusses the virus's identification in 1970 in the Democratic Republic of Congo and reemergence in Nigeria in 2017. Two genetic clades of the virus are identified, with the Central African clade typically causing more severe illness. Person-to-person transmission is documented. Supportive treatment aims to relieve symptoms and prevent complications. Prevention involves avoiding contact with infected animals or materials and implementing isolation protocols.

1. MONKEYPOX
SURG SLT LO MAJOLAGBE
NNRH OJO
1

2. OUTLINE
1. Background
2. Transmission
3. Epidemiology
4. Signs and Symptoms
5. Diagnosis
6. Supportive Treatment
7. Prevention
8. Outbreak Control
9. References
2

3. BACKGROUND
1. The human monkeypox is caused by a virus
belonging to the Family – Poxviridea, Genus -
Orthopoxvirus
2. Smallpox virus (Variola) eradicated in 1980
3. The virus was isolated from primate tissues in 1958
4. In 1970, human monkeypox was identified the
Democratic Republic of Congo (DRC)
5. Re-emergence in 2017 in Nigeria, Bayelsa state
6. Zoonotic outbreaks were subsequently observed in
the US, Europe and Middle-East but monkeypox
was not considered a threat to humans
3

4. BACKGROUND
1. There are two distinct genetic groups (clades) of
monkeypox virus – Central African and West
African
2. Human infections with the Central African
monkeypox virus clade are typically more severe
compared to those with the West African virus
clade and have a higher mortality
3. Person-to-person spread is well documented for
Central African monkeypox virus and limited with
West African monkeypox
4

5. OUTBREAK AT A GLANCE
Since 13 May 2022, cases of monkeypox have been
reported to WHO from 28 Member States across four WHO
regions (the Region of the Americas as well as the
European, Eastern Mediterranean, and Western Pacific
Regions) where monkeypox is not usual or has not
previously been reported.
In addition, since the beginning of the year, there are 1,536
suspected cases reported from eight countries in the WHO
African Region, of which 59 cases have been confirmed and
72 deaths reported.
5

6. TRANSMISSION
1. Occurs when a person comes into contact with the
virus from an animal, human, or materials
contaminated with the virus
2. Enters the body through broken skin, respiratory tract
or mucous membranes
3. Animal to human transmission may occur by bite or
scratch, bush meat preparation, direct contact with
body fluids or lesion material, or indirect contact with
lesion material, such as contaminated beddings
4. Human-to-human transmission occurs through large
respiratory droplets by prolonged face-to-face contact
as these droplets can not travel more than a few feet
6

7. TRANSMISSION
The reservoir host (main disease
carrier) of monkeypox is still unknown
although African rodents, squirrels
and monkeys (bonobo apes) are
suspected to play a part in
transmission
7

8. EPIDEMIOLOGY
Cases of monkeypox in countries where monkeypox is not usually or had
not previously been reported, 13 May to 8 June 2022
8

9. EPIDEMIOLOGY
Cases of monkeypox in WHO African Region reported since January 2022, as of 8
June 2022
9

10. EPIDEMIOLOGY
10

11. KEY INDICATORS IN NIGERIA
11

12. Nigeria confirmed monkeypox cases by state, September 2017 - April 2022
12

13. Map of Nigeria Showing States with Confirmed MPX Cases from September 2017 till date (22
states)
13

14. Age and sex distribution of Nigeria confirmed monkeypox cases September 2017 - April
2022
14

15. Age distribution of confirmed Monkeypox cases September 2017 - April 2022
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16. SIGNS AND SYMPTOMS
 The incubation period (interval from infection to onset of
symptoms) of monkeypox is usually from 6 to 16 days but
can range from 5 to 21 days. The infection can be divided
into two periods:
 The invasion period (0-5 days): this is characterised by fever
(high grade), intense headache, lymphadenopathy (swelling
of lymph nodes), back pain, myalgia (muscle ache) and an
intense asthenia (lack of energy);
16

17. SIGNS AND SYMPTOMS
 The skin eruption period (within 1-3 days after appearance of
fever): this period is where the various stages of the rash
appears, often beginning on the face and then spreading
elsewhere on the body. The face (in 95% of cases), and palms of
the hands and soles of the feet (75%) are most affected.
 Evolution of the rash from maculopapules (lesions with a flat
bases) to vesicles (small fluid-filled blisters), then pustules (pus
containing rash) followed by crusts (dried blisters), occurs in
approximately 10 days. It might take three weeks before the
complete disappearance of the crusts.
17

18. MONKEY POX RASH IMAGES
18

19. SIGNS AND SYMPTOMS
Muco-cutaneous involvement of
monkeypox
19

20. 2017 MONKEYPOX OUTBREAK IN
NIGERIA
20

21. COMPLICATIONS
 Secondary bacterial affected lesions
 Bronchopneumonia
 Septicaemia
 Encephalitis
 Corneal ulceration – blindness
 Skin colour changes
1. Hyperpigmentation (keratitis)
2. Hypopigmentation
21

22. COMPLICATIONS
 Scars
 Contractures
 Alopecia
 Deformity
22

23. HYPERPIGMENTATION (KERATITIS)
23

24. DIAGNOSIS
 Though clinical recognition of monkeypox is the first step in
diagnosis, the definitive diagnosis can however only be
done in the laboratory where the virus can be identified by
a number of different tests:
1. Enzyme-linked immunosorbent assay (ELISA)
2. Antigen detection tests
3. Polymerase chain reaction (PCR) assay
4. Virus isolation by cell culture
5. Electron microscopy
 The swabs of lesions, fluid samples or crusts are most
appropriate for laboratory monkeypox tests
 The differential diagnoses that must be considered include
other rash illnesses e.g. smallpox, chickenpox, measles,
bacterial skin infections, scabies, syphilis, and medication-
associated allergies 24

25. Electron micrograph of Monkeypox virus
identified in vesicle fluid from an infected patient
25

26. SUPPORTIVE TREATMENT
System affected/
Syndrome
Treatment
Objective
Therapeutic considerations/clinical setting Follow up/
monitoring
Fever Prevent and treat
episodes of fever
Antipyretic medications, external cooling Routine
temperature
monitoring
Pain Relieves pain Analgesics Pain monitoring
Pruritus Prevent and relieve
skin itching
Warm bath/warm clothing
Calamine lotion
Antihistamines
Evidence of scratch
marks
Skin lesions Minimise insensible
fluid loss/promote
lesion healing
Clean with normal saline, clean ulcers with povidone-iodine
solution, moisturised dressing, topical antibiotics (eg
mupiricon), surgical debridement, skin grafts if necessary
Lesion count/rash
burden, body
weight, fluid
intake/ output
Bacterial skin
infection
Prevention/
treatment of
secondary bacterial
infections
Oral/intravenous antibiotics, incision and drainage, advanced
wound management eg negative pressure wound therapy
Fever, pain
/tenderness,
erythema, edema,
exudate, warmth
Lymphadenopathy Minimise pain and
decrease size of
lymphadenopathy
Oral/intravenous anti-inflammatory/analgesic medication Size of lymph nodes
26

27. TREATMENT
 The Centers for Disease Control and Prevention
(CDC) has issued interim Guidance for Use of
Smallpox Vaccine, Cidofovir, and Vaccinia
Immune Globulin (VIG) for prevention and
treatment in the setting of outbreak of
monkeypox.
27

28. PSYCHOLOGICAL ISSUES
ASSOCIATED WITH MONKEYPOX
 Fear
 Anxiety/Panic
 Loneliness
 Depression
 Stigma
 Discrimination
 Abandonment or ejection from communities
 Denial of diagnosis and refusal of admission or
isolation
28

29. PREVENTION
 Measures that can be taken to prevent infection
with monkeypox virus include:
 Avoiding direct contact with animals that could harbor
the virus including sick or dead animals especially in
areas where monkeypox occurs
 Avoiding contact with any material that has been in
contact with a sick animal.
 Isolation of infected patients from others who could be
at risk for infection.
 Hand washing with soap and water after contact with
infected animals.
 Wearing gloves and protective equipment when taking
care of ill people.
29

30. PREVENTION
 Regular hand washing after caring for, or visiting sick
people.
 Thoroughly cooking all animal products before eating
 Implementation of standard infection control precautions
by health workers.
 Isolating potentially infected animals from other animals
 Immediate quarantine of any animals that might have
come into contact with an infected animal, handling
them with standard precautions and observing for
monkeypox symptoms for 30 days.
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31. HANDWASHING
31

32. NN PERSONNEL IN APAPA IN 2017
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33. ISOLATION CHAMBER
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34. THANK YOU FOR YOUR RAPT
ATTENTION
34

35. REFERENCES
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properties of the causal agent of a new variola-like disease (monkeypox) in man. Bull World
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zoonosis in the tropical rain forests of Africa. Am J Trop Med Hyg 1985;34:781-9.
 Jezek Z, Fenner F. Human monkeypox. In: JL Melnick, editor. Monographs in virology.
Volume 17. Basel: Karger; 1988.
 von Magnus P, Andersen EK, Petersen KB, Birch-Andersen A. A pox-like disease in
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 Khodakevich L, Jezek Z, Messinger D. Monkeypox virus: ecology and public health
significance. Bull World Health Organ 1988;66:747-52.
 Khodakevich L, Szczeniowski M, Manbu-ma-Disu, Jezek Z, Marennikova S, Nakano J, et al.
The role of squirrels in sustaining monkeypox virus transmission. Trop Geogr Med
1987;39:115-22.
 Jezek Z, Grab B, Szczeniowski MV, Paluku KM, Mutombo M. Human monkeypox: secondary
attack rates. Bull World Health Organ 1988;66:465-70.
 Jezek Z, Arita I, Mutombo M, Dunn C, Nakano JH, Szezeniowski M. Four generations of
probable person-to-person transmission of human monkeypox. Am J Epidemiol
1986;123:1004-12.
 Mukinda VB, Mwema G, Kilundu M, Heymann DL, Khan AS, Esposito JJ. Re-emergence of
human monkeypox in Zaire in 1996. Lancet 1997;349:1449-50.
 Centers for Disease Control and Prevention. Human monkeypox- Zaire, 1996-2022. MMWR
Morb Mortal Wkly Rep 1997;46:304-7. 35