Monkeypox in Africa: an old acquaintance with thousands of cases a year and dozens of deaths

Monkeypox is an old acquaintance in Africa, particularly in the central and western regions, where each year it causes thousands of cases and dozens of deaths.

In fact, outbreaks have increased in the last two decades due to factors such as the cessation of vaccination against smallpox as of 1980, which generated cross-immunity, and deforestation and demographic pressure in tropical forest areas, where several species of squirrels and rodents that, according to the most recent research, could be the natural hosts of the virus.

For this reason and due to the growing risk of contagion outside of Africa, scientists have long warned of the need to allocate more funds to research, prevention and vaccination.

“Not enough has been done.

We continue to have very limited knowledge of the different aspects of the disease and until there is a contagion in the global north, the attention that this virus deserves is not dedicated.

We are being more reactive than proactive,” says Nikola Sklenovská, an epidemiologist specializing in monkeypox.

The virus was first identified in 1958 at the Copenhagen State Serological Institute in a population of apes, hence the name of the disease, which had been brought to Europe from different African countries to be used as guinea pigs in the development of the vaccine. against polio.

Years later, another outbreak occurred in US zoos, affecting primates, antelope, and rodents.

Primates are considered to be incidental hosts and not the main reservoir of the virus.

However, it was not until 1970 that the first human case was detected in the Democratic Republic of the Congo (DRC).

Over the next 10 years, there were just 45 recorded cases, almost all of them in the lush Congolese rainforest, as well as in Liberia and Sierra Leone.

In fact, the disease appeared only very sporadically until, in the early 2000s, a change in the pattern and an increase in outbreaks began to be observed.

"Currently we have about 2,000 cases each year in the DRC in a growing trend, although with current information it is difficult to know if it is due to environmental causes or because an effort has been made in detection," says Sklenovská.

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The first scare in Western countries occurred in 2003 with an outbreak in the United States in which some 70 people were infected by rodents from Ghana that had become fashionable as pets.

In Europe, the first three infected were identified in 2018, specifically in the United Kingdom.

Two of them were people who had been in Nigeria, where an epidemic that same year caused 400 confirmed and suspected cases.

During one of the outbreaks in Congo, Katy Brown, a nurse and health adviser for the Médecins Sans Frontières (MSF) emergency unit, cared for a five-year-old boy suffering from this disease.

"Because of the rash in his mouth, it was difficult for him to eat and drink, so hydration and nutritional support were very important, as well as infection prevention and control," she says.

In fact, most deaths in Africa are caused by septicemia derived from wounds caused by the virus, especially on the skin of the face, torso and extremities.

"It was a scary time for the boy and his father, we had to isolate them both and they needed a lot of support," she recalls Brown.

two variants

There are two known variants of monkeypox, one prevalent in central Africa and more virulent, with a lethality among children that can reach 10%, although in recent outbreaks it has dropped to 6%, and another present in West Africa which is considered milder because it causes only 1% of deaths on average.

The WHO defines it as "a rare viral zoonotic disease that occurs mainly in remote parts of central and western Africa, near tropical forests."

However, this definition has become outdated as cases have appeared more frequently and also in more urban settings.

"There are two vaccines," explains Miriam Alía, head of vaccination and emergency response at MSF, "one approved by the US drug agency used by the US for its cases and another authorized by the European Medicines Agency," she says.

“The problem is that few are produced and, for many African countries, it is difficult to access the doses.”

Immunization against monkeypox is not massive, but in rings: contacts of infected people are vaccinated, as is the case with Ebola.

The smallpox vaccine provided protection of up to 85%, but since this disease has been eradicated it has not been administered since 1980. “Immune people are dying and children are being born who are not vaccinated: this creates a niche for the expansion of the virus,” recalls Sklenovská.

For years scientists have warned about the re-emergence of this disease.

In 2017, in an interview with EL PAÍS, the biologist Anne Laudisoit recalled the threat posed by this virus, especially in Africa, but also for the rest of the world, and warned with a tone of frustration that "as long as there is no target with monkeypox that presents pustules and rash as if it were smallpox, everything will remain the same.

In Brown's opinion, “alleviating the suffering caused by monkeypox and other neglected tropical diseases deserves to be taken seriously, regardless of their location in the world;

it is reprehensible that certain diseases only deserve attention when they affect high-income countries.”