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  • NICD monkeypox update: No cases detected in SA but risk of importation ‘a reality’

    NICD monkeypox update: No cases detected in SA but risk of importation ‘a reality’

    More than 140 cases of monkeypox have been reported in 15 countries – mostly in Europe and North America – sparking fears that the world could soon be facing another global emergency while still in the throes of the COVID-19 pandemic.

    South Africa’s National Institute for Communicable Diseases (NICD) said the risk of importation of monkeypox is a reality but also offered that it is usually a “self-limiting disease.” Therefore, the current outbreak is unlikely to be a global disaster.

    NO CASES OF MONKEYPOX IN SA

    The NICD confirmed that there are currently no monkeypox cases in South Africa, in a statement on 23 May.

    “The implications for South Africa are that the risk of importation of monkeypox is a reality as lessons learnt from COVID-19 have illustrated that outbreaks in another part of the world can fast become a global concern,” said NICD Executive Director, Professor Adrian Puren.

    The NICD is equipped to test for monkeypox at the Centre for Emerging, Zoonotic and Parasitic Diseases (CEZPD), which has diagnostic polymerase chain reaction (PCR) and electron-microscopy capacity, said Dr Jacqueline Weyer from the Special Viral Pathogens Division at the CEZPD.

    The Institute detailed how the World Health Organization (WHO) was notified of two lab-confirmed cases of the disease, and one probable case – from the same household –  in the United Kingdom on 13 May.

    Two days later, four more lab-confirmed cases were reported amongst sexual health services patients that presented a vesicular rash illness. The rash was mostly found in men that have sex with men.

    Since then, 15 countries have reported more than 140 cases. Of those cases, men – aged between 20 and 55 – accounted for more than 70 percent of the cases. The infections were detected through sexual health services.

    The first known infection of the current outbreak was detected in a traveller who returned to the UK from Nigeria, where monkeypox is endemic.

    Since then, investigations have been unable to link that case to any of the other cases detected, suggesting that there have been multiple introductions of the virus into the UK and elsewhere.

    “Milder cases of monkeypox may go undetected and represent a risk of person-to-person transmission,” said the NICD.

    SEXUAL TRANSMISSION OF MONKEYPOX NOT PROVEN

    The NICD said most cases are mild and patients present lesions on the genitalia or peri-genital areas. Additional symptoms include rash, fever, painful lymph nodes and oral ulcers.

    Sexual transmission of monkeypox has not yet been proven and it is believed that transmission between sexual partners may occur – during sex – when contact is made with infectious skin and mucosal lesions (including oral).

    “Genital lesions have previously been uncommon and reflect a unique aspect of this outbreak,” said the NICD.

    The United Nations’ Aids agency has come out and condemned the reporting on the current monkeypox outbreak as racist and homophobic.

    As mentioned, a significant portion of the cases detected has been found in gay, bisexual and other men who have sex with men. However, transmission is most likely made via close contact with an infected person and therefore anyone could be affected.

    “Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one,” said UNAIDS deputy executive director, Matthew Kavanagh.

    MOST CASES WILL RECOVER WITHOUT TREATMENT

    Most cases will recover from monkeypox within a few weeks without treatment, said the NICD. However young children, pregnant women and immunocompromised individuals may be vulnerable to severe disease.

    Vaccination against smallpox – which has been eradicated – was protective against monkeypox in the past.

    Contact tracing is underway in the affected countries and a smallpox vaccine is being offered to higher-risk contacts, as needed. The availability of the vaccine across the globe is a challenge.

    NO TRAVEL RESTRICTIONS IN PLACE

    The WHO has not recommended any travel restrictions and is working on limiting the transmission of monkeypox within the affected countries.

    The NICD advised that residents and travellers to endemic countries should avoid contact with sick animals that could carry the monkeypox virus – rodents, marsupials and primates – and should refrain from eating or handling wild game.

    Puren said residents and travellers to countries affected by the outbreak must report any illness to a healthcare professional.

    Table. Countries reporting monkeypox cases, May 2022

    CountryNumber of cases
    Australia2
    Austria1
    Belgium3
    Canada22
    Canary Islands2
    France1
    Germany1
    Israel1
    Italy3
    Netherlands1
    Portugal34
    Spain50
    Sweden1
    Switzerland1
    United Kingdom20
    United States of America2
    Total145

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