Health Essentials
Monkeypox outbreak 2022 …and what you need to know
Introduction
It was a warm day in October 2003 in San Diego, California, USA. I was attending the Infectious Disease Society of America’s annual conference. I passionately stood up at a meeting to express my thoughts about media reports connecting Ghana, my country of birth, to a monkeypox outbreak in the US. Fifty three people had contracted monkeypox in a multistate outbreak.
It turned out that after testing and investigation by the CDC, the infection was related to prairie dogs purchased as pets at a pet store in Illinois. The prairie dogs had been kept close to rodents imported from Ghana, a country where the human monkeypox disease has never been reported to date. These rodents were later found to test positive for the monkeypox virus.
The prairie dogs became infected as a result of proximity to the infected rodents and then transmitted the infection to their owners. This resulted in a ban on importation of African rodents into the US to date to prevent further outbreaks. That was the last time the US had an outbreak of monkeypox disease. No one died in the outbreak. One child developed a brain infection or encephalitis.
Monkeypox, a disease caused by the monkeypox virus, occurs very infrequently and in very scattered locations in parts of Africa. There are two clades (or types) of the virus: a West Africa (WA) clade in which 1 to 3.6 out of 100 infected patients die (1% to 3.6% mortality) and the Congo Basin (CB) variant, in which about 10 out of 100 infected patients can die (10% mortality). So far, the virus isolated in this current outbreak is of the West African variant, implying that the risk of dying from this disease is very low.
Background
The outcome of the 2003 outbreak reflects concepts in the natural history of the disease. It is a zoonosis in which humans get infected from infected animals. Monkeypox disease is usually a mild self-limited illness caused by the monkeypox virus. It usually does not require treatment. It can be severe in children, pregnant women, and those with impaired immune systems.
The virus belongs to the orthopox family of viruses. It is a disease that affects animals. It was first discovered in a laboratory monkeys in Copenhagen, Denmark in 1958. The monkeys had been imported from Singapore to study the polio vaccine, giving rise to the name, “monkeypox”. Since then there have been a few more outbreaks in laboratories around the world including the US. However, mentally, people tend to associate it with Africa because in 1970, the first human case was reported in an African child.
Since its discovery in 1970, there have been infrequent occurrences in a few locations around the world. From January 1, 2022, to May 1, 2022, the Democratic Republic of Congo reported 1,238 cases with 57 deaths, while Nigeria reported 46 cases and no deaths. In July and November of 2021, two travelers returning to the US from Nigeria were diagnosed with monkeypox and recovered. Between 2018 and May 2022, there have been nine cases related to travel in non-endemic countries: Two in the US, five in the UK, one in Israel and one in Singapore. None of the travel companions were infected, and only one healthcare worker in the UK became infected.
On May 18, 2022, a man in Massachusetts with no history of travel was diagnosed with a confirmed case of the disease, and eight suspected cases are under investigation. This is occurring at a time when 250 cases have been reported since May 13, 2022, in 18 countries, in persons who have not travelled to the countries where cases have occurred in the past- suggesting a worldwide outbreak. These countries include USA, Canada, Portugal, Spain, Australia, France, Germany, Italy, Netherland, Sweden, and the United Kingdom. Portugal and Spain have the largest numbers. The cases have been found mainly, but not exclusively, in men who have had sex with men, and are seeking care in sexual and outpatient clinics for a rash appearing around the genital areas.
Signs and symptoms
Monkeypox disease starts with a headache, fever, cough, sore throat, and lymphadenopathy (enlarged lymph nodes) accompanied by muscle aches and a profound sense of exhaustion. This lasts about three days and occurs about five to 21days after exposure to an index case. This period of carrying the disease without showing symptoms is known as the incubation period. These initial symptoms are followed by a rash. The rash is made up of flat lesions (macules), which progress to palpable flat-topped rashes (papules), and then to fluid-filled lesions (vesicles). These rashes start around the mouth, progressing to the head, chest and abdomen, and then to the arms and legs, including the palms of the hands and soles of the feet.
Symptoms can mimic chickenpox, smallpox, and syphilis. However, smallpox disease does not present with enlarged lymph nodes. Chickenpox disease has rashes at various stages of development while in monkeypox the stages of the rash is the same on all parts of the body. Chickenpox rash starts on the hands and moves to the centre of the body while the rash of monkeypox starts in the centre parts of the body and marches to the arms and legs. The monkeypox rash is deep in the skin and, therefore, firmer to touch. The individual rashes may have a dimple or appear umbilicated. The fluid in these rashes are infectious. Over a period of two to four weeks, the rashes will scab over and subsequently become noninfectious.
The infected person can transmit the infection in three main ways: direct contact, respiratory droplets and inanimate objects. This period of being infectious starts a day before the person is feverish, and if he or she has a rash, during the whole period of the active rash. First, very close contact may cause the virus in bodily fluids to get onto another person. Second, large respiratory droplets from the sick person can be inhaled leading to infection. Finally, fomites (particles of clothing or other inanimate objects) from the body of the patient can cause the disease to be transmitted too. A pregnant woman can also transmit to her unborn child leading a congenital infection and still birth.
Infection by droplets can occur if an individual is within three to six feet of sick persons. Unlike chickenpox, monkeypox is not airborne and cannot travel for long distances. In this current outbreak, the rash is in the genital area and seems to be occurring in men who have sex with men suggesting that close contact with the skin around the genital area of an infected person is key to the transmission.
Diagnosis
Diagnosis is established by finding the virus using with real time polymerase chain reaction (PCR) or DNA sequencing performed on body fluids from infected persons. There are three categories of sick persons for consideration in view of disease control and mitigation methods.
A suspected case is any person of any age presenting with an unexplained acute rash in a non-endemic country, who has a fever, lymph nose swelling and other characteristic symptoms, and whose rash cannot be explained by causes such as chickenpox, chikungunya virus, zika virus, dengue fever, drug reaction or the more common causes of an acute rash.
A probable case is a suspected case who also has the following: an exposure to a confirmed case, travel history to an endemic country, multiple anonymous sexual partners in the last 21 days, hospitalised or tested positive for the orthopox family of virus with an antibody test or other testing method.
A confirmed case is a probable or suspected case whose bodily fluids have been tested to be positive for the monkeypox virus by real time PCR testing or sequencing. This person should isolate for 21 days, and his or her contacts should be monitored closely.
Prevention and control action points
All doctors and healthcare workers worldwide should be on the lookout for all cases and report to local authorities to allow prompt diagnoses and prevent spread.
All probable and confirmed cases should be reported to the World Health Organisation.
Hospitals and healthcare workers should use standard contact and droplet precautions when they care for these patients. Masks must be worn when in proximity with an infected person because of the respiratory method of transmission. Healthcare workers must promptly identify infections so that confirmed or suspected patients can isolate themselves and prevent transmission and curtail the outbreak.
Specimen from infected, suspected, and probable cases should be handled with care when being transported to designated equipped laboratories to prevent transmission to the laboratory staff.
Treatment and vaccination
In September 2019, a new vaccine, JYNNEOS, was licensed by the FDA for prevention of smallpox and monkeypox in people older than 18 years of age. It was made from the Modified Vaccinia Ankara- Bavarian Nordic (MVA-BN), a live non replicating virus. Its other names are IMVAMUNE, MVA, or IMVANEX. ACAM 2000 is a live vaccinia virus vaccine that was approved in 2007. It tends to cause self inoculation and has been associated with heart muscle inflammation in 5.7 out 1000 recipients. It has 85 per cent efficacy against the monkeypox and has received emergency access investigational drug use for other orthopox viruses such as monkeypox in an outbreak. Both vaccines can be deployed in individuals whose risk of disease acquisition is high and in healthcare workers who have been exposed or may be exposed to the disease.
Tecovirimat is an antiviral agent that occurs in oral formulation and intravenous forms approved by the FDA in July, 2018, and in May 2022 respectively for the treatment of smallpox. Tecovirimat can be used to treat severe monkeypox and is available by calling the US CDC. It goes by the name TPOXX or ST-246. Vaccinia Immune Globulin intravenous (VIGIV) originally licensed for use in complications related to smallpox vaccination is also available for post exposure treatment.
The CDC will take requests for vaccines, Tecovirimat and VIGIV only from State or Territorial health authorities. Medical countermeasures for monkeypox can be obtained by calling the CDC Emergency Operations Centre at 770-448-7100. The CDC can be reached for information by also calling 1-800-CDC-INFO in the US (1800 232 4636)
The general risk of acquiring this infection is currently extremely low. It is nowhere as highly transmissible as COVID-19. The risk of dying from this disease is very low. It has no potential to cause a pandemic.
Stay calm and arm yourself with knowledge.
Ref: www.WHO.Int www.cdc.gov
Dr. Bertha Serwa Ayi is an infectious disease consultant who has been in practice for over 17 years as a specialist.
Www.berthaayi.com
Email: Serwabb@berthaayi.com
By Dr. Kojo Cobba Essel
WHEN Dorcas reaches for a chilled bottle of her favourite soft drink after lunch, she rarely considers its long-term effects on her health. For the 29-year-old secretary in Accra, the sweetness is comforting. The tiny print on the label—numbers, percentages and scientific terms—feels too distant to warrant concern.
“I take these drinks because they are less expensive compared to natural fruit juice. They are easy to get. Sometimes the drinks paired with a bun, buff loaf, cookies or biscuits serve as a full meal,” she says.
Nutrition experts, however, warn that a single 300ml bottle of soda can contain as many as nine cubes of sugar, almost twice the recommended daily limit.
“Even when you dilute it, the sugar content doesn’t reduce. Your tongue may not taste it, but your body absorbs every gram,” says Harriett Nuamah Agyemang, Country Director of SEND Ghana, which is leading advocacy for Front-of-Pack Labelling (FOPL) to help consumers make healthier choices.
Rising consumption and growing risk
Professor Richmond Nii Okai Aryeetey, a Public Health Nutrition Expert at the University of Ghana, says a recent study shows that one-third of Ghanaian adolescents consume sugary drinks at least once a day.
“Before the end of 2025, Ghana has already purchased almost US$1.3 billion worth of sugar-sweetened beverages. There is not enough data, but we know enough to see that consumption is high and rising, especially among the youth,” he indicates.
According to the Ghana Living Standards Survey, households spend nearly three per cent of their income—about GH¢2,200 annually—on sugary drinks.
Prof. Aryeetey says diets dominated by sugar, salt and fat, common in Ultra-Processed Foods (UPFs), are driving increases in hypertension, diabetes and heart disease.
“Ultra-processing takes food to another level. You combine ingredients that are intensely refined, and add industrial formulations, colours, flavours, sweeteners, that never appear in home cooking,” he explains. He identifies doughnuts, pizza, ketchup, burgers, and fizzy drinks as common UPFs.
The numbers behind the burden
The World Health Organisation (WHO) estimates that non-communicable diseases (NCDs), including stroke, heart disease, diabetes and cancers, account for 48 per cent of all deaths in Ghana.
In 2019, the age-standardised mortality rate for major NCDs stood at 750 per 100,000 males and 563 per 100,000 females. Projections indicate that by 2034, nearly 41 per cent of all deaths could be linked to complications from four major NCDs: stroke, heart attack, heart failure and chronic kidney disease, largely driven by unhealthy diets.
Ghana Health Service (GHS) data shows that in 2024 alone, more than 584,000 people were diagnosed with hypertension and nearly 200,000 with diabetes. In the first half of 2025, a further 255,000 hypertension cases and 88,000 diabetes cases were recorded.
Public health experts describe this as evidence of a “sick food environment”, where consumers are surrounded by cheap, aggressively marketed products high in salt, fat and sugar.
Convenience foods and changing lifestyles
From instant noodles and tomato paste to packaged snacks and fizzy drinks, UPFs have become staples in homes, schools, and workplaces.
Ms Agyemang links the trend to changing lifestyles.
“People spend hours in traffic and get home late. They go for the quick options canned, instant or fried. But the long-term cost to their health is enormous,” she says.
Ghana’s current labelling regulations require nutritional information to be placed on the back of packages, often in fine print that many consumers struggle to interpret.
“Even educated consumers struggle with it. For the ordinary person, it’s even more confusing,” she adds.
Front-of-Pack Labeling
Several countries, including South Africa, Nigeria, Mexico and Chile, have adopted Front-of-Pack Labelling, using simple symbols or colours to indicate high levels of salt, sugar or fat.
The WHO says FOPL enables consumers to identify healthier options at a glance and encourages manufacturers to reformulate products in order to avoid warning labels.
“It doesn’t only guide shoppers. It forces companies to compete on health, not just price,” Ms Agyemang notes.
At Rawlings Park in Accra, food vendor, Asia Bintu, says she checks only expiry dates.
“I don’t understand the numbers and those tiny inscriptions. Canned foods are cheaper and easier to cook,” she says.
Advocates say such responses reflect low food literacy, underscoring the need for public education and regulation.
Health system under pressure
Maxwell Bisda Konla, Principal Dietician at the University of Ghana Hospital, says Ghana’s progress in improving national nutrition has slowed.
“Obesity, hypertension and other NCDs are rising at an alarming rate as Ghanaians shift from traditional fibre-rich foods to highly processed meals, sugary drinks and refined carbohydrates,” he says.
Heart disease, kidney failure, and liver complications now feature prominently in mortality data.
He calls for stronger policies to limit the importation and marketing of unhealthy foods while promoting local alternatives such as brown rice, whole grains, fruits, vegetables, nuts, and seeds.
Schools as a focal point
Labram Musah, National Coordinator of the Ghana NCD Alliance, says schools are critical to reversing current trends.
“Children are increasingly exposed to unhealthy diets, especially in urban areas. What they eat in schools shapes their lifelong habits,” he says.
He advocates regulation of foods sold in and around schools, and the introduction of practical nutrition education, including school gardens and healthy meal plans.
“It’s not enough to tell children what to eat. We must make healthy options available and affordable. Imagine if every school had a small garden, it would change how children think about food.”
Mr Musah also urges the integration of FOPL into Ghana’s broader NCD prevention strategy, alongside salt reduction, sugar taxes and restrictions on marketing UPFs to children.
Evidence from Africa
A randomised controlled trial in Kenya involving 2,198 shoppers found that FOPL significantly improved participants’ ability to identify sugar, salt and saturated fat in packaged foods and reduced intentions to buy unhealthy products, particularly when black warning labels were used.
A South African study similarly found that simplified Front-Of-Pack Labels were more effective than detailed back-of-pack tables in helping consumers identify unhealthy foods.
Prevention as priority
The WHO says clear labelling can drive product reformulation and reduce diet-related diseases over time.
“Reading a label could be the difference between good health and a lifetime of medication. If we don’t act now, we will keep spending millions treating preventable diseases,” Ms Agyemang warns.
For Ghana, a stronger focus on prevention could reduce pressure on health facilities already managing growing NCD caseloads.
Nutrition advocates say introducing Front-of-Pack Labelling would strengthen Ghana’s response to NCDs by making nutritional quality visible at the point of purchase and supporting healthier decision-making.
Advancing SDG Three
The rising burden of diet-related NCDs poses a significant challenge to achieving Sustainable Development Goal Three, which aims to reduce premature deaths from NCDs through prevention and treatment.
Improving Ghana’s food environment through clearer labelling, salt and sugar reduction policies and better access to affordable healthy foods is considered essential to meeting these targets.
By prioritising preventive nutrition policies and healthier diets, Ghana could reduce avoidable illness, ease pressure on the health system and advance efforts to ensure healthy lives and well-being for all.
-GNA
THE past few years I have been thinking a lot about how to make the life of elderly parents fulfilling and with less stress on our lives. How we should also prepare adequately for our golden years while we provide guidance to our children and grandchildren.
These thoughts have on several occasions shifted to peri-menopause and menopause, and the role of finance and wellness in all this cannot be taken for granted.
As Christmas draws closer, thoughts of people being “so busy” we neglect the elderly keeps flooding my mind. Age does creep up on us. One minute you are a toddler, then a teen, with neither fears nor cares, and in a blink of an eye you are a parent of teens who will remind you that being around for over half a century is old.
Is 50 that old? I do not think so, but a lot depends on what we have been doing for most of the 50 years. It is never too late to make changes.
As we trudge through life most of us never think about the challenges that our elderly parents may face, and we are just not prepared when reality stares us in the face. Every age bracket has its unique issues and between 40 to 65 years we often have quite a lot on our plate; supporting our elderly parents, putting our own lives in order and guiding our young ones.
Necessary steps to enhance life of elderly
- Never boss or try to “parent” your parents
- Think about this; we unconsciously start “ordering” our parents. Telling them what to do without finding their preferences etc. Parenting our parents is one of the challenges many elderly parents endure silently. Stop It!
- Ask for their opinion
- Being old does not mean one no longer has opinions. Ask. Argue in love, discuss issues such as exercise, medication, hospital visits, food, friends, religion, and politics. Everything. By all means seek their opinion.
- Do not over treat them medically
- Not every change you see in an elderly person requires medical intervention. Be careful what you buy medicines for and stay away from unnecessary tests. Make sure you speak to a knowledgeable health professional.
- Hospital stays should be as brief as possible
- Plan hospital or clinic visits to make them as short and convenient as possible. If possible, get tests and consultations done on the same day. If it is not an emergency find out if the medical facility has special arrangements for the elderly and also check the time of days with the shortest wait time. Many elderly people do not like the stress of hospital environments and why should they?
- When admitted for an illness, work together with the medical team to ensure they are home as soon as possible. Most of them do best in familiar surroundings and home is numero uno.
- Have them stay at home for as long as possible
- Sometimes children are in a hurry to send parents off to homes that care for the elderly. People often ask where they could get such support. I think we should all plan to keep parents at home for as long as humanly possible. Sometimes we do not have the option of having them at home, but we need to explore all our options.
- Help them to socialise
- Organise time with friends etc. at home and out of home. This brings a breath of fresh air to everyone including our elderly parents. This makes them happier, healthier and they live longer.
- …and the more time we spend with our elderly parents, the longer they live.
- Ensure physical activity
- No matter one’s age and medical condition, there is always a form of physical activity to engage in. It may be as simple as making fists or moving arms, but every movement goes a long way to make life better
- Sunlight is a must. Do whatever it takes to ensure at least one gets a few minutes of sunlight a day.
- The presence or chance to see beautiful plants is a bonus worth going the extra mile for.
- Spend quality time with the elderly this Christmas
- We are already in December and the world is already preparing for Christmas. Spending time with the elderly during the season is PRICELESS!! Yes, you can make some time for that.
Steps to prepare for our own golden years
- Start a wellness plan or continue if you already have one
- It is a must!! Learn to breathe, build muscle, move to ensure your heart is happy and even more important parts of your brain that protect you from dementia will grow.
- Keep in touch with your classmates
- They have known you for years and a phone call or occasional visit or gathering definitely ignites memories and it brings “warmth” beyond your wildest imagination
- Surround yourself with younger people
- They can support you in many ways and their visits brighten your day while your advice is priceless to them. It is a win-win situation.
- Avoid loneliness at all costs
- You are not an island. Even if you think you are better off on your own and with your thoughts, nature does not agree with that. Kindly make a few good friends.
- Protect your brain / memory
- Dementia is a matter of when and not if; exercise will enlarge the part of the brain that controls memory. Having a larger hippocampus means it takes longer for dementia to show up.
Age will definitely catch up with each of us if we hang around Earth long enough. It is a matter of when and not if so we should take steps to make our golden years and those of our loved ones happy and fulfilling. I will choose SUCCESSFUL ageing over USUAL ageing any day.
AS ALWAYS LAUGH OFTEN, ENSURE HYGIENE, WALK AND PRAY EVERYDAY AND REMEMBER IT’S A PRICELESS GIFT TO KNOW YOUR NUMBERS (blood sugar, blood pressure, blood cholesterol, BMI)
Dr. Kojo Cobba Essel
Health Essentials Ltd (HE&W Group)
(dressel@healthessentialsgh.com)
Dr. Essel is a Medical Doctor with a keen interest in Lifestyle Medicine, He holds an MBA and is an ISSA Specialist in Exercise Therapy, Fitness Nutrition and Corrective Exercise. He is the author of the award-winning book, ‘Unravelling The Essentials of Health & Wealth.’
Thought for the week (1) – “Ageing comes with Psychosocial challenges such as neglect, abuse, sexual adjustment, emotional disorders, other mental health challenges, issues with living arrangement and several others. Let us all help to make life easier and more enjoyable for the elderly”-Kojo Cobba Essel
BY Dr. Kojo Cobba Essel
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