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
It feels like Christmas of last year was just a couple of weeks ago. The reality though is that we celebrated what is arguably the most adored season of the year well over 300 days ago.
Many of us put ourselves in tight corners, saddling our families with debt and avoidable hardships in the early weeks of the New Year.
Quite often we discuss what to do to improve our health and this is one of those days when discussing the things to avoid comes to the fore. If we can start these today, we will have a great Christmas season and open doors to a wonderful new year.
What should we avoid so that we will not drain our energy?
- Focusing on the past
- Not getting adequate sleep
- Not drinking enough water but loading yourself with alcohol, caffeine and energy drinks
- Spending all your time working and leaving no time to rest and socialize
- Not being physically active
- Spending all your time behind screens, TV, phone, computer. Making social media king
- Eating junk food most of the time
- Being resentful, negative or surrounding yourself with people who see no good in anything
- Creating clutter and a mess wherever you are
- Trying hard to impress others
The list is endless but if you find a way to avoid the above and tap into the ones below, you will be on a great path to a Merry Christmas and a happy, healthy and successful new year.
Do these for sure:
- Listen to great relaxing music; start your Christmas carols early even if no one else is playing them (but any other relaxing music will do. I believe in the power of Music Therapy)
- Spend time in nature and get some sunlight if you are lucky to be in a place where it’s in abundance
- Make time to rest and meditate (pray and read your Bible after all its Christ’s birthday)
- Move as often as possible and make time to do deep belly breathing
- Be positive
- Surround yourself with people who make you happy
- Get adequate sleep
- Eat healthy food as often as possible and drink a lot of water
- Be grateful for what you have
- Make sure you avoid clutter
I hope these tips will help you stay in the best state of your life and remember to continue doing these for the rest of your life. Does that sound too difficult?
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/ Medics Clinic
(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 – “WHERE YOU LIVE SHOULD NOT DETERMINE IF YOU LIVE.”- WHO
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Teenage Hypertension: The silent threat to Ghana’s young generation
For many Ghanaian teenagers, high blood pressure may seem like a health problem for their parents and grandparents. But as unhealthy eating habits, excess weight and increasingly sedentary lifestyles become concerns for younger populations, protecting heart health during adolescence deserves greater attention.
The danger is that hypertension can develop without obvious symptoms. A teenager may feel perfectly healthy while elevated blood pressure goes undetected, potentially delaying medical assessment and appropriate care.
Although not every teenager with unhealthy habits will develop hypertension, early awareness, healthy lifestyle choices and appropriate blood pressure checks can help reduce future cardiovascular risks.
A growing concern
Hypertension, commonly known as high blood pressure, is a major public health concern worldwide. The World Health Organisation identifies it as an important contributor to premature death, largely because it increases the risk of serious cardiovascular complications.
While the condition is often associated with adulthood, the factors that contribute to its development can begin much earlier in life.
Frequent consumption of foods high in salt, poor dietary habits, excess body weight and insufficient physical activity can undermine cardiovascular health. Family history and certain underlying medical conditions may also increase an individual’s risk.
For teenagers, therefore, the conversation about hypertension should extend beyond hospital visits and include the everyday habits that shape their health.
When lifestyle choices become a concern
Adolescence is a period when young people begin making more independent decisions about what they eat, how they spend their leisure time and how physically active they are.
Convenience foods, processed meals, salty snacks and sugary drinks may become regular features of their diets. At the same time, long hours spent on mobile phones, computers and other digital devices can leave less time for physical activity.
Academic demands and inadequate sleep may further affect their general well-being.
These habits do not automatically lead to hypertension. However, when unhealthy diets and physical inactivity contribute to excess weight, they can increase the risk of high blood pressure, particularly among people with other predisposing factors.
Recognising these risks early offers families, schools and health professionals an opportunity to encourage healthier choices before unhealthy patterns become established.
What Ghana’s cardiovascular health figures reveal
A cardiologist and Senior Lecturer at the University of Ghana Medical School, Professor Alfred Doku, in an interview highlighted the seriousness of cardiovascular disease in Ghana, citing figures indicating that it accounted for approximately 43 to 50 per cent of deaths in the country.
He also stated that about 30 per cent of Ghanaian adults had hypertension, with approximately 70 per cent of those affected unaware of their condition.
Although these figures concern adults and the wider population rather than teenagers specifically, they point to the importance of improving awareness, screening and early detection of high blood pressure.
Professor Doku urged people to know their blood pressure readings and monitor other important health indicators, including blood sugar, cholesterol levels and body weight.
His advice underscores the importance of understanding personal health risks rather than waiting for illness to become apparent before seeking medical attention.
For adolescents, any blood pressure reading that raises concern should be assessed by a qualified health professional. Because blood pressure varies with age, growth and other factors, its interpretation in children and teenagers requires appropriate clinical assessment.
The danger of a condition without obvious symptoms
The Head of the National Cardiothoracic Centre, Dr Kow Entsua-Mensah, also stressed the importance of awareness and early detection in addressing cardiovascular disease.
He explained that hypertension could remain undetected for years because affected individuals might not experience noticeable symptoms.
Dr Entsua-Mensah noted that several factors, including diabetes, high cholesterol, obesity, physical inactivity, unhealthy diets, tobacco use and harmful alcohol consumption, could contribute to cardiovascular damage over time.
He called for greater public awareness of the importance of checking blood pressure and other health indicators before complications develop.
The challenge with hypertension is that the absence of symptoms can create a false sense of security. People may assume they are healthy simply because they feel well, overlooking the need for preventive health checks.
Dr Entsua-Mensah emphasised that addressing cardiovascular disease required cooperation among healthcare professionals, government institutions, schools, businesses, community organisations and the media.
Such collaboration is particularly important for young people, whose health habits are influenced by their homes, schools, peer groups and the wider environment.
Small habits, lasting benefits
Professor Doku said many cases of heart disease and stroke could be prevented or their risks reduced through appropriate lifestyle changes and effective management of contributing factors.
He encouraged young people to reduce their salt intake, eat balanced meals, exercise regularly and avoid smoking.
Describing hypertension as a silent threat, he warned that people should not wait for symptoms before taking their blood pressure seriously.
Hypertension, he stressed, could have serious consequences, including heart failure and stroke, when left undetected or inadequately managed.
For teenagers, protecting heart health does not necessarily require complicated routines. It begins with practical, everyday decisions: eating a balanced diet, choosing foods with less salt, participating in regular physical activity and getting adequate sleep.
Avoiding tobacco products and maintaining a healthy weight are also important steps towards reducing cardiovascular risks.
Young people who are diagnosed with hypertension should follow the advice of their healthcare providers and take prescribed medication as directed. Lifestyle changes can support treatment, but they should not replace medication when it is medically necessary.
Parents have an important role to play by encouraging healthy eating and physical activity at home. Schools can contribute by providing opportunities for exercise, promoting health education and making nutritious food choices more accessible to students.
Healthcare professionals, meanwhile, can help identify young people who may be at risk, assess abnormal readings and guide families on appropriate follow-up care.
Protecting the next generation
Addressing hypertension among young people requires more than individual effort. It calls for a coordinated response involving families, schools, healthcare providers, policymakers and the media.
Public education should challenge the perception that high blood pressure is exclusively an older person’s condition. Teenagers need accurate information about cardiovascular health, the factors that increase their risk and the importance of seeking professional advice when necessary.
Appropriate screening and follow-up care can also help identify elevated blood pressure and ensure that young people who need medical attention receive it.
However, the extent of hypertension among Ghanaian teenagers should not be inferred from statistics relating to adults. Reliable, age-specific national data are needed to establish the scale of the problem and guide targeted interventions.
That evidence gap makes it important to approach the subject with both urgency and accuracy: raising awareness of the risks without exaggerating what is known about their prevalence among adolescents.
For Ghana’s young generation, the message is clear. Feeling healthy does not always mean that blood pressure is normal, and good cardiovascular health should not be left until adulthood.
By encouraging healthier habits, improving access to appropriate health checks and making reliable information available to young people, Ghana can take meaningful steps towards protecting the heart health of its next generation.
By Esinam Jemima Kuatsinu
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