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
The call often comes at the worst possible moment. A mother is bleeding heavily after childbirth. A road crash victim has been rushed into surgery. A child with severe anaemia needs an urgent transfusion.
Then comes the message to relatives: “The patient needs blood. Find donors.”
Within minutes, family members begin making frantic calls, sending WhatsApp messages, and appealing on social media. Some race from one hospital to another in search of matching donors. Others simply pray that blood arrives before it is too late.
For many Ghanaians, this is their first encounter with a reality healthcare professionals know all too well-blood remains one of the country’s most critical and vulnerable healthcare resources.
Despite years of progress, experts say Ghana’s blood collection, storage, and transfusion system still faces significant gaps that affect access, quality, and safety. And in emergencies, those gaps can cost lives.
A system built out of necessity
For decades, hospitals across Ghana collected blood however they could because patients needed it. There was no law governing blood services. There was simply the urgent need to save lives.
It was only in 2020 that Parliament passed the Blood Service Act (Act 1042), establishing the National Blood Service (NBS) as the agency responsible for ensuring safe and adequate blood supplies nationwide.
Charity and philanthropy
According to Dr. Shirley Owusu-Ofori, Chief Executive Officer of the NBS, the law marked a major shift toward a coordinated national system. But reforming practices that evolved over generations remains a challenge.
The blood that is not there
One of the biggest weaknesses is Ghana’s continued dependence on family replacement donors. These are relatives and friends who donate blood only when someone they know requires a transfusion.
The preferred option, experts say, is a strong pool of voluntary, unpaid donors who donate regularly, allowing blood to be available before emergencies occur.
“The blood should be waiting when the emergency happens, not the other way round,” Dr. Owusu-Ofori said.
The numbers reveal the challenge.
The World Health Organization recommends that countries collect at least 10 units of blood per 1,000 people.
Ghana currently collects about 6.6 units per 1,000 population, an improvement from previous years but still well below the recommended threshold. Yet demand continues to rise.
An estimated 80 to 85 per cent of blood requests in Ghana are for emergencies, leaving little room for delays.
More than a bag of blood
Many people assume donated blood goes straight to a patient. It does not. Every unit must first be screened for infections such as HIV, hepatitis B, hepatitis C, and syphilis. It must then be processed, stored under strict temperature conditions, and transported safely.
Blood itself is not a single product. Red blood cells, plasma, and platelets all require different storage conditions and handling procedures.
Maintaining those standards requires specialized equipment, trained personnel, and continuous monitoring.
And that is where another challenge emerges.
The infrastructure gap
Across the country, some hospitals lack adequate blood storage facilities and the specialized equipment required to operate fully functional blood banks. Others depend on nearby facilities for supplies when emergencies arise.
While healthcare workers often improvise to meet patients’ needs, experts warn that blood safety cannot depend on improvisation.
Storage conditions, transportation systems, and quality controls must work every time.
A breakdown anywhere along the chain can compromise blood quality and patient safety.
Unequal access
Geography presents another challenge. For years, Ghana relied on three major blood centres in Accra, Kumasi, and Tamale to serve the entire country. The arrangement made blood collection and distribution across vast regions difficult and expensive.
To address this, the National Blood Service has established five regional blood centres in the Greater Accra, Ashanti, Northern, Volta, and Central regions.
More are planned.
But with 16 regions nationwide, large areas still remain underserved.
The result is uneven access to blood and blood products, particularly for facilities located far from regional centres.
Closing the regulatory gaps
The Food and Drugs Authority (FDA) says recent assessments have uncovered compliance challenges across the blood sector.
According to Dr. Edwin Nkansah, Director of Vaccine Vigilance and Clinical Trials at the FDA, gaps exist across the entire transfusion chain, from donor recruitment and testing to storage and transfusion practices.
To strengthen oversight, the FDA is embarking on a programme to regulate and license selected blood facilities across the country. The aim is not punishment, he stressed, but improvement.
Facilities will undergo audits, receive technical support, and be guided to meet approved standards.
The goal is simple: ensuring that blood transfused in any hospital meets the same safety requirements.
The missing link
For all the discussions about infrastructure, regulation, and accreditation, experts agree that the biggest solution lies with ordinary citizens.
Every unit of blood starts with a donor. Yet voluntary blood donation remains far below what the country requires.
Health officials estimate that if just one per cent of eligible Ghanaians donated blood regularly, shortages could be dramatically reduced.
That would mean fewer desperate appeals from hospital wards and fewer families scrambling for donors during medical emergencies.
A race against time
Ghana has made important strides in strengthening blood services. Collection rates are improving. Regulatory oversight is expanding. New regional centres are being established. Yet significant gaps remain.
And for the mother experiencing postpartum haemorrhage, the accident victim on the operating table, or the child awaiting a transfusion, those gaps are not statistics. They are the difference between life and death.
Until safe blood is available whenever and wherever it is needed, Ghana’s blood system will remain a critical work in progress—one whose success depends not only on regulators and hospitals, but also on the willingness of citizens to roll up their sleeves and donate.
Because when blood is missing, every second matters.- GNA
Health Essentials
The role of GAPHTO in disease prevention in Ghana, public health, national development
Every day across Ghana, thousands of public health professionals wake up before dawn and head into communities, schools, markets, health facilities and households. They inspect sanitation conditions, monitor disease outbreaks, educate communities on healthy practices, investigate health threats and help prevent epidemics before they occur.
Yet despite their critical contribution to national health and development, many Ghanaians know very little about the men and women behind these efforts.
These are the Public Health Technical Officers (PHTOs) — a dedicated workforce that operates largely behind the scenes but serves as one of the country’s most important lines of defence against disease and public health emergencies.
Now, the newly elected President of the Ghana Association of Public Health Technical Officers (GAPHTO), Mr Owusu Ansah Asante, wants to change that.
Having assumed office this year, Mr Asante has placed visibility, professional recognition and strategic advocacy at the centre of his leadership agenda. His goal is to ensure that the work of Public Health Technical Officers is better understood, appreciated and supported by the public, policymakers and development partners.
While doctors and nurses are often the most visible faces of healthcare, Public Health Technical Officers perform preventive functions that help stop diseases before people require medical treatment.
They are involved in environmental sanitation, disease surveillance, outbreak investigations, health promotion, food hygiene inspections, water quality monitoring, vector control and community health education.
Their work becomes especially critical during disease outbreaks such as cholera, meningitis, yellow fever and other infectious diseases that threaten communities.
“When outbreaks occur, our members are among the first responders in the field,” Mr. Asante explained. “They work directly with communities to identify risks, educate the public and implement preventive measures that save lives.”
According to him, preventive healthcare remains one of the most cost-effective investments any nation can make because it reduces the burden on hospitals while improving the overall health and productivity of citizens.
“Many people only think about healthcare when they visit a hospital. Yet there are professionals working every day to prevent diseases before people become patients. That contribution deserves greater public appreciation and support,” he said.
Founded in 1984, GAPHTO has evolved into one of Ghana’s most significant public health professional associations.
Today, the association boasts more than 4,000 members working across districts, municipalities, metropolitan assemblies, regional health directorates and various public health institutions nationwide.
For more than four decades, the association has contributed to Ghana’s efforts in disease prevention, environmental health management, sanitation improvement and public health education.
Members have played active roles in major national health interventions, helping to address public health challenges ranging from sanitation-related diseases to epidemic preparedness and response.
Despite these contributions, Mr Asante believes the profession has not received the level of recognition that matches its impact.
“There is a lot of excellent work being done across the country by Public Health Technical Officers. Unfortunately, much of this work goes unnoticed because it happens quietly in communities. One of our goals is to tell these stories and help people understand the importance of what our members do,” he said.
For the new GAPHTO President, increasing visibility is not merely a public relations exercise.
Instead, he sees communication and public engagement as strategic tools for strengthening public health outcomes and attracting support for preventive healthcare initiatives.
Under his leadership, the association plans to strengthen its communication efforts, improve engagement with the media, expand public education activities and highlight the achievements of members across the country.
Mr Asante believes greater visibility will not only enhance public appreciation for the profession but also create opportunities for partnerships, policy influence and professional development.
“We want GAPHTO to become a household name in matters of public health and disease prevention. When people hear about sanitation, disease surveillance, health promotion and community health protection, they should immediately recognise the role of Public Health Technical Officers,” he said.
Beyond visibility, the new leadership is committed to building the capacity of members to respond to emerging public health challenges.
Rapid urbanisation, climate change, population growth and evolving disease patterns continue to create new public health risks that require innovative solutions and highly skilled professionals.
Mr Asante noted that his administration will focus on continuous professional development, leadership training, research and knowledge sharing to ensure members remain equipped to address contemporary health challenges.
“We live in a rapidly changing world. Public health professionals must continue to upgrade their skills and knowledge to respond effectively to new and emerging threats,” he said.
The GAPHTO President is convinced that the association’s work extends far beyond the health sector.
According to him, effective disease prevention and environmental health management contribute directly to economic growth, educational outcomes and national productivity.
Healthy communities are more productive, children are able to attend school consistently and families spend less on medical treatment when diseases are prevented before they occur.
This, he argues, makes Public Health Technical Officers important contributors to Ghana’s broader development agenda.
“Public health is not only about health. It is about development. It is about creating environments where people can live productive lives and contribute meaningfully to society,” he explained.
As part of his vision, Mr Asante is seeking stronger collaboration between GAPHTO and government institutions, development agencies, civil society organisations, academia and the private sector.
He believes partnerships will be essential for addressing complex public health challenges that require coordinated action across multiple sectors.
The association also hopes to create stronger platforms for advocacy on issues relating to sanitation, environmental health and disease prevention.
As Ghana continues to pursue universal health coverage and strengthen its health systems, Mr Asante believes Public Health Technical Officers must occupy a more prominent place in national conversations about healthcare and development.
His message is simple: disease prevention deserves as much attention as disease treatment, and the professionals who dedicate their careers to protecting communities deserve greater recognition.
For decades, they have worked quietly in the background, helping to keep Ghanaian communities healthy and safe.
Under the leadership of Mr Owusu Ansah Asante, GAPHTO hopes that story will no longer remain hidden.
The association’s new chapter seeks not only to strengthen the profession but also to ensure that the thousands of men and women who stand on the frontlines of disease prevention finally receive the visibility their contributions have long deserved.
By Geoffrey Buta
