While monkeypox in the United Kingdom hit headlines in May 2022, Africa has a long history of combating the disease and isolating cases. Monkeypox, similar to smallpox, is a zoonotic disease that causes skin lesions, fever and body aches. In endemic countries, 3-6% of reported cases of monkeypox in Africa result in death. Monkeypox is endemic in 10 African countries, often in poor rural areas.

Smallpox only infected humans, making it simpler to eradicate through vaccination. Monkeypox also spreads from animal to human, making it more difficult to control the spread. Vaccines became readily available to non-endemic and wealthier countries this year when monkeypox cases appeared outside Africa, but are still not available to African nations, which have experienced sickness and death due to monkeypox for decades.

Strains of Monkeypox in Africa

Cases of monkeypox, specifically in sub-Saharan Africa, increased in the past 30 years. Several strains of monkeypox plague Africa, the most deadly being the Congo Basin strain that kills 10% of those infected. Despite its deadly nature, the Congo Basin strain has never strayed outside of Africa. Individuals self-isolate when infected to slow the spread. The Democratic Republic of the Congo experienced the most deaths in 2022 with 58 total deaths by June 2022. The West African strain is less deadly, with a mortality rate of 1-3%.

How Monkeypox Spreads

The first known case of monkeypox emerged in 1970 in the Democratic Republic of the Congo. At the same time that scientists were trying to end smallpox, a 9-month-old child appeared to have monkeypox. Despite its name, historically, scientists have only found monkeypox in African monkeys once. It is most commonly contracted by rats and squirrels that live in close proximity to humans.

Monkeypox can spread from human to human by symptomatic infected individuals, such as through contact with bodily fluids and skin lesions. The year 2022 is not the first time monkeypox spread to countries outside of Africa. In 2003, monkeypox entered the United States via infected prairie dogs that came into contact with Gambian pouched rats from Ghana. These dogs, sold to people through pet shops, infected the humans who came into contact with them.

Risk Factors and Treatment

The World Health Organization recommends providing food and fluids to those infected. However,  in the Democratic Republic of the Congo, 57% of residents do not have clean drinking water and 43% of children are malnourished, says Opportunity International.

Monkeypox has a higher mortality rate for the young and immune-compromised. Children infected with monkeypox in Africa have a higher risk of death than adults. During the 2017 monkeypox outbreak in Nigeria, about 57% of residents who died were HIV-positive.

In 2022, the European Medicines Agency (EMA) licensed an antiviral treatment for smallpox, known as tecovirimat, to treat monkeypox. The treatment is not readily available in Africa yet. The vaccine for smallpox is about 85% effective in protecting against monkeypox, additionally, in circumstances similar to the coronavirus vaccine hoarding by wealthier countries, wealthier countries are stockpiling monkeypox vaccines as well.

Reducing animal trade from Africa lowers the risk of creating groups of infected animals in other countries as most cases come from contact with sick and dead animals

Vaccine Inequity

From January 2022 to June 1, 2022, Africa has noted 63 deaths from monkeypox while non-endemic countries have not noted any deaths. In Africa, the sick must isolate and recover without the medications other countries provide to the sick.

Despite a history of inequity, there is hope as organizations work to extend relief to Africa.

Hope for Africa

As of May 31, 2022, Africa reported almost 1,400 cases of monkeypox to the World Health Organization (WHO) for the year 2022.

The WHO is now working with endemic African countries and other relevant parties to “bolster laboratory diagnosis, disease surveillance, readiness and response actions to prevent further infections.” The WHO is also supplying Africa with the knowledge and tools necessary to conduct testing, provide medical treatment and manage infections. The organization is also providing guidance on “how to inform and educate the public about monkeypox and its risks and how to collaborate with communities to support disease control efforts.”

The Jynneos vaccine, approved for use by the United States FDA in 2019, is known to prevent serious and fatal cases of monkeypox. Jynneos is 85% effective at preventing monkeypox cases and is administered in two doses spread four weeks apart. The WHO is working to improve access to the Jynneos vaccine in more countries, including those in Africa. While the history of monkeypox in Africa is long, organizations are working to reverse the course of health inequity often visible during global health crises.

– Sara Sweitzer
Photo: Wikimedia Commons