No monkeypox cases detected in SA, but more than 140 cases reported in 15 countries - NICD

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  • Cases of monkeypox have been reported to the WHO from countries that are not endemic for the virus.
  • On Monday, the NICD confirmed that no cases have been detected in SA.
  • The outbreak is unlikely to progress to a global health emergency, it said.

No monkeypox cases have been detected in South Africa, the National Institute for Communicable Diseases (NICD) confirmed in a statement on Monday.  

More than 140 cases have so far been identified in 15 countries. These include the US, UK, Australia, Belgium, Canada, France, Germany, Italy, Israel, the Netherlands, Portugal, and Spain.

The rare viral disease occurs mostly in central and west Africa, where it is endemic in 12 countries. However, the 15 countries above are not endemic for the virus.

The outbreak was first reported in the UK on 4 May 2022 in a traveller who returned from Nigeria, a monkeypox endemic area. According to the NICD, investigations have been unable to link this case to any of the other cases detected. This suggests that there have been multiple introductions of the virus into the UK and other countries, with cases potentially having gone undetected till now. 

"Although monkeypox, which is related to smallpox (which has been eradicated), sporadically causes small outbreaks, transmission is believed to be inefficient as close contact is required. Thus the current outbreak is unlikely to progress to being a global emergency," the institute added. 

NICD executive director Professor Adrian Puren cautioned:

"Currently there are no monkeypox cases in South Africa. The implications for South Africa, however, are that the risk of importation of monkeypox is a reality, as lessons learned from Covid-19 have illustrated that outbreaks in other parts of the world can fast become a global concern."

About monkeypox

Monkeypox was first identified in laboratory monkeys in a Danish lab in 1958. 

The rare viral disease is transmitted from person to person via close contact with lesions, body fluids, respiratory droplets, and contaminated materials such as bedding, notes the WHO. 

Like the coronavirus, it is a zoonotic virus (transmitted to humans from animals). While the natural reservoir of monkeypox remains unknown, it is believed that African rodents and non-human primates, such as monkeys, may harbour the virus and infect people, adds the US Centers for Disease Control and Prevention (CDC).

There are two clades of monkeypox virus: the West African clade and the Congo Basin (Central African) clade. The WHO notes that infections with the West African clade appear to cause less severe disease than the Congo Basin clade, with a case fatality rate of 3.6% compared to 10.6%, respectively.

Current cases, symptoms to look out for

The currently identified cases with known information indicate that males, mostly aged between 20-55 years, accounted for more than 70%, said the NICD.

Common symptoms that have been reported include headache, fever, painful and swollen lymph nodes, rash, myalgia (muscle and body aches), and lesions on the genitalia or peri-genital areas.

The NICD added that genital lesions have previously been uncommon in monkeypox cases and "reflect a unique aspect of this outbreak".

While the disease is generally self-limiting, with symptoms resolving spontaneously within 14 to 21 days, infection can be severe in some people, such as children, pregnant women, or people who are immunocompromised. 

Continuous monitoring

The health entity said that public health investigations were ongoing in the non-endemic countries that have identified cases.

"The situation is evolving and WHO expects there will be more cases of monkeypox identified as surveillance expands in non-endemic countries," it said on 21 May. Those who are most at risk are individuals who have had close physical contact with someone with monkeypox, while they are symptomatic, current evidence indicates.

The NICD has also requested that any residents or travellers to countries that have been affected with monkeypox should report any illness of concern to a healthcare professional, including information about all recent travel, immunisation history, and contact with any known cases, said Puren.

The WHO added that vaccination for monkeypox, where available, is being deployed to manage close contacts, such as healthcare workers.

Susan Hopkins, chief medical advisor for the UK Health Security Agency, told CNN while there was "no direct vaccine for monkeypox, we are using a form of smallpox vaccine or third-generation smallpox vaccine that's safe on individuals who are contacts of cases".

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