Monkeypox (MPX) is a viral zoonosis with lesions like smallpox. Though rare in Nigeria, sporadic outbreaks have been reported in 17 states since September 2017. Unfortunately, the COVID-19 pandemic has further reduced surveillance and reporting of MPX disease. This study seeks to assess the effect of an enhanced surveillance approach to detect MPX cases and measure the cumulative incidence of MPX in priority states in Nigeria. We identified three priority states (Rivers, Delta and Bayelsa) and their Local Government Areas (LGAs) based on previous disease incidence. We also identified, trained, and incentivized community volunteers to conduct active case searches over three months (January to March 2021). We supported case investigation of suspected cases and followed up on cases in addition to routine active surveillance for MPX in health facilities and communities. Weekly and monthly follow-up was carried out during the same period. Out of the three states, 30 hotspots LGAs out of the 56 LGAs (54%) were engaged for enhanced surveillance. We trained three state supervisors, 30 LGA surveillance facilitators and 600 Community informants across the three priority states. Overall, twenty-five (25) suspected cases of MPX were identified. Out of these, three (12%) were confirmed as positive. Enhanced surveillance improved reporting of MPX diseases in hotspots LGAs across the priority states. Extension of this surveillance approach alongside tailored technical support is critical intra and post-pandemic.

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Background: Monkeypox (MPX) is a viral zoonoses characterized by pustular rashes similar to smallpox. It is endemic in the Democratic Republic of Congo and West Africa. The outbreak of MPX was first reported outside Africa in 2003 following horizontal infection of Prairie dogs by imported African rodents. Two distinct clades are known, the Central (more severe) and the West African clade (Mild). In Nigeria, the first confirmed case of MPX was in a 4-year old child in 1971. This was followed by a lull of 39 years. Since September 2017, sporadic outbreaks have been reported in 17 states across Nigeria. As at week 36 of 2019, Akwa Ibom reported ten suspected cases with one lab-confirmed. Methods: We revised MPX case definition and constituted a team comprising of State DSNO, Laboratory and RRT from NCDC. We identified retrospective cases from the state line list, their contacts traced and samples collected. We carried out a case-control study on the 3 cases in Mkpat Enin LGA. Twenty-one (21) pre-tested (KAP) questionnaire was administered to health care workers (HCW) and community members to access knowledge awareness and risk perception of MPX. HCWs were trained, and community sensitization carried out. We accessed the capacity of IDH Uyo to manage MPX cases and conducted a case-control study to determine the odds of association of MPX with individuals in contact with confirmed MPX cases at Mkpat Enin LGA. Results: Eight new cases identified during active case search were negative of MPX. The level of awareness of MPX amongst HCW was high (n=20); pre-test score 16.5(85%) and 18 (90%) posttest. Knowledge of clinical presentation of MPX amongst HCW was also high 17(85%). There was a high-risk perception of MPX 18(90%), assessment of best practice 16 (76%) and proper sample collection 15 (75%). CM awareness of MPX (n=20) was at 12(62%), health-seeking behaviour at 2(11%) and the consumption of giant rats and monkeys at 12(86%). There was a weak association of transmission of infection by MPX cases to individuals in contact with them {(OR=0.333, (0.0673, 1.6516), Fisher exact 0.1756}.  We identified a general apathy by HCW (Nurses) at the IDH Uyo to accept and manage MPX cases. Conclusion: The high HCW and community awareness negates the poor health-seeking behaviour of members of Ekpat Enin community due to paucity of funds to access health care or rejection by HF within the area. Monkeys and giant rats are delicacies high within the community hence a risk factor in MPX zoonoses. Consequently, individuals who consume such delicacies or come into contact with confirmed cases are at times likely to contact MPX.