The 2017 human monkeypox outbreak in Nigeria—Report of outbreak experience and response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria

Abstract

Background In September 2017, Nigeria experienced a large outbreak of human monkeypox (HMPX). In this study, we report the outbreak experience and response in the Niger Delta University Teaching Hospital (NDUTH), Bayelsa state, where the index case and majority of suspected cases were reported. Methods In a cross-sectional study between September 25 th and 31 st December 2017, we reviewed the clinical and laboratory characteristics of all suspected and confirmed cases of HMPX seen at the NDUTH and appraised the plans, activities and challenges of the hospital in response to the outbreak based on documented observations of the hospital’s infection control committee (IPC). Monkeypox cases were defined using the interim national guidelines as provided by the Nigerian Centre for Disease Control (NCDC). Results Of 38 suspected cases of HMPX, 18(47.4%) were laboratory confirmed, 3(7.9%) were probable, while 17 (18.4%) did not fit the case definition for HMPX. Majority of the confirmed/probable cases were adults (80.9%) and males (80.9%). There was concomitant chicken pox, syphilis and HIV-1 infections in two confirmed cases and a case of nosocomial infection in one healthcare worker (HCW). The hospital established a make-shift isolation ward for case management, constituted a HMPX response team and provided IPC resources. At the outset, some HCWs were reluctant to participate in the outbreak and others avoided suspected patients. Some patients and their family members experienced stigma and discrimination and there were cases of refusal of isolation. Repeated trainings and collaborative efforts by all stakeholders addressed some of these challenges and eventually led to successful containment of the outbreak. Conclusion While the 2017 outbreak of human monkeypox in Nigeria was contained, our report reveals gaps in outbreak response that could serve as lessons to other hospitals to strengthen epidemic preparedness and response activities in the hospital setting.

A Case Report of Monkeypox in a 4-Year-Old Boy from the DR Congo: Challenges of Diagnosis and Management

“…is includes lack of recognition of the disease by local and expatriate health personnel and lack of diagnostic tools at rural health facilities (however, PCR on a blood sample performed in a centralized laboratory could have confirmed the case positive). Furthermore, the diagnostic process may be delayed by logistic challenges, i.e., lack of knowledge on how to collect and send a sample safely, as well as fear among staff of handling contagious specimens, which has also been reported in other countries [12]. Finally, cases may remain undiagnosed due to reluctancy among local and expatriate health leaders to put efforts into making a correct diagnosis, as the importance of this is not recognized.…”

Suicide during COVID-19 and other major international respiratory outbreaks: A systematic review

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Infectious disease outbreak preparedness and response in Nigeria: history, limitations and recommendations for global health policy and practice

“…The monkeypox virus was first identified in 1958 in captive monkeys imported into Copenhagen, Denmark from Africa [25] . However, the first human case of monkeypox was identified in a 9-year old in the village of Bukenda, Zaire (now the Democratic Republic of Congo (DRC)) [26] .…”