We ask African researchers for their advice for Canada on monkeypox. this is what they said

When Yap Boum saw the first headlines this year about the outbreak of a rare disease in several countries, instead of surprise, she felt a sense of déjà vu.

Not only had he heard of monkeypox, which had long been endemic in West Africa, including Cameroon, where he resides, but the attention paid to it followed a pattern familiar to what he had seen during his work on the ebola That was it: generally ignored until cases appeared in the US and Europe.

“If you see your neighbor’s house on fire, don’t close your window, go and help him; because if he doesn’t, he will get to him at some point,” Boum, an epidemiologist at Epicenter, the research arm of Doctors Without Borders, told the Star from Yaoundé, Cameroon’s capital.

“We are interconnected,” he said. “We shouldn’t see the disease that occurs in the South as something that won’t come back to us in the West.”

With more than a thousand confirmed cases in Canada and the United States declaring a national health emergency, many are wondering what will happen next with monkeypox. For experts in West and Central Africa, regions where the disease is endemic in about a dozen countries, it’s a familiar but deeply frustrating story.

They have warned for years about the threat, pushed for more research funding to address outstanding questions about the disease, and are now watching the West gain access to the vaccine as they continue to grapple with infections.

These researchers have an idea of ​​the best way to keep outbreaks under control and prevent the next big health threat. Now, finally, the world is paying attention.

A history of decades

Although many Canadians had never heard of monkeypox before May, the first human case of the disease dates back to 1970, in the Democratic Republic of the Congo.

As it is an Orthopoxvirus, from the same family as smallpox, this vaccine also protects against it.

Many countries, including Canada, stopped giving the smallpox vaccine when the disease was eradicated around 1980, although the government kept a reserve, in case terrorists ever deliberately caused an outbreak.

Nigeria is often included in the story that monkeypox is endemic in Africa. But a new outbreak there in 2017 prompted scientists to alert the global community that the disease was spreading in ways they hadn’t seen before.

In 2017, an 11-year-old boy was the first suspected case in that country in nearly 40 years. Nigerian scientists wrote in a paper that was published in the Lancet Infectious Diseases in 2019, describing how more cases, mostly among young adults, were quickly confirmed in multiple states. The disease was also spreading from person to person in cities, whereas in the past outbreaks had occurred more in rural areas.

The current cases in Europe and North America, the first substantial human-to-human spread outside the African continent, in addition to a 2003 US outbreak caused by prairie dogs, were reported in May this year in the United Kingdom. They appear to be a West African Subtype called the West African clade (although there are calls to change the name as it stigmatizes the region).

Nigerian virologist Dr. Oyewale Tomori suspects a connection between the 2017 Nigerian outbreak and the current global one, with the virus “establishing itself undetected” in Europe until it took hold in gay and bisexual men in a couple of events. spring superspread. . Some of the first European cases they date back to raves in Spain and Belgium, and gay pride events in the Canary Islands.

But Dr. Emmanuel Agogo, a Nigerian expert fellow at the Africa Centers for Disease Control and Prevention and a Kofi Annan Global Health Leadership Fellow, says the only thing he can really tell the world for sure if the outbreaks current come from Nigeria, is analyzing the genetic fingerprint of the disease, a process that is underway.

The search for answers and financing

Many of the big questions about monkeypox are still difficult to answer, because it was neglected long before the West caught on, Boum said. For example, experts don’t believe it has historically been sexually transmitted, but Boum said hearing about recent cases in gay men made scientists want to go back and look at this question again.

“The challenge is that there hasn’t been any funding for that,” he said, from Western governments or aid agencies. “If we had, we would be better equipped to respond to what is happening in the West today.”

There should also be funding to study animals with the disease, to understand which species primarily drive transmission, he added.

So far there have been no deaths from monkeypox either in Ontario, where there are now 511 confirmed cases, or in Canada. The cases have been overwhelmingly in men who have sex with men. In Ontario, 99 percent of cases have been in male patients, with an average age of 36, according to the most recent data from Public Health Ontario.

The province’s chief medical officer of health, Dr. Kieran Moore, said Monday that he is confident in the vaccination strategy, with more than 20,000 people receiving injections for the disease. However, he did confirm that there was recently a case involving someone at a homeless shelter in Toronto, which is concerning because the homeless are generally more vulnerable.

Some fight outbreaks without access to vaccines

As Canada and other Western countries try to contain monkeypox, the Democratic Republic of the Congo (DRC) is also dealing with a serious outbreak, without any vaccine, Boum said, something that “doesn’t really make sense.”

There is no monkeypox vaccine available anywhere in Africa, but The Associated Press reported this week that talks were underway with partners to supply them.

There have been 4,000 cases in the Democratic Republic of the Congo this year and around 176 deaths, Boum added.

They are classified as the “Congo Basin clade,” a subtype that is thought to be more fatal than the West African type, which is Canada. But it’s hard to know when not all infections are confirmed, and the best care isn’t available for all patients, Boum said.

All three experts agree that surveillance, testing, contact tracing and isolation of confirmed cases are key to controlling cases.

What worked for them included creating a task force to monitor the Nigerian outbreak; laboratory testing capacity building; and increase awareness and advocacy, Agogo said.

Canada should focus on those principles, and not just rely on vaccines, added Tomori, a former professor of virology and a former World Health Organization regional virologist.

“If you put all of that in place, you can actually nip it in the bud,” he said.

Boum’s advice to Canadian public health officials and governments is to also identify vulnerable populations who are at risk, whether they are children, older adults or immunocompromised people, such as those with HIV.

“That’s where we have real concern, because it’s affecting a young population now,” and the number of deaths in the West has been very low.

There have been some positive developments stemming from this most recent outbreak, Boum added, as “an opportunity for the South to implement research and properly understand the disease.”

In the Central African Republic (CAR), researchers are about to start the second round of a clinical trial for the experimental drug Tecovirimat. Now that monkeypox has a higher profile, they have more funding from Oxford University.

If other countries continue to neglect these viruses, Boum said, they will eventually show up on their doorstep anyway.

“If you don’t go to the deep jungle of the Congo or the Central African Republic, it will just come to you.”

The climate change factor

These types of outbreaks will become more common, Agogo added, with more diseases jumping from animals to humans, as monkeypox originally did in the 1970s, because habitats are shrinking.

Scientists have pointed out to the climate emergency as a driver for this, as changing temperatures push animals into new areas and bring diseases and parasites with them.

A study published Monday in the journal Nature Climate Changefound that more than half of all infectious diseases in humans, including Lyme, West Nile, and HIV, were made worse by climate change.

Already another new virus that appears to come from animals, called Langya henipavirus (LayV), has infected at least 35 people in China, but has so far not caused any deaths.

“No one is safe until everyone is safe,” Agogo said.

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