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[ANALYSIS] Mapping the spread of Monkeypox

NCDC mums on claim Monkeypox figure not true reflection of actual cases




Following spikes in cases worldwide, the World Health Organization (WHO) and the United States have declared monkeypox a public health emergency.

The US government declaration came barely two weeks days after WHO described monkeypox as a public health emergency of international concern.

The US which has detected more than 8,900 cases as of August 9, described the declaration as part of the Biden-Harris Administration’s comprehensive strategy to combat the monkeypox outbreak.


At least 31,800 confirmed cases have been reported from 90 countries and territories since the start of 2022.

In 2022, the first case was found on May 6, in the United Kingdom in a person with travel ties to Nigeria, which is where the initial cluster of cases was found. Since its discovery in Central and West Africa, monkeypox has never before spread so widely elsewhere.

The virus does not fall under the category of a sexually transmitted infection. However, a research published in the New England Journal of Medicine, indicated that sex, particularly sex between men, was the mode of transmission for 95 per cent of cases of monkeypox.

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Europe has recorded the most cases among all continents. While infections continue to spiral, mortality has been very low. The disease has killed more than five globally this year.

What is Monkeypox?

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe. With the eradication of smallpox in 1980 and the subsequent cessation of smallpox vaccination, Monkeypox has emerged as the most important orthopoxvirus for public health.

Monkeypox primarily occurs in central and west Africa, often in proximity to tropical rainforests, and has been increasingly appearing in urban areas. Animal hosts include a range of rodents and non-human primates.

The recent outbreak has seen eleven countries in Africa reporting cases.

Top ten countries with highest confirmed case (1)

Monkeypox has its origin in the Democratic Republic of the Congo and Nigeria where it is endemic. The monkeypox virus usually does not spread easily between people.

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The first human-reported case was diagnosed in the DRC in 1970, in a 9-month-old boy in a region where smallpox had been eliminated in 1968.

Since then, most cases have been reported from rural, rainforest regions of the Congo Basin, particularly in the Democratic Republic of the Congo and human cases have increasingly been reported from across central and west Africa. The virus mainly spread through people exposed to infected animals, either through bites or scratches or preparing meat from wild game.

According to research, the number of monkeypox cases in the DRC has increased. From 2010 to 2019, there were more than 18,000 confirmed or suspected cases, up from roughly 10,000 occurrences from 2000 to 2009, and more than 6,000 suspected cases in 2020. According to the WHO, Nigeria has reported more than 200 confirmed cases and more than 500 suspected cases since 2017.

NCDC mums on claim Monkeypox figure not true reflection of actual cases

Meanwhile, a Nigerian Professor of medicine and infectious diseases at Niger Delta University in Nigeria Dimie Ogoina alleged that health officials in Nigeria slowed down their search for new cases during the Monkeypox outbreak in 2017.

Ogoina in a report published by National Public Radio (NPR) July, 2022, said the number of cases in Nigeria was not an accurate representation of actual cases.

“Over time, interest and attention to Monkeypox just dropped. Surveillance declined. The number of cases we’ve had in Nigeria is not a true representation of actual cases because we are not doing sufficient surveillance”, he said.

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The ICIR sent multiple messages to the NCDC official email address, WhatsApp number and Twitter account requesting a response to what  the professor said but has not received any response as of the time of filing this report.

However, a prominent Nigerian virologist  Oyewale Tomori in a 2021 article, titled ‘Monkeypox in Nigeria: why the disease needs intense management’, attributed the likely reason for under-representation of monkeypox cases in 2021 to the fact that many people were avoiding healthcare facilities for the fear of contracting COVID-19 disease.

In another article, published in May 2022, the Virologist further confirmed that Nigeria probably doesn’t know how much of the monkeypox disease they have.

He said, “In Nigeria, we probably don’t know how much of the disease we have because surveillance is not what it should be. We are definitely missing many of the monkeypox cases in the rural areas.

“From September 2017 to the end of April 2022, Nigeria reported a total of 558 suspected cases with 231 (41.4 per cent) confirmed. This year, from January 1 to April 30, we have reported 46 suspected cases and confirmed 15 from 7 states. No death has been recorded this year.”

“The surveillance of diseases in Nigeria was affected by the COVID pandemic. Take Lassa fever, for example. Nigeria confirmed 1181 Lassa fever cases in 2020, the year COVID came, in 2021, the number of confirmed cases dropped significantly to 510, less than half of the number confirmed in 2020. Now that the effect of COVID is waning and things are gradually returning to normal, the number of confirmed Lassa fever cases for the first four months of the year 2022 stands at 759.”

“The same situation has been reported for the surveillance and reporting of other diseases. The over-concentration and shift of resources to respond to COVID and the fear of contracting COVID in health facilities contributed to the low numbers reported from 2020 to 2021 for a host of diseases, including yellow fever and measles. There has also been a drop in delivering routine vaccines to Nigerian children. In Oyo State, Nigeria, measles coverage dropped from 77.0 per cent in 2019, to 64.6 per cent in 2020 while yellow fever vaccine coverage dropped from 74.5 per cent in 2019 to 58.6 per cent in 2020.”

Meanwhile, Onoiga also explained the new behaviour of the virus and how he was able to detect that cases are now spreading from person to person, rather than from an animal, after discovering the first known Nigeria case of MoneyPox in 38 years in an 11-year-old boy who visited his clinic on September 22, 2017, with an unusual skin rash and sore within his mouth.

“He had extensive lesions affecting his face and all over his body.”

He said they had to send a test sample from the boy to Senegal and even to the U.S. to make a diagnosis due to Nigeria at that time not having proper testing facilities, which showed that the boy had monkeypox.

Few weeks after the reported boy case, according to the report, more cases began appearing across the country, affecting people not fitting the typical profile for monkeypox patients.

He said they began seeing cases in men in their 20s and 30s and not from men hunting animals, but from middle-class men, living in busy, modern cities.

A study by researchers, including Ogoina published in 2019 into the 2017 monkeypox outbreak, titled “The 2017 human monkeypox outbreak in Nigeria—Report of outbreak experience and response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria on the outbreak”, confirmed that the little boy actually contracted the virus from a male cousin in his home rather than from an animal.

The report went on to state that the virus that causes Monkeypox could now move from person to person more readily and did not require an animal to jump from to a human. That it might be capable of sustaining transmission from person to person in a way that it was previously unable to.

The ICIR confirmed that Nigeria in September 2017, notified the WHO of a suspected outbreak of human monkeypox in Bayelsa State.

The WHO in a report published on its website in December 2017, said from 4 September through 9 December, 172 suspected and 61 confirmed cases have been reported in different parts of the country.

Since the 2017 reported outbreak, Nigeria has reported more than 900 suspected cases, according to data from WHO and NCDC.

Between September 2017 and June 2021, Nigeria had 466 suspected Monkeypox cases of which 205 were confirmed. Of the confirmed cases, there were 88 in 2017, 49 in 2018, 47 in 2019, 8 in 2020 and 34 in 2021. There have been twelve deaths since September 2017.

Author profile

Olayinka works with The ICIR as the Social Media Manager, Reporter and Fact-checker. You can shoot him an email via [email protected] You can as well follow him on Twitter via @BelloYinka72

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