Lessons learned from the World Health Organization’s late initial response to the 2014-2016 Ebola outbreak in West Africa

Amao, Lateefat Kikelomo; Olatunji, David Idowu; Igbodo, Gordon; Chieloka, Okoli Solomon; Amaechi, Ifeanyichukwu; Goni, Muhammad Isa; Ehiakhamen, Odianosen; Aderinola, Olaolu; Ogunleye, Adesola; Ogunbode, Oladipo; Adeleye, Adesola; Arowolo, Tajudeen; Suleman, Kabiru; Hassan, Abubakar; Yelwa, Mohammed Usman; Inam, Nsikak; Akinpelu, Afolabi; Fahad, Muhammad; Jinadu, Kola; Onoh, Ikenna; Akinrogbe, Jessica Toyin; Ilori, Elsie; Abaye, Biobelu; Richard, Ikwuogu; Nwadiuto, Ifeoma; Diemebonso, Oyaba; Nwakaego, Ogbue; Owhodar, Emmanuel; Okpokoro, Evaezi; Ihekweazu, Chikwe

doi:10.4081/jphia.2022.2184

Cited by 15 publications

(15 citation statements)

References 16 publications

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“…Before 2018, no outbreaks had been reported between the outbreak in Sangha Mbaéré prefecture during 1983-1984 and the outbreak in Mbomou prefecture in 2001 (17,18). We observed a similar pattern in areas of sporadic endemicity, where recent outbreaks occurred in Cameroon in 2018 after 29 years of absence (30), in Sierra Leone in 2014 after 44 years (31), and in Nigeria in 2017 after 39 years (32). More generally, the recent increase in the number of outbreaks in CAR has been mirrored elsewhere, in West Africa and the Congo Basin region, and seems to reflect improvements in surveillance, as well as increased viral circulation in a region experiencing major ecologic disturbances (33).…”

Section: Discussionsupporting

confidence: 72%

National Monkeypox Surveillance, Central African Republic, 2001–2021

Besombes¹,

Mbrenga²,

Schaeffer³

et al. 2022

Emerg. Infect. Dis.

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M onkeypox, caused by monkeypox virus (MPXV), a member of the Orthopoxvirus genus, was considered a rare emerging disease before a multinational outbreak was identified in May 2022 (1).After global smallpox eradication in 1977, monkeypox became the most concerning human Orthopoxvirus infection. Clinical manifestations of monkeypox typically resemble those of smallpox, including a febrile prodrome and subsequent disseminated maculopapular rash, including vesicles and pustules, that occurs in successive stages (2). Lymphadenopathy is a prominent feature of monkeypox and usually does not occur for smallpox and chickenpox (3). Illness is less severe and death less likely among monkeypox cases than smallpox cases, but monkeypox mortality rates vary and are higher for clade I (formerly the Congo Basin clade) than for clade II (formerly the West African clade) viruses (2). Prior smallpox vaccination can confer cross-immunity for monkeypox, but smallpox vaccination programs worldwide ended in the early 1980s (4).In 1970, a human monkeypox case was reported from Basankusu, Equateur Province, Democratic Republic of the Congo (DRC) (5). Subsequent sporadic monkeypox cases were reported among human and animal populations from remote areas of Central Africa during the 1970s and 1980s (6,7). Since 1990, increases in the frequency and scale of epidemics in Africa have been reported for clade I and, to a lesser extent, since 2000 for clade II. Since 2016, confirmed monkeypox cases have been reported in DRC, Central African Republic (CAR), Republic of Congo (hereafter Congo), Nigeria, Sierra Leone, Liberia, and Cameroon (6). The true burden, circulation rates, and geographic range of this emerging disease remain unknown because many countries lack systematic routine monkeypox surveillance and affected areas often are remote (8,9).An outbreak of human monkeypox disease occurred outside Africa in 2003, after infected animals from Ghana were imported into the United States

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Section: Discussionsupporting

confidence: 72%

National Monkeypox Surveillance, Central African Republic, 2001–2021

Besombes¹,

Mbrenga²,

Schaeffer³

et al. 2022

Emerg. Infect. Dis.

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“…3 Pool prevalences forest plots of the cutaneous lesion characteristics and sites long-term follow-up cohort assessments. More studies from outside Africa, now that 37 non-endemic countries have reported cases are necessary to contribute to the growing volume of data, in addition to the increasing number of studies appearing in 2022 from African countries [84][85][86]. Even more, assessing the impact of spreading events, including the pride parties and festivals on Grand Canary island in Spain or Belgium, needs better evaluations [18,36,41,42,[71][72][73].…”

Section: Discussionmentioning

confidence: 99%

Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Benítes-Zapata

Ulloque-Badaracco

Alarcón-Braga

et al. 2022

Ann Clin Microbiol Antimicrob

104

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Introduction A multicountry monkeypox disease (MPX) outbreak began in May 2022 in Europe, leading to the assessment as a potential Public Health Emergency of International Concern (PHEIC) on June 23, 2022. Some observational studies have partially characterised clinical features, hospitalisations, and deaths. However, no systematic reviews of this MPX outbreak have been published. Methods We performed a systematic review with meta-analysis, using five databases to assess clinical features, hospitalisations, complications and deaths of MPX confirmed or probable cases. Observational studies, case reports and case series, were included. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In addition, we carried out a subgroup analysis according to the continents and a sensitivity analysis excluding studies classified as having a high risk of bias. Results A total of 19 articles were included, using only 12 articles in the quantitative synthesis (meta-analysis). For 1958 patients, rash (93%, 95% CI 80–100%), fever (72%, 95% CI 30–99%), pruritus (65%, 95% CI 47–81%), and lymphadenopathy (62%, 47–76%), were the most prevalent manifestations. Among the patients, 35% (95% CI 14–59%) were hospitalised. Some 4% (95% CI 1–9%) of hospitalised patients had fatal outcomes (case fatality rate, CFR). Conclusion MPX is spreading rapidly, with a third of hospitalised patients, but less than 5% with fatal outcomes. As this zoonotic virus spreads globally, countries must urgently prepare human resources, infrastructure and facilities to treat patients according to the emerging guidelines and the most reliable clinical information.

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“…Individuals with MPX have an incubation period of 7 to 21 days before the onset of clinical manifestations [ 14 ], such as fever, headache, muscle aches, back pain, chills, rash, and lymphadenopathy [ 15 , 16 ]. Complications of MPX may include pneumonitis, encephalitis, visibly life-threatening keratitis, and secondary bacterial infections [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Situation of Monkeypox Transmission by Possible Sexual Contact: A Systematic Review

et al. 2022

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Monkeypox (MPX), a zoonotic infection caused by the monkeypox virus (MPXV), has re-emerged worldwide with numerous confirmed cases with person-to-person transmission through close contacts, including in sexual networks. Therefore, this study aimed to determine the epidemiological situation of monkeypox transmission by possible sexual contact. A systematic literature review was conducted using PubMed, Scopus, Web of Science, and Embase databases until 18 August 2022. The key search terms used were “monkeypox”, “sexual contact”, “sexual intercourse” and “sexual transmission”. A total of 1291 articles were retrieved using the search strategy. After eliminating duplicates (n = 738) and examining by title, abstract, and full text, 28 studies reporting case reports of monkeypox with a detailed description of clinical features, sexually transmitted diseases, method of diagnosis, location and course of skin lesions, and treatment were included. A total of 4222 confirmed cases of monkeypox have been reported, of which 3876 monkeypox cases are the result of transmission by sexual contact distributed in twelve countries: 4152 cases were male with a mean age of 36 years. All confirmed cases of monkeypox were diagnosed by reverse transcriptase-polymerase chain reaction (RT-PCR). The most frequent clinical manifestations were fever, lymphadenopathy, headache, malaise, and painful perianal and genital lesions. The most frequent locations of the lesions were perianal, genital, oral, trunk, upper and lower extremities. Patients were in good clinical condition, with treatment based on analgesics and antipyretics to relieve some symptoms of monkeypox. A high proportion of STIs and frequent anogenital symptoms were found, suggesting transmissibility through local inoculation during close skin-to-skin or mucosal contact during sexual activity. The highest risk of monkeypox transmission occurs in men who have sex with men, and MPXV DNA could be recovered in seminal fluid. It is essential to establish health policies for the early detection and management of patients with monkeypox.

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Lessons learned from the World Health Organization’s late initial response to the 2014-2016 Ebola outbreak in West Africa

Cited by 15 publications

References 16 publications

National Monkeypox Surveillance, Central African Republic, 2001–2021

National Monkeypox Surveillance, Central African Republic, 2001–2021

Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Epidemiological Situation of Monkeypox Transmission by Possible Sexual Contact: A Systematic Review

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