Health Essentials
Monkeypox outbreak 2022 …and what you need to know
Introduction
It was a warm day in October 2003 in San Diego, California, USA. I was attending the Infectious Disease Society of America’s annual conference. I passionately stood up at a meeting to express my thoughts about media reports connecting Ghana, my country of birth, to a monkeypox outbreak in the US. Fifty three people had contracted monkeypox in a multistate outbreak.
It turned out that after testing and investigation by the CDC, the infection was related to prairie dogs purchased as pets at a pet store in Illinois. The prairie dogs had been kept close to rodents imported from Ghana, a country where the human monkeypox disease has never been reported to date. These rodents were later found to test positive for the monkeypox virus.
The prairie dogs became infected as a result of proximity to the infected rodents and then transmitted the infection to their owners. This resulted in a ban on importation of African rodents into the US to date to prevent further outbreaks. That was the last time the US had an outbreak of monkeypox disease. No one died in the outbreak. One child developed a brain infection or encephalitis.
Monkeypox, a disease caused by the monkeypox virus, occurs very infrequently and in very scattered locations in parts of Africa. There are two clades (or types) of the virus: a West Africa (WA) clade in which 1 to 3.6 out of 100 infected patients die (1% to 3.6% mortality) and the Congo Basin (CB) variant, in which about 10 out of 100 infected patients can die (10% mortality). So far, the virus isolated in this current outbreak is of the West African variant, implying that the risk of dying from this disease is very low.
Background
The outcome of the 2003 outbreak reflects concepts in the natural history of the disease. It is a zoonosis in which humans get infected from infected animals. Monkeypox disease is usually a mild self-limited illness caused by the monkeypox virus. It usually does not require treatment. It can be severe in children, pregnant women, and those with impaired immune systems.
The virus belongs to the orthopox family of viruses. It is a disease that affects animals. It was first discovered in a laboratory monkeys in Copenhagen, Denmark in 1958. The monkeys had been imported from Singapore to study the polio vaccine, giving rise to the name, “monkeypox”. Since then there have been a few more outbreaks in laboratories around the world including the US. However, mentally, people tend to associate it with Africa because in 1970, the first human case was reported in an African child.
Since its discovery in 1970, there have been infrequent occurrences in a few locations around the world. From January 1, 2022, to May 1, 2022, the Democratic Republic of Congo reported 1,238 cases with 57 deaths, while Nigeria reported 46 cases and no deaths. In July and November of 2021, two travelers returning to the US from Nigeria were diagnosed with monkeypox and recovered. Between 2018 and May 2022, there have been nine cases related to travel in non-endemic countries: Two in the US, five in the UK, one in Israel and one in Singapore. None of the travel companions were infected, and only one healthcare worker in the UK became infected.
On May 18, 2022, a man in Massachusetts with no history of travel was diagnosed with a confirmed case of the disease, and eight suspected cases are under investigation. This is occurring at a time when 250 cases have been reported since May 13, 2022, in 18 countries, in persons who have not travelled to the countries where cases have occurred in the past- suggesting a worldwide outbreak. These countries include USA, Canada, Portugal, Spain, Australia, France, Germany, Italy, Netherland, Sweden, and the United Kingdom. Portugal and Spain have the largest numbers. The cases have been found mainly, but not exclusively, in men who have had sex with men, and are seeking care in sexual and outpatient clinics for a rash appearing around the genital areas.
Signs and symptoms
Monkeypox disease starts with a headache, fever, cough, sore throat, and lymphadenopathy (enlarged lymph nodes) accompanied by muscle aches and a profound sense of exhaustion. This lasts about three days and occurs about five to 21days after exposure to an index case. This period of carrying the disease without showing symptoms is known as the incubation period. These initial symptoms are followed by a rash. The rash is made up of flat lesions (macules), which progress to palpable flat-topped rashes (papules), and then to fluid-filled lesions (vesicles). These rashes start around the mouth, progressing to the head, chest and abdomen, and then to the arms and legs, including the palms of the hands and soles of the feet.
Symptoms can mimic chickenpox, smallpox, and syphilis. However, smallpox disease does not present with enlarged lymph nodes. Chickenpox disease has rashes at various stages of development while in monkeypox the stages of the rash is the same on all parts of the body. Chickenpox rash starts on the hands and moves to the centre of the body while the rash of monkeypox starts in the centre parts of the body and marches to the arms and legs. The monkeypox rash is deep in the skin and, therefore, firmer to touch. The individual rashes may have a dimple or appear umbilicated. The fluid in these rashes are infectious. Over a period of two to four weeks, the rashes will scab over and subsequently become noninfectious.
The infected person can transmit the infection in three main ways: direct contact, respiratory droplets and inanimate objects. This period of being infectious starts a day before the person is feverish, and if he or she has a rash, during the whole period of the active rash. First, very close contact may cause the virus in bodily fluids to get onto another person. Second, large respiratory droplets from the sick person can be inhaled leading to infection. Finally, fomites (particles of clothing or other inanimate objects) from the body of the patient can cause the disease to be transmitted too. A pregnant woman can also transmit to her unborn child leading a congenital infection and still birth.
Infection by droplets can occur if an individual is within three to six feet of sick persons. Unlike chickenpox, monkeypox is not airborne and cannot travel for long distances. In this current outbreak, the rash is in the genital area and seems to be occurring in men who have sex with men suggesting that close contact with the skin around the genital area of an infected person is key to the transmission.
Diagnosis
Diagnosis is established by finding the virus using with real time polymerase chain reaction (PCR) or DNA sequencing performed on body fluids from infected persons. There are three categories of sick persons for consideration in view of disease control and mitigation methods.
A suspected case is any person of any age presenting with an unexplained acute rash in a non-endemic country, who has a fever, lymph nose swelling and other characteristic symptoms, and whose rash cannot be explained by causes such as chickenpox, chikungunya virus, zika virus, dengue fever, drug reaction or the more common causes of an acute rash.
A probable case is a suspected case who also has the following: an exposure to a confirmed case, travel history to an endemic country, multiple anonymous sexual partners in the last 21 days, hospitalised or tested positive for the orthopox family of virus with an antibody test or other testing method.
A confirmed case is a probable or suspected case whose bodily fluids have been tested to be positive for the monkeypox virus by real time PCR testing or sequencing. This person should isolate for 21 days, and his or her contacts should be monitored closely.
Prevention and control action points
All doctors and healthcare workers worldwide should be on the lookout for all cases and report to local authorities to allow prompt diagnoses and prevent spread.
All probable and confirmed cases should be reported to the World Health Organisation.
Hospitals and healthcare workers should use standard contact and droplet precautions when they care for these patients. Masks must be worn when in proximity with an infected person because of the respiratory method of transmission. Healthcare workers must promptly identify infections so that confirmed or suspected patients can isolate themselves and prevent transmission and curtail the outbreak.
Specimen from infected, suspected, and probable cases should be handled with care when being transported to designated equipped laboratories to prevent transmission to the laboratory staff.
Treatment and vaccination
In September 2019, a new vaccine, JYNNEOS, was licensed by the FDA for prevention of smallpox and monkeypox in people older than 18 years of age. It was made from the Modified Vaccinia Ankara- Bavarian Nordic (MVA-BN), a live non replicating virus. Its other names are IMVAMUNE, MVA, or IMVANEX. ACAM 2000 is a live vaccinia virus vaccine that was approved in 2007. It tends to cause self inoculation and has been associated with heart muscle inflammation in 5.7 out 1000 recipients. It has 85 per cent efficacy against the monkeypox and has received emergency access investigational drug use for other orthopox viruses such as monkeypox in an outbreak. Both vaccines can be deployed in individuals whose risk of disease acquisition is high and in healthcare workers who have been exposed or may be exposed to the disease.
Tecovirimat is an antiviral agent that occurs in oral formulation and intravenous forms approved by the FDA in July, 2018, and in May 2022 respectively for the treatment of smallpox. Tecovirimat can be used to treat severe monkeypox and is available by calling the US CDC. It goes by the name TPOXX or ST-246. Vaccinia Immune Globulin intravenous (VIGIV) originally licensed for use in complications related to smallpox vaccination is also available for post exposure treatment.
The CDC will take requests for vaccines, Tecovirimat and VIGIV only from State or Territorial health authorities. Medical countermeasures for monkeypox can be obtained by calling the CDC Emergency Operations Centre at 770-448-7100. The CDC can be reached for information by also calling 1-800-CDC-INFO in the US (1800 232 4636)
The general risk of acquiring this infection is currently extremely low. It is nowhere as highly transmissible as COVID-19. The risk of dying from this disease is very low. It has no potential to cause a pandemic.
Stay calm and arm yourself with knowledge.
Ref: www.WHO.Int www.cdc.gov
Dr. Bertha Serwa Ayi is an infectious disease consultant who has been in practice for over 17 years as a specialist.
Www.berthaayi.com
Email: Serwabb@berthaayi.com
By Dr. Kojo Cobba Essel
Health Essentials
Revival Outreach Church donates food items, others to Street Academy
The Revival Outreach Church in La on Friday presented food items to the Street Academy in Accra.
The gesture was to support the academy to take care of the underprivileged children and help in the organisation of an Easter picnic for the children on Easter Monday.
The items worth over Gh₵27,000 include rice, sugar, maize, tin fish, gari, toiletries, clothes and many others.
Led by Rev. Prof. Abednego Okoe Amartey, immediate past Vice Chancellor of the University of Professional Studies, Accra (UPSA) said the gesture was to put smiles on the faces of the children and also encourage the staff of the Academy for the good work.
He said the presentation has been an annual thing and believes it has come to stay.
According to him, it was important for other churches and organisations to join the effort to keep these children off the street and be trained in their areas of interest.
Rev. Emmanuel Amuzu who presented the items commended the staff and management of the Academy for the good work it was doing to giving the children a bright future.
He said the items were not meant for the children alone, adding that, “part of it would go to the teachers who train these children. That should serve as an incentive to them.”
He lauded the vision of the Academy Director, Ataa Lartey and urged more organisations to offer similar support.
“What the Academy is doing is massive. These are children who on regular days would roam the streets and grow up becoming social deviants. Parents should try to be more responsible taking care of their wards.
“However, traditionally when a child is born, his or her development and upbringing becomes the responsibility of the society. It is the reason we, as a church, would continually support the academy to keep these children to get the training to be responsible adults,” he explained.
The Director of the Academy, Ataa Lartey thanked the leadership and members of the church for the presentation which he said would go a long way to ease the burden on them.
By Spectator Reporter
Health Essentials
‘Every birth counts’: The critical need to improve emergency maternal care in Ghana
Imagine a young woman in labour, her heart racing, her unborn child in distress. She arrives at a district hospital — tired, scared, and in need of immediate care. What happens next determines whether she lives, whether her baby survives — and whether another Ghanaian family is shattered by a preventable loss.
A recent study in the Lower Manya Krobo Municipality of the Eastern Region is shedding new light on the realities of emergency obstetric and newborn care (EmONC) in Ghana. The findings are sobering — but they also reveal a clear path forward.
Why this matters now
Despite progress in maternal health, far too many Ghanaian women are still dying from childbirth-related complications. Ghana’s maternal mortality ratio is estimated at 308 per 100,000 live births — nearly 20 times higher than the average in high-income countries.
“We know what the problems are, and we know how to solve them,” says Dr Reuben Esena, one of the study authors. “The question is: are we willing to invest where it matters most — in women’s lives?”
What the study found
The research, published in the International Journal of Science Academic Research, evaluated three key hospitals — St. Martins Catholic Hospital, Atua Government Hospital, and Akuse Government Hospital — which serve a population of over 108,000 in Lower Manya Krobo.
The study reviewed 271 cases of obstetric complications and found that the most common were:
– Foetal distress (18 per cent)
– Complications from previous C-sections (13 per cent)
– Pre-eclampsia and eclampsia (8 per cent)
– Cephalopelvic disproportion and breech deliveries (7 per cent)
These complications are not rare, nor are they unpredictable. Most are entirely preventable or manageable — with timely intervention and well-equipped facilities.
A mixed picture: Progress and gaps
The good news? All three hospitals provide round-the-clock EmONC services, staffed by midwives, medical officers, and anaesthetists. Life-saving drugs like oxytocin and magnesium sulfate are widely available. Caesarean sections and manual placenta removal are routinely performed when needed.
The bad news? None of the facilities had an infant laryngoscope — essential for newborn resuscitation. Only one had ergometrine to control bleeding after childbirth. And not a single case utilised assisted vaginal delivery — even where it might have been appropriate.
In some cases, multiple complications overlapped, such as foetal distress plus severe pre-eclampsia. For a woman in that situation, every minute counts. Every delay risks two lives — or more.
Who’s Most at Risk?
Women aged 25–29 years had the highest number of complications — a reminder that even “prime age” pregnancies can be dangerous without the right support. But adolescents and women over 40 faced some of the most severe risks, including eclampsia, foetal death, and difficult labour.
“Our younger girls, especially those between 15–19 years, are particularly vulnerable,” the study noted. “They come late to the hospital, sometimes after trying traditional remedies at home. By the time they arrive, it’s often too late.”
A national crisis demands national response
The maternal health challenges in Lower Manya Krobo reflect a broader national reality. Many districts across Ghana lack the full complement of staff, drugs, and equipment required for quality EmONC services.
But the solutions are not out of reach.
So what must we do?
1. Invest in life¬-saving supplies and training: Every hospital handling deliveries should be equipped with the full range of emergency tools — including items as simple, but critical, as an infant laryngoscope or ergometrine injection.
2. Improve documentation and digital health systems: Accurate records allow clinicians to track complications and adjust care accordingly. Ghana’s shift to digital health must prioritise maternal health systems.
3. Decentralise comprehensive EmONC: More health centres and CHPS compounds need capacity to offer basic EmONC. Complications don’t wait for referrals — care must be accessible at the first point of contact.
4. Promote community education: Women and families must be educated on the importance of antenatal care, early referrals, and hospital deliveries, especially in rural areas where myths and delays still cost lives.
Every woman deserves a safe birth
This study is more than data — it’s a call to action. Behind every statistic is a mother, a child, a family. Ghana has the knowledge, the workforce, and the policy framework to make maternal death a thing of the past.
What remains is commitment — not just in funding, but in leadership, in community involvement, and in valuing every single life.
As the researchers conclude: “Emergency Obstetric and Newborn Care is not a privilege. It is a right — and one that Ghana must deliver.”
By Henry Okorie Ugorji
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