Authors: Emmanuel A. A. Ubiu & Emmanuel Matua. Date: Monday,16 September 2024.
Country: South Sudan, Uganda.
Source: 17 commercial trucks confiscated at Nimule and Nesitu for crossing into South Sudan without being tested. (Eye Radio website)
While only a few cases have been reported in countries like Uganda and South Sudan, health authorities are enhancing surveillance, testing, and cross-border cooperation to prevent further spread. Drawing on lessons from the COVID-19 pandemic, swift global action is crucial to control mpox and prevent a potential future pandemic. Here we discuss how Mpox has an ability to completely disrupt cross-border trade.
Reminiscing about how Corona virus (COVID-19) affected the globe, disrupting key areas like health, education, economy, supply chains, travel, tourism, and entertainment, could the world be at the brink of another pandemic?
Key health organizations like WHO and Africa CDC; have already declared Mpox a public health emergency of international concern (PHEIC).
Mpox previously called monkey pox is a zoonotic (a virus transmitted to humans from animals) that occurs primarily from tropical rainforest areas of Central and West Africa and is occasionally exported to other regions. Mpox is caused by a virus called monkey pox virus and its symptoms are like those seen in small pox patients though less severe.
In 1980, following eradication of smallpox, pox subsequently emerged. The same year it was noticed that people younger than 40 years and not vaccinated against smallpox were susceptible to get infected by Mpox. Currently Mpox is considered the most potentially life-threatening orthopox virus, with a case fatality rate historically noted between 3-6%.
It has two genetic clades, Congo Basin (CB, Clade I) Clade, also known as Central African (CA) clade and the West Africa C (WA, Clade II). The latter is less severe after infection.
However, a new lineage B.1, classified as clade 2b for its close relationship to clade 2b, has been identified in 2022 global outbreak. This new B.1 lineage has been associated with strains circulating in Nigeria during the 2017 outbreak.
In addition, experts say that this clade 1 has further evolved into clade 1b which transmits more easily.
Signs and symptoms
Mpox presents with the following features; skin rash, fever, sore throat, intense headache, body aches, back pain, body pain, body weakness, low energy, swollen lymph nodes and mucosal lesions that can take 2-4 weeks to disappear.
At times symptoms can disappear even without treatment but it is very important to seek medical help once you feel one or two of these symptoms.
How it spreads
Mpox can be spread through a number ways that may not only be limited to the following; Person to person contact.
This can happen in one of the several ways; Close contact with skin lesion and body fluids, inhaling contaminated particles (respiratory droplets) or viruses, contaminated materials such as needles, beddings, tattoos, linen, clothing, eating utensils, sex toys etc.
However, the most reported mode of transmission is sexual intercourse.
Comparison between Mpox and Covid-19
While both diseases are zoonotic, meaning they can be transmitted from animals to humans, they differ in many ways as discussed below;
The incubation period of Mpox is between 3 to 17 days and symptoms begin to show up at 21 days while the incubation period of Covid-19 is 6 days.
People with Mpox can experience severe complications mainly bacterial skin infections, Mpox affecting the brain (encephalitis), heart (myocarditis) or lungs (pneumonia), and eye problems while people with Covid-19 can lead to Acute Respiratory Distress Syndrome (ARDS) and also other complications.
People at risk
The following groups of people are at risk of getting monkey pox;
People in close interaction with Mpox patients e.g. household members and sexual partners (including commercial sex workers).
People taking care of Mpox patients without the correct use of personal protective equipment.
People, who hunt, kill, handle, butcher, and prepare animals such as squirrels, rats, mice and monkeys.
People who work in laboratories without the correct use of personal protective equipment, children, women and people who may be weak due to other health conditions.
People who have many sexual partners and/ or frequent anonymous sexual partners. Even though some people at risk more than others, it is important to remember that anyone, anywhere can get monkey pox.
Mpox in Uganda
Uganda has so far registered 11 cases of Mpox. These cases are as follows; Kasese 04, Mayuga 03, Kampala 02, Wakiso 01, Amuru 01. A total of only 4 of them have been admitted with a cumulative recovery of 06.
What has the Government of Uganda done
The Ministry of Health is closely monitoring the situation and it has put in place the following measures;
Strengthening testing capabilities at Uganda Virus Research Institute (UVRI) to test and accurately diagnose Mpox.
Intensified surveillance by all health workers to look out for patients with suspected signs and symptoms of monkey pox and reported to the Ministry of Health through the formal reporting channels.
Intensified Partner and stakeholder engagements with other Ministries, Departments and Agencies (MDAs) including Wild Life Authority to strengthen surveillance both in the animals and human health surveillance.
Several webinars are being organized nationwide to update all the health workers on the current test algorithms for Mpox and Mpox sample management from sample collection, storage and transportation.
The health workers are also being informed about the available mobile laboratories and the major testing centers. A number of health organizations working in the country such as International Rescue Committee (IRC) that operates in most Refugee Settlements in the country are especially on high alert and doing intensive surveillance on Mpox.
Mpox cases in S. Sudan
In early August 2024, South Sudan reported its first suspected cases of Mpox, a viral illness formerly known as monkeypox.
The identification of these cases raises concerns about public health readiness and the spread of the virus within the country. Authorities are closely monitoring the situation, and efforts are underway to confirm the diagnoses and implement preventive measures.
Measures by S. Sudan to curb Mpox
South Sudan is looking for ways to increase isolation units in Nimule, a border town near Uganda, as well as enhancing the capacity of Nimule Hospital laboratory.
These efforts are part of the country's preparations to address the potential spread of the disease.
Cooperation between S. Sudan and Uganda
South Sudan collaborates with Uganda in the health sector, as the infectious disease poses a public health risk to both countries.
Despite no confirmed cases in South Sudan, the close health cooperation between the two nations is in good faith to ensure that an outbreak in Uganda shouldn’t quickly impact South Sudan and vice versa. This has led to the health organizations of both countries to cooperate and work together to prevent any outbreaks in both countries.
This is done through cross-border Health Coordination meeting between the two Countries.
Effects of Mpox on cross border trade between South Sudan and Uganda
Although Mpox has not been declared a direct threat to cross border and international trade, it has significant abilities to completely disrupt trade in the East African region.
Taking a leaf from how Covid-19 affected trade, we can see how Mpox has the ability to disrupt supply chain through cross border quarantine of truck drivers who are the backbone of cross-border trade.
Conclusion
"As of now, the spread is not rampant, but looking into the infection, the exporters are definitely concerned, hoping it will not spread," Federation of Indian Export Organizations (FIEO) Director General Ajay Sahai said. This clearly shows how paranoid the trade industry leaders are about Mpox.
In conclusion, while the global community is still recovering from the far-reaching impacts of the COVID-19 pandemic, the emergence of Mpox as a public health threat demands swift and coordinated international action.
Mpox's zoonotic nature, along with its ability to spread through both human contact and various materials, poses a risk not just to public health but also to key sectors like cross-border trade, travel, and the economy.
However, the experiences gained from managing COVID-19 have better prepared health organizations, governments, and communities to respond effectively.
With increased surveillance, cross-border cooperation, and public health awareness, it is possible to contain mpox before it becomes a full-scale global crisis. The world stands at a critical juncture, and timely intervention is essential to avoid another pandemic.
[1] WHO (2024), WHO Director-General declares mpox outbreak a public health emergency of international concern, https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern
[2] Africa CDC (2024), Africa CDC Declares Mpox a Public Health Emergency of Continental Security, Mobilizing Resources Across the Continent, https://africacdc.org/news-item/africa-cdc-declares-mpox-a-public-health-emergency-of-continental-security-mobilizing-resources-across-the-continent/
[3] Relief Web (2024), Mpox Epidemic Africa, https://reliefweb.int/report/democratic-republic-congo/ifrc-disaster-snapshot-2-o-f-26-august-2024-mpox-epidemic-africa
[4] Euro News (2024), Will mpox trigger a COVID-like pandemic? Experts agree it's 'concerning' but not the same, https://www.euronews.com/health/2024/08/24/will-mpox-trigger-a-new-global-pandemic-experts-agree-its-concerning-but-not-covid
[5] Radio Tamazuj (2024), South Sudan detects two suspected monkeypox cases in Aweil, https://www.radiotamazuj.org/en/news/article/south-sudan-detects-two-suspected-monkeypox-cases-in-aweil
[6] Eye Radio (2024), Health Ministry beefs up surveillance as mpox “engulfs” S. Sudan, https://www.eyeradio.org/health-ministry-beefs-up-surveillance-as-mpox-engulfs-s-sudan/
[7] Wikipedia (2024), Pandemic, https://en.wikipedia.org/wiki/Pandemic
[8] Code Blue (2024), Key Differences Between Mpox And Covid-19, https://codeblue.galencentre.org/2024/08/27/key-differences-between-mpox-and-covid-19-dr-lim-say-hiang-dr-lim-yin-cheng-prof-dr-rafdzah-ahmad-zaki/
[9] Ministry of Health (June, 2022) Uganda Heights Surveillance ahead of Monkey Pox Outbreak https://www.health.go.ug/document/uganda-heights-surveillance-ahead-of-monkeypox-outbreak/
[10] UNICEF (June, 2024) Mpox-Flyer-August_revised.pdf PDF (www.unicef.org) https://www.unicef.org/uganda/documents/monkey-pox-mpox
[11] The East African (2024) Uganda records two imported mpox cases https://www.theeastafrican.co.ke/tea/news/east-africa/uganda-records-2-imported-mpox-cases-4712440
[12] Deccan Herald (2024), Mpox in Africa: Exporters keep fingers crossed, https://www.deccanherald.com/world/mpox-in-africa-exporters-keep-fingers-crossed-3154810
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