Nigeria Travel Alert Issued for Monkeypox Virus Outbreak

A Level 1 Travel Alert has been issued by the US Centers for Disease Control and Prevention (CDC) for the African country of Nigeria. 

This ‘Practice Usual Precautions’ Travel Alert was issued on May 21, 2019, due to the increased risk for exposure to the monkeypox virus. 

As of April 2019, Nigerian health officials have reported more than 300 cases of monkeypox, including multiple deaths. There have been mortality rates reported to be up to 10 percent during outbreaks, with most deaths occurring in younger age groups. 

Previously, in 2018, there were 3 international travelers infected with monkeypox in Nigeria, who then returned home to the United Kingdom and one to Israel. There was also a reported secondary case of the disease in a healthcare worker in the United Kingdom. 

Most recently, in May 2019, the Singapore Ministry of Health reported a 4th exported case of the disease in a traveler who arrived from Nigeria. 

Both Canada and the UK have issued updated travel advice for visitors to Nigeria regarding monkeypox. 

These Travel Alerts are important since over 1.8 million people visit Nigeria annually.

In 2003, the USA experienced an outbreak of 37 confirmed monkeypox cases in 6 states: Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, says the CDC. 

Human-to-human transmission, while possible, is limited. A person is infectious only during the period when he has monkeypox symptoms, particularly a skin rash. 

As a precautionary measure, close contacts have been quarantined either at home or at a designated government quarantine facility and monitored for 21 days from their date of exposure to the confirmed case. 

Research suggests that the current smallpox vaccine, ACAM2000, is 85 percent effective in preventing Monkeypox when given before exposure to monkeypox. 

The vaccine is made from a virus called vaccinia, which is a "pox"-type virus related to smallpox but causes milder disease. 

ACAM2000 cannot cause smallpox, but, there are known side effects related to the ACAM2000 vaccine. 

At this time, the ACAM2000 vaccine has been stockpiled by the USA federal government for emergencies and is strictly controlled for biodefense purposes.

The ACAM200 smallpox vaccine is not commercially available in the USA, according to the CDC. 

Monkeypox is a sylvatic zoonosis with incidental human infections caused by the monkeypox virus (MPXV) and belongs to the Orthopoxvirus family. 

The disease is self-limiting, with symptoms usually resolving spontaneously within 14-21 days. 

Residents and travelers to endemic areas/countries should avoid contact with sick, dead or live animals that could harbor rodents, marsupials, and primates. 

And, should refrain from eating or handling bush-meat. 

Any illness during travel or upon return should be reported to a health professional, including information about all recent travel and immunization history. 

Timely contact tracing, surveillance measures and raising awareness of imported emerging diseases among health care providers are essential to prevent secondary cases and effectively manage monkeypox cases and outbreaks. 

The USA, Canada, and the UK are not recommending any travel restrictions for Nigeria, at this time.