Dream - Six years ago, on September 22, 2017, an 11-year-old boy came to Dr. Dimie Ogoina's clinic in Nigeria with a strange rash on his skin and sores inside his mouth. The 11-year-old boy may have been the most important patient throughout Dr. Dimie Ogoina's career as an infectious disease specialist. The boy was a patient with monkeypox infection which marked the beginning of the largest monkeypox outbreak in world history.

"He has a very large rash that affects his face and entire body," said Dr. Ogoina, a specialist in infectious diseases at Niger Delta University, Nigeria. The rash looks like chickenpox. "But the child has already had chickenpox," Ogoina said. So, he knew that wasn't the main cause. Considering the size of the rash and its location, Ogoina wondered if the child might be suffering from a very rare disease at the time: monkeypox or Mpox. "Suspicions of monkeypox arose out of nowhere," he recalled."

At that time, Nigeria did not have the capability to test the disease. So, she had to send samples from the child to Senegal and even to the US to make a diagnosis. "We had to wait." A few days later, the results came. And Ogoina's intuition was correct: the child was suffering from monkeypox. "He is the first monkeypox case in Nigeria in the last 38 years," said Ogoina.

"In the following months, he and his colleagues began to detect more than 20 additional cases in their clinic. Now scientists, including Ogoina, are starting to realize that this boy is the first case, not only for Nigeria but also for the whole world. ***This 11-year-old child is the first known case of an international monkeypox outbreak, which is currently spreading in 78 countries."

Since May 2022, the world has detected more than 20,000 cases of monkeypox, including over 7,000 cases in the US. In fact, the World Health Organization or WHO on July 23, 2022, declared this outbreak as a public health emergency of international concern. Scientists have started to understand where and when this major outbreak began. And they have traced it back to cases that occurred in Nigeria in 2017, including the first case detected in Ogoina's clinic.

Data shows that the virus has been continuously spreading among humans in Nigeria for at least the past five years. Eventually, the epidemic spread worldwide. When Ogoina first diagnosed the boy with monkeypox in 2017, he thought the virus would behave as it had for over 50 years in other parts of Africa, as explained by scientists in textbooks. This means that outbreaks usually start when someone comes into contact with infected animals. "There is speculation that this boy played with monkeys around his house," Ogoina said.

But in cases like that, the virus does not spread easily among people because it is not highly contagious, especially among adults. "In the past, monkeypox mainly attacked children," said Ogoina. As a result, previous monkeypox outbreaks have always been small. It often only involved a few dozen cases. And it will subside on its own. Ogoina and other doctors thought the outbreak in 2017 would be the same. "We thought, 'Okay, this is just the usual monkeypox that we know.'"

However, a few weeks after diagnosing the boy, Ogoina began to worry. This is because the monkeypox outbreak in Nigeria started to spread rapidly. Cases were popping up not only in the area near this boy, but also everywhere else. "Suddenly, we saw cases appearing all over the country," said Ogoina. The virus seemed to be spreading farther and faster than he anticipated. And this virus was not only infecting children, but also men in their 20s and 30s. "Young productive men were getting monkeypox," said Ogoina. "That was very unusual at the time."

"Young productive men are affected by monkeypox," said Ogoina. "It was very unusual at that time." These people also do not fit the typical profile of monkeypox patients. They do not hunt or keep animals, but rather middle-class men living in busy modern cities. Ogoina wonders: "Why doesn't it affect children? Or women? Or the elderly? Why do we only see young men, aged 20 to 40 years old?""

The following is the translation of the given 'Bahasa' text to 'English' while preserving any html tags: "In fact, recently Ogoina and his colleague finally found out that the first boy he took care of didn't even contract the virus from animals, but from a male relative in his home. And the rash or lesions that affect this patient are not the type that chooses where monkeypox attacks. Instead of on their faces, blisters also occur around their genitals. "They have very extensive genital lesions. Very, very extensive," said Ogoina.***"

Ogoina and his colleagues began to further investigate this patient. "We decided to assess the sexual history of several cases," he said. The assessment found that many patients engaged in high-risk sexual behavior, including multiple partners and sexual encounters with prostitutes. So there is a significant realization: the nature of the monkeypox virus has changed. For the first time, the virus is spreading through sexual contact. Ogoina and his colleagues even mentioned this idea in a study published in 2019: "

"Although the role of sexual transmission of human monkeypox has not been established, sexual transmission makes sense in some of these patients through close skin-to-skin contact during sexual intercourse or through transmission via genital secretions," wrote Ogoina and colleagues in the journal PLOS One. Ogoina knows that this shift in transmission has significant implications. It means that monkeypox virus can spread more easily from person to person, eliminating the need for transmission from animals to humans. It may also sustain transmission from human to human in a way that did not occur previously."

That means the outbreak in Nigeria will be much harder to stop. It could possibly last for years and eventually spread to other countries. In many ways, this finding means that monkeypox is no longer just a threat to communities in West and Central Africa, but also a potential threat to the world. Over the past few years, Ogoina said he has been trying to repeatedly warn health officials and scientists that monkeypox has changed its nature and may spread through sexual contact.

At one international meeting, he tried to suggest the possibility of monkeypox transmission through sexual intercourse. However, someone told him to keep quiet. "Yes, someone told me that I should not say it. That I should not say that sexual transmission is possible," Ogoina recalled with a desperate tone. "He told me, 'We don't need to worry about sexual transmission,'" he bitterly recalled, as quoted by NPR.***

In 2017, Nigeria reported about 200 cases of monkeypox. And then suddenly, in early 2018, the cases decreased rapidly. On the surface, it seemed like the country had successfully controlled the monkeypox virus and the outbreak had ended, just like all previous monkeypox outbreaks. But Ogoina said that was not the problem. Instead, he said health officials slowed down their search for new cases. "Over time, interest and attention to monkeypox declined. Surveillance decreased," he said.

"The number of cases we experienced in Nigeria is not a true representation of the actual cases that occurred because we did not conduct adequate surveillance," he said. New genetic data, collected by researchers worldwide, supports the Ogoina hypothesis. The data shows that indeed, the monkeypox epidemic in Nigeria never stopped. Instead, virus transmission has been silently ongoing underground for years.""

And finally, the outbreak there spread to other countries and turned into a developing international epidemic that the world is currently fighting against. Overall, these findings mean that the world has nearly five years to eradicate monkeypox. To prevent the virus from possibly taking hold, not only in Nigeria but also in Europe and North America. However, international efforts to stop the outbreak in Nigeria have been lessened compared to efforts to stop monkeypox elsewhere.

For example, when doctors diagnosed the first cases in England and Spain in May, health officials immediately urged to start immunizing people at risk or who have been exposed to the monkeypox virus with the monkeypox vaccine. In the United States, health workers have vaccinated tens of thousands of people, and the federal government has obtained over 300,000 doses of the vaccine. How many people in Nigeria have received the monkeypox vaccine? None!***

In Nigeria as well, doctors first discovered clues about a new pattern that would repeat worldwide. Many of the patients were men, and many had genital lesions, indicating transmission through sexual contact. Four years later, many cases in Europe and America also occurred in men and were also marked by genital lesions. "It's like déjà vu for me," said Dimie Ogoina as quoted by The Atlantic.

The translation of the given text from Bahasa to English while preserving any HTML tags is as follows: "Virus is known to spread through droplets and all types of physical contact with contagious wounds and sores— but sex, in particular, has never been the highest on the list of transmission risks. The unusual pattern and unusual size of the Nigerian outbreak should have been a signal that something was changing for monkeypox. But the world ignored it until it was too late, and now a global monkeypox epidemic is occurring."

Because monkeypox has become a global issue, patients in Europe and North America are quickly seeking antivirus drugs. Health workers and close contacts of patients are also offered vaccines. However, in their hospitals in Nigeria, according to Ogoina, doctors never had antivirus drugs or vaccines. What they have for monkeypox patients is supportive care. Additionally, the number of cases is likely being underestimated at the moment. "We need to enhance surveillance," he said, pointing out the need for more laboratories that can diagnose the virus, antibody surveys to study its prevalence, and monitoring of potential animal carriers.

"In Nigeria, according to Dimie Ogoina, there is inaccurate reporting of cases, especially in the sub-region of West Africa. For example, while the Nigeria Centre for Disease Control reported 21 cases in the country since January, WHO put the number between January and April at 36 cases. Ogoina attributed it to 'surveillance challenges' and a very fragile healthcare system."

"The challenges we have in our healthcare system are very deep and extensive. I will not say that we have overcome all the challenges because sometimes when you have a big problem, even if you make a lot of efforts, as long as the problem is very big, the efforts are not visible," he said. He acknowledged that there have been some improvements and the Nigerian government has taken steps to address some issues."

"Typically, before COVID-19, we only had four laboratories that could diagnose COVID-19, or even three. But now, due to the investment resulting from COVID-19, almost every state can make a diagnosis of COVID-19." ***The problem is, many African countries currently do not have sufficient facilities to diagnose monkeypox. To All Africa, Ogoina said that only the national laboratory can diagnose monkeypox in Nigeria."

"Many investments are needed and also sensitivity from the community because the community does not fully appreciate contagious diseases, and how they are transmitted," he said. "That's why we have many myths and misunderstandings when this disease emerges." Countries in Europe and North America may be able to tame the monkeypox outbreak in their countries. But "infections anywhere have the potential to become infections everywhere," said Anne Rimoin, an epidemiologist at UCLA."

During the circulation of monkeypox in Africa, this case will continue to spread elsewhere. And it will infect and kill people in Africa. Early warning signs for monkeypox have been present all this time, and they should not be ignored now.

Dr Dimie Ogoina has been warning the world about the changing pattern of monkeypox transmission for the past five years. That monkeypox can spread through sexual transmission. But he was ignored. He was even told to keep quiet. The world had to pay a high price when the monkeypox virus spread to dozens of countries, affecting tens of thousands of people. A fatal negligence. (eha) Source: NPR, The Atlantic, All Africa