Close-up of monkeypox lesions on the arm and leg of a female child. Human infection with monkeypox-like virus in 4 year-old female in Bondua, Grand Gedeh County, Liberia. This infection was caused by a pox virus of the vaccinia, variola, monkeypox type.

The Ministry of Health (MOH) has just issued a press release to confirm a case of imported monkeypox infection in Singapore.

According to its press release on Thursday, the patient is a 38-year-old Nigerian who arrived in Singapore on 28 April and tested positive for the virus on 8 May.

MOH states that the patient is currently in stable condition and housed in an isolation ward at the National Centre for Infectious Diseases (NCID).

MOH in its release said, “The patient reported that prior to his arrival in Singapore, he had attended a wedding in Nigeria, where he may have consumed bush meat, which could be a source of transmission of monkeypox virus,”

It has been revealed that the man had been staying at 21 Lorong 8 Geylang, the address of Hotel 81 Orchid, before he was hospitalised. He had also attended a workshop at 3 Church Street on 29 and 30 April.

On 30 April, he developed fever, muscle ache, chills and skin rash. MOH noted that he remained in his hotel room most of the time between 1 and 7 May.

He was taken to Tan Tock Seng Hospital by ambulance on 7 May 7, and was referred to NCID that same day.

23 people were identified by MOH during its tracing efforts as those who came into close contact with the patient.

These people include 18 individuals who attended the same workshop, one staff member of the workshop venue and four hotel employees.

MOH said, “Close contacts of the patient have been assessed by NCID and offered vaccination, which can prevent the disease or reduce the severity of symptoms,”

“As a precautionary measure, they will be quarantined and monitored for 21 days from their date of exposure to the patient.”

According to the World Health Organisation, Monkeypox is a rare viral zoonosis (a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe. With the eradication of smallpox in 1980 and subsequent cessation of smallpox vaccination, it has emerged as the most important orthopoxvirus. Monkeypox occurs sporadically in central and western parts of Africa’s tropical rainforest.

Secondary, or human-to-human, transmission can result from close contact with infected respiratory tract secretions, skin lesions of an infected person or objects recently contaminated by patient fluids or lesion materials. Transmission occurs primarily via droplet respiratory particles usually requiring prolonged face-to-face contact, which puts household members of active cases at greater risk of infection. Transmission can also occur by inoculation or via the placenta (congenital monkeypox). There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population.

Early stage symptoms (0-5 days) of the disease are fever, intense headache, lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle ache) and an intense asthenia (lack of energy); Skin eruption period (within 1-3 days after appearance of fever) in which the various stages of the rash appear often beginning on the face and then spreading elsewhere on the body. The face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of cases) are most affected. Evolution of the rash from maculopapules (lesions with a flat bases) to vesicles (small fluid-filled blisters), pustules, followed by crusts occurs in approximately 10 days.

Monkeypox is usually a self-limited disease with the symptoms lasting from 14 to 21 days. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and severity of complications.

The case fatality has varied widely between epidemics but has been less than 10% in documented events, mostly among young children. In general, younger age-groups appear to be more susceptible to monkeypox disease.

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