How NPHIL is Combating Liberia’s Monkeypox Threat with Early Action

Dr. Dougbeh Chris Nyan, Director General of the National Public Health Institute of Liberia, fifth from the left, with staff in Nimba County on September 7, 2024, to enhance border surveillance in the fight against Mpox.

Ganta, Nimba County –  When the Africa Centers for Disease Control and Prevention (ACDC) and the World Health Organization (WHO) declared Monkeypox (Mpox) a global health emergency, the National Public Health Institute of Liberia (NPHIL) responded immediately.

By Robin Dopoe, contributing writer

“Given the virulent nature of this strain of Mpox, we activated our response mechanisms right away to prepare for any eventuality,” said Dr. Dougbeh Chris Nyan, Director General of NPHIL.

The preparation included the swift activation and deployment of surveillance officers at key entry points, including Roberts International Airport and other entry points around the country, to quickly identify, assess, and respond to suspected Mpox cases.

These measures, along with a forthcoming health regulation requiring all incoming travelers to complete Mpox health declaration forms, form the backbone of NPHIL’s strategy to stay ahead of the virus and minimize the risk of widespread transmission. This comes as NPHIL has made it mandatory for incoming passengers at Roberts International Airport to be thoroughly screened for any sign of Mpox.

“The best defense against a public health threat is to prepare before it reaches your doorstep,” says Dr. Abdul-Rahman Fayiah Bah, Chair of the Department of Public Health at the African Methodist Episcopal University. “NPHIL’s early preparation means Liberia is in a stronger position to prevent a serious outbreak and protect its citizens from the fear and uncertainty surrounding this Mpox strain.”

NPHIL’s swift response is grounded in its history with the Ebola outbreak of 2014-2016, which claimed over 4,800 lives in Liberia alone, leaving an indelible mark on the country. The lesson learned during that crisis is that an early “active response mechanism” saves lives and prevents the health system from crashing.

According to experts, the lingering scars of Ebola, coupled with the threat posed by the current Clade 1b strain of the Monkeypox virus — which has a higher mortality rate than previous strains — are driving NPHIL’s vigilance to quickly detect and isolate any potential cases, thus increasing the country’s chances of containing Mpox.

The declaration of Mpox as a public health emergency by the WHO in August was the second in just two years. However, this outbreak differs from the 2022-2023 international Mpox emergency, which was driven by the Clade 2 virus and not the Clade 1b strain, which is associated with more severe illness and higher mortality rates.

To date, cases of the Clade 1b strain have been reported in Sweden, Thailand, and Pakistan, pushing the number of affected countries to over 14, with more than 16,000 suspected cases and 500 deaths. However, nearly all of the cases and deaths reported so far are in Africa, with the Democratic Republic of Congo being twice as hard-hit as any other African country. According to WHO data, children under 15 are more vulnerable to the virus, with higher fatality rates than adults.

Discovered in 1958, Mpox is a viral disease that causes skin rashes and mucosal lesions, such as mouth sores. It spreads through contact with infected animals, people, or materials. In severe forms, Mpox can also lead to brain inflammation and sepsis, and an infectious person remains contagious until all their lesions have crusted over, scabs have fallen off, and a new layer of skin has formed underneath.

“As part of our preventive measures, we are advising people to avoid proximity to infected individuals or items they have used, such as bedsheets,” says Dr. Nyan. “We are also encouraging people to isolate themselves if they show any signs of the virus.”

 In a September 5 press release, Dr. Nyan noted that Liberia has confirmed two Mpox cases since the Africa Centers for Disease Control and Prevention and WHO declared Mpox a Public Health Emergency of International Concern on August 14, 2024.

The cases, the release says, were identified in children of seven and two years old, who had fever, rash, and other symptoms characteristic of the Monkeypox virus infection in humans, and are now isolated and receiving home-based care. More than four contacts, since the two cases were established, have been traced and identified. However, it remains unclear whether or not the cases are linked to the Clade 1b strain of the virus currently spreading. Historically, Liberia has had sporadic outbreaks of the Mpox Clade 2 virus, which is less severe with a low mortality rate.

“The current cases are being sequenced, and we expect results soon to determine the strains circulating in Liberia,” Dr. Nyan said. “One reason we activated our response team early was to improve surveillance and detect cases quickly to stem any potential spread.”

While Mpox is not new to Liberia, our preparedness has positioned us to prevent severe impacts from the Clade 1b strain, thus protecting the population,” he added. “In fighting any disease of any kind, early preparation is key, and we’ve done just that.”

While waiting on the sequenced result of the two confirmed cases, NPHIL has moved to equate the Mpox cases to an outbreak, citing “the evolving epidemiological and biological dynamics as well as established guidelines.”

As part of this move, the National Incident Management System (IMS) has been activated to coordinate and manage the country’s outbreak preparedness and response in collaboration with international partners, the Ministry of Health, and local communities, among others.

 “In light of the announcement by the IMS of an outbreak situation, county health and surveillance officers of NPHIL and the Ministry of Health around the country have heightened their activities as sporadic suspected cases of Mpox have begun springing up,” Dr. Nyan says.

Dr. S. Mohammed Sheriff, a former Deputy Minister of Health during President Ellen Johnson Sirleaf’s administration, noted that NPHIL’s “early response mechanism” has significantly reduced the likelihood of any sustained Mpox transmission in Liberia, as the country is now on high alert, with systems in place to swiftly diagnose imported or locally transmitted cases and prevent further spread.

Dr. Sheriff also pointed out that Mpox does not spread as easily as COVID-19 via respiratory droplets and airborne particles.

“The NPHIL’s actions so far are commendable. Had they delayed their response, we could have been facing the potential for a widespread outbreak,” says Dr. Sheriff, who is also a lawyer and former administrator of the JFK hospital.  “The new leadership at NPHIL is working tirelessly to keep our communities safe from Mpox, which disproportionately affects women and children.”

While NPHIL’s pre-response mechanism may have led to the swift diagnosis of the current Mpox cases, challenges remain ahead, something Dr. Nyan has acknowledged. Despite the isolation of the current cases, experts noted that the situation remains fluid, and one or two people from the “case contact” may still test positive.

“We’ve learned from the past; we’re prepared for the present and the future. Our level of preparation gives us the confidence to prevent any widespread or significant Mpox outbreak in Liberia,” Dr. Nyan says.

As NPHIL is not taking the threat of Mpox lightly, it has also ramped up public awareness about the disease and prevention measures. Additionally, a plan has been made to double efforts to work closely with community leaders, health workers, and the media to ensure that accurate information reaches “every corner of the country.”

“Public awareness is the first line of defense against an outbreak,” says Dr. Bah of AME University. “When people are informed, they are more likely to take the necessary precautions to protect themselves and their families.”

“The current level of NPHIL’s awareness campaigns is good, but it needs to double its efforts so that more people are aware of the risks and know how to respond,” he added.

And so, as the threat of Mpox remains, so too does the determination of those working to protect the nation from harm.

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