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07 June 2022 | Story Prof Felicity Burt, Prof Dominique Goedhals and Dr Charles Kotzé
Prof Felicity Burt, Dr Charles Kotze and Prof Dominique Goedhals
From the left; Prof Felicity Burt, Dr Charles Kotzé and Prof Dominique Goedhals.

Opinion article by Prof Felicity Burt , Prof Dominique Goedhals , Division of Virology at the University of the Free State (UFS), and Dr Charles Kotzé, National Health Laboratory Service (NHLS), Universitas Academic Hospital.
The recent COVID-19 pandemic has certainly highlighted the importance of vigilance and awareness of emerging diseases with public health implications. The monkeypox virus has recently made headlines, after the detection of more than 200 cases in geographically distinct regions. On 13 May, the World Health Organisation (WHO) was notified of human cases of the monkeypox disease occurring in the United Kingdom, outside of the known endemic region.

Exported cases have been detected previously and usually occur sporadically. In contrast, within the past two weeks, human cases have been confirmed in at least 21 countries, including various European countries, the United Kingdom, Israel, the Canary Islands, Canada and the United States, and Australia. The initial case appears to have been a traveller from Nigeria. Sequence data may help to determine if there have been multiple exportations from West Africa. 

What is monkeypox and what do we know

What is monkeypox and what do we know about the aetiologic agent? Monkeypox is the name given to a disease caused by the monkeypox virus, a zoonotic pathogen endemic in Central and West Africa and responsible for cases of the disease in the endemic region, with occasional exported cases in travellers. The virus was initially identified in 1958 in monkeys housed at a research laboratory in Denmark, and the name monkeypox was derived from the appearance of lesions and the occurrence in monkeys. The first human case was identified 52 years ago in the Democratic Republic of the Congo. Since then, human monkeypox cases have been reported in several other Central and West African countries: Cameroon, the Central African Republic, Ivory Coast, the Democratic Republic of the Congo, Gabon, Liberia, Nigeria, Republic of the Congo, and Sierra Leone. The first monkeypox outbreak outside of Africa was in the United States of America in 2003 and was linked to contact with infected prairie dogs imported as exotic pets. Since then, there have been various small, contained outbreaks outside of Africa that have mostly been linked to the importation of the virus from African countries. 

The virus is related to the smallpox virus, which was eradicated in the 1970s by vaccination. Although belonging to the same family of viruses as the smallpox virus, the disease caused by monkeypox is less severe, with fewer fatalities.   Unlike smallpox, which carries a case fatality rate of 30%, the case fatality rate in monkeypox is low (estimated at 3-6% in more recent outbreaks).  There are two clades of the monkeypox virus: the West African clade and the Congo Basin (Central African) clade. In this outbreak, all of the cases have been linked to the West African clade of the monkeypox virus.

Transmission occurs from animal to human, and from human to human, through close contact with lesions, body fluids, and contaminated materials. The virus enters the body through the respiratory tract, mucous membranes, or broken skin.  The disease begins with non-specific symptoms such as fever, headache, muscle pains, and swollen lymph nodes. This is followed by the typical skin rash, which progresses through stages known as macules, then papules, vesicles, pustules, and lastly crusts or scabs. Lesions can also occur on mucous membranes such as the mouth, eye, and genital area.  The infectious period lasts through all stages of the rash, until all the scabs have fallen off. There are a number of other infectious and non-infectious conditions that need to be differentiated; therefore, individuals presenting with these symptoms will need to consult their doctor to determine whether a diagnosis of monkeypox needs to be considered. In the current outbreak, a number of the cases in the United Kingdom and Europe have been detected in men who have sex with men, during visits to sexual health clinics. This pattern of spread has not previously been described and it remains to be determined whether the spread has occurred through close person-to-person contact or through sexual transmission.  

Vaccination against smallpox virus offers 85% protection against monkeypox

To date, no cases have been detected in South Africa, but the recent global spread of the severe acute respiratory syndrome coronavirus 2 (SARS_CoV-2) highlights the ability of pathogens to spread. The National Institute for Communicable Diseases (NICD) in Johannesburg offers a specialised diagnostic service for the monkeypox virus, using molecular assays and electron microscopy. 

Vaccination against the smallpox virus is believed to offer 85% protection against monkeypox, hence older persons should have some protection; however, vaccination against smallpox was phased out globally following the eradication of smallpox during the 1970s. A more recently developed vaccine against monkeypox is available but has very limited availability.  No specific antivirals are available with proven efficacy in clinical trials.

While the monkeypox virus can be spread via the respiratory route, this occurs in the form of large droplets, rather than aerosol transmission, which is seen with SARS-CoV-2 (causing COVID-19). Aerosols are smaller particles that can remain suspended in the air for prolonged periods, facilitating the transmission of SARS-CoV-2. Monkeypox is therefore less contagious than COVID-19, as close contact is required for longer periods.  For this reason, many experts around the world predict that this outbreak will not spread like SARS-CoV-2. The importation of monkeypox to South Africa is a definite possibility, because South Africa is a significant economic and travel hub for Africa. Previous outbreaks of monkeypox in non-endemic areas have been interrupted by contact tracing and isolation, which was very effective in controlling further spread.  Heightened vigilance is therefore needed for the early detection of such cases.

News Archive

Socially inclusive teaching provides solution to Grade 4 literacy challenges
2017-01-23

 Description: Motselisi Malebese Tags: Motselisi Malebese

Mots’elisi Malebese, postdoctoral Fellow of the Faculty
of Education at the University of the Free State (UFS) tackles
Grade 4 literacy challenges.
Photo: Rulanzen Martin

Imagine a teaching approach that inculcates richness of culture and knowledge to individual learners, thus enhancing equity, equality, social justice, freedom, hope and fairness in terms of learning opportunities for all, regardless of learners’ diversity.

This teaching strategy was introduced by Mots’elisi Malebese, postdoctoral Fellow of the Faculty of Education at the University of the Free State (UFS), whose thesis focuses on bringing together different skills, knowledge and expertise in a classroom environment in order to enhance learners’ competence in literacy.

A teaching approach to aid Grade 4 literacy competency
Titled, A Socially Inclusive Teaching Strategy to Respond to Problems of Literacy in a Grade 4 Class, Malebese’s post-doctoral research refers to an approach that improves listening, speaking, reading, writing, technical functioning and critical thinking. Malebese, who obtained her PhD qualification in June this year, says her research confirmed that, currently, Grade 4 is a bottleneck stage, at which learners from a low socio-economic background fall behind in their learning due to the transition from being taught in their home language to English as a medium of instruction.

Malebese, says: “My study, therefore, required practical intervention through participatory action research (PAR) to create conditions that foster space for empowerment.”

PAR indoctrinates a democratic way of living that is equitable, liberating and life-enhancing, by breaking away from traditional teaching methods. It involves forming coalitions with individuals with the least social, cultural and economic power.

Malebese’s thesis was encouraged by previous research that revealed that a lack of readiness for a transitional phase among learners, teachers’ inability to teach literacy efficiently, and poor parental involvement, caused many learners to experience a wide variety of learning barriers.

A co-teaching model was adopted in an effort to create a more socially inclusive classroom. This model involves one teacher providing every learner with the assistance he or she needs to succeed, while another teacher moves around the room and provides assistance to individual learners.

“Learners’ needs are served best by allowing them to demonstrate understanding in a variety of ways, because knowledge is conveyed and accomplished through collaborative work,” Malebese said.

She believes the most important benefit of this model is assuring that learners become teachers of their understanding and experiences through gained knowledge.

Roleplayers get involved using diverse expertise in their field
Teachers, parents and several NGOs played a vital role in Malebese’s study by getting involved in training, sewing and cooking clubs every weekend and during school holidays. English was the medium of teaching and learning in every activity. A lodge, close to the school, offered learners training in mountain biking and hiking. These activities helped learners become tour guides. Storyteller Gcina Mhlophe presented learners with a gift of her latest recorded storytelling CD and books. Every day after school, learners would read, and have drama lessons once a week.

AfriGrow, an organisation that works with communities, the government and the corporate sector to develop sustainable community-driven livelihoods through agricultural and nutrition programmes, provided learners with seedlings, manure and other garden inputs and training on how to start a sustainable food garden. The children were also encouraged to participate in sporting activities like soccer and netball.

“I was aware that I needed a large toolbox of instructional strategies, and had to involve other stakeholders with diverse expertise in their field,” Malebese said.

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