Mpox in Nigeria: Perceptions and knowledge of the disease among critical stakeholders-Global public health consequences.

BACKGROUND: The mpox (monkeypox) disease is a re-emerging viral zoonosis of international concern that is endemic in parts of Africa. The mpox virus (MPXV), which was hitherto largely limited to some Central and West African countries, was declared a public health emergency of international concern by the WHO on July 23, 2022 following the rapid spread of the virus to non-endemic countries. Globally, as of March 16, 2023, the WHO had reported 86,496 laboratory-confirmed cases of mpox and 111 deaths in 110 countries. Of the 1,420 cases of mpox reported in Africa as of March 16, 2023, Nigeria alone recorded 57.1% (812) of the confirmed cases and eight fatalities recorded in the continent. To help improve on the understanding of the current situation in Nigeria, the present study assessed the perception and knowledge of mpox among Nigerian healthcare workers, academics and tertiary students. The study also sought to highlight the global public health significance of the MPXV, and recommend a One Health approach to limit exporting of the virus beyond the borders of Nigeria. METHODS: A web-based cross-sectional survey was conducted between 24 July 2022 and 12 August 2022 to evaluate the perception and knowledge of mpox among 1544 Nigerians, consisted of healthcare workers (n = 832), academics (n = 306) and tertiary students (n = 462). Data on the respondents' socio demographics and their information sources on mpox were also collected. Each correct response was allotted one point while an incorrect response was scored zero. The scores for perception and knowledge were dichotomized into positive (>5.5) and negative (≤5.5) and adequate (>5.8) and inadequate (≤5.8), respectively; using the average scores for perception and knowledge. The average score for perception and knowledge were summarised and presented as the mean and standard deviation (SD). Chi-square tests of association and binary logistic regression were carried out to determine factors associated with the outcome variables. RESULTS: Of the 1452 respondents that had heard of mpox, 878 (60.5%) and 419 (28.9%) had adequate knowledge and positive perception concerning MPXV infection respectively. Average perception score was 5.5. Mean perception and knowledge scores were 4.5(SD: 2.0) and 5.8 (SD: 1.9), respectively. Factors that were significantly associated with knowledge level were age (p = 0.020) educational qualification attained (p = 0.004), occupation (p<0.001), and geopolitical zone of residency (p = 0.001). There was a positive correlation between perception and knowledge scores (r = 0.4, p<0.001). Positive perceptions were likely among respondents who had tertiary education, and residing in North-west Nigeria. Likewise, adequate knowledge scores were likely among respondents under 30 years of age, with tertiary education or reside in North-west Nigeria. Sources of information were significantly associated with perception (p = 0.004) and knowledge (p<0.001) of the respondents. CONCLUSION: The findings of this study show that there is disparity in the knowledge and perception of mpox in the study population, and as a result, there is a need to intensify awareness about MPXV infection to enhance positive perception among the respondents. This has potential to safeguard public health and contain the disease thus preventing it from spreading to the global community. A One Health approach involving animal and human health workers is imperative for improved knowledge and a good perception towards the disease among respondents, and enhanced active surveillance and early detection of MPXV in reservoir hosts (rodents and non-human primates); to prevent reverse zoonotic transmission of the virus at the human-animal interface.

Persisting Vaccine Hesitancy in Africa: The Whys, Global Public Health Consequences and Ways-Out-COVID-19 Vaccination Acceptance Rates as Case-in-Point.

Vaccine hesitancy (VH) is the seventh among the WHO's top 10 threats to global public health, which has continued to perpetuate the transmission of vaccine preventable diseases (VPDs) in Africa. Consequently, this paper systematically reviewed COVID-19 vaccine acceptance rates (VARs)-including the vaccine uptake and vaccination intention-in Africa from 2020 to 2022, compared the rates within the five African regions and determined the context-specific causes of VH in Africa. Generally, COVID-19 VARs ranged from 21.0% to 97.9% and 8.2% to 92.0% with mean rates of 59.8 ± 3.8% and 58.0 ± 2.4% in 2021 and 2022, respectively. Southern and eastern African regions had the top two VARs of 83.5 ± 6.3% and 68.9 ± 6.6% in 2021, and 64.2 ± 4.6% and 61.2 ± 5.1% in 2022, respectively. Based on population types, healthcare workers had a marginal increase in their mean COVID-19 VARs from 55.5 ± 5.6% in 2021 to 60.8 ± 5.3% in 2022. In other populations, the mean VARs decreased from 62.7 ± 5.2% in 2021 to 54.5 ± 4% in 2022. As of 25 October 2022, Africa lags behind the world with only 24% full COVID-19 vaccinations compared to 84%, 79% and 63% reported, respectively, in the Australian continent, upper-middle-income countries and globally. Apart from the problems of confidence, complacency, convenience, communications and context, the context-specific factors driving COVID-19 VH in Africa are global COVID-19 vaccine inequality, lack of vaccine production/maintenance facilities, insecurity, high illiteracy level, endemic corruption, mistrust in some political leaders, the spreading of unconfirmed anti-vaccination rumors and political instability. With an overall mean COVID-19 acceptance rate of 58%, VH still subsists in Africa. The low VARs in Africa have detrimental global public health implications, as it could facilitate the emergence of immune invading SARS-CoV-2 variants of concern, which may spread globally. Consequently, there is a need to confront these challenges frontally and engage traditional and religious leaders in the fight against VH in Africa, to restore public trust in the safety and efficacy of vaccines generally. As the availability of COVID-19 vaccines improves, the vaccination of pets and zoo-animals from which reverse zoonotic transmission of SARS-CoV-2 have been reported is recommended, to limit the evolution and spread of new variants of concern and avert possible SARS-CoV-2 epizootic or panzootic diseases in susceptible animal species.

COVID-19 Vaccine Hesitancy and Determinants of Acceptance among Healthcare Workers, Academics and Tertiary Students in Nigeria.

The COVID-19 pandemic has resulted in millions of human deaths, prompting the rapid development and regulatory approval of several vaccines. Although Nigeria implemented a COVID-19 vaccination program on 15 March 2021, low vaccine acceptance remains a major challenge. To provide insight on factors associated with COVID-19 vaccine hesitancy (VH), we conducted a national survey among healthcare workers, academics, and tertiary students, between 1 September 2021 and 31 December 2021. We fitted a logistic regression model to the data and examined factors associated with VH to support targeted health awareness campaigns to address public concerns and improve vaccination rates on par with global efforts. A total of 1525 respondents took part in the survey, composed of healthcare-workers (24.5%, 373/1525), academics (26.9%, 410/1525), and students (48.7%, 742/1525). Only 29% (446/1525) of the respondents were vaccinated at the time of this study. Of the 446 vaccinated respondents, 35.7% (159/446), 61.4% (274/446) and 2.9% (13/446) had one, two and three or more doses, respectively. Reasons for VH included: difficulty in the vaccination request/registration protocols (21.3%, 633/1079); bad feelings towards the vaccines due to negative social media reports/rumours (21.3%, 633/1079); personal ideology/religious beliefs against vaccination (16.7%, 495/1079); and poor confidence that preventive measures were enough to protect against COVID-19 (11%, 323/1079). Some health concerns that deterred unvaccinated respondents were: innate immunity issues (27.7%, 345/1079); allergic reaction concerns (24.6%, 307/1079); and blood clot problems in women (21.4%, 266/1079). In the multivariable model, location of respondents/geopolitical zones, level of education, testing for COVID-19, occupation/job description and religion were significantly associated with VH. Findings from this study underscore the need for targeted awareness creation to increase COVID-19 vaccination coverage in Nigeria and elsewhere. Besides professionals, similar studies are recommended in the general population to develop appropriate public health interventions to improve COVID-19 vaccine uptake.

Antimicrobial drug usage pattern in poultry farms in Nigeria: implications for food safety, public health and poultry disease management.

Good antimicrobial drug stewardship in food­producing animals boosts productivity and limits transmission of zoonotic pathogens, but the imprudent usage is counterproductive. A nation­wide survey to determine the pattern of antimicrobial drug usage in poultry was therefore conducted across 12 of the 36 States in Nigeria. The survey was conducted using structured questionnaire designed to elicit information on socio­demographics, pattern of antimicrobial drug usage and awareness of the consequences of imprudent use of antimicrobials in food­producing animals, among 2,402 randomly selected poultry farmers. Critically important antimicrobials, belonging to the WHO's lists of 'Highest' and 'High' priority antibiotics, were administered sub­therapeutically for prophylaxis and growth enhancement purposes. Many diseases that warranted the antimicrobial administration were of viral etiology. Only 64.2% of the farmers administered the drug based on veterinary doctors' prescription. Majority (62.3%) of the farmers did not observe recommended withdrawal period after the drug administration. Awareness of the respondents on consequences of non­prudent agricultural use of antimicrobials was generally poor. There is need for enlightenment of the farmers on the benefits of prudent agricultural use of antimicrobials. Immediate discontinuation of sale of essential antimicrobials as over­the­counter drugs is imperative to safeguard their therapeutic efficacy and curtail spread of antimicrobial­resistance organisms.

Antimicrobial Resistance and Virulence of Methicillin-Resistant Staphylococcus aureus from Human, Chicken and Environmental Samples within Live Bird Markets in Three Nigerian Cities.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a major threat to public health. This study investigated the occurrence of MRSA in humans, chickens, chicken meat and environmental samples within poultry farms and live bird markets in southwestern Nigeria. Methods: MRSA were isolated using selective culture and tested for antimicrobial susceptibility by broth microdilution. Selected isolates were characterized by whole genome sequencing (WGS). From WGS data, spa, dru, multilocus sequence typing (MLST) and SCCmec types, but also virulence and antimicrobial resistance genes, were identified. Results: Fifty-six MRSA isolates were detected in 734 samples. They showed resistance to ß-lactams (100%), tetracycline (60.7%), ciprofloxacin (33.9%), erythromycin (28.6%), gentamicin (32.1%), and trimethoprim/sulfamethoxazole (10.7%). All 30 isolates investigated by WGS carried mecA, dfrG, and tet(38) genes. Other resistance genes detected were blaZ (83.3%), fosB (73.3%), tet(K) (60.0%), aacA-aphD (36.6%), aphA3 (33.3%), msr(A) (30.0%), mph(C) (30.0%), dfrS1 (3.3%), and sat4 (3.3%). Seven spa types (t091, t314, t657, t1476, t2331, t4690 and t12236), four known (dt9aw, dt10ao, dt10cj, and dt11a) and two novel (dt10dr and dt11dw) dru types, as well as five sequence types (ST8, ST121, ST152, ST772 and ST789) were found among the MRSA isolates. All ST121 isolates carried an SCCmec type IV cassette and were not dru-typeable. ST152 and ST121 were found only in specific sample categories within defined locations, while ST8 and ST772 were distributed across most sample categories and locations. Three SCCmec types, IVa, V and Vc, were identified. All MRSA isolates possessed virulence genes including aur, clpP, coa, fnbA, esaA, hly, hla, ica, isdA, srtB, sspA, and vWbp, among others. The toxic shock syndrome toxin gene (tst) was not detected in any isolate, whereas the Pantone-Valentine leukocidin genes lukF-PV/lukS-PV were present in all ST121, all ST772, and all but one ST152 isolates. Conclusion: The results of this study (i) showed that chicken meat is contaminated by MRSA and (ii) suggested that live bird markets may serve as focal points for the dissemination of MRSA within the community.

Determinants of Work-Related Risks among Veterinary Clinical Students in South West Nigeria.

Veterinary practices or activities expose professionals, including students, to hazards associated with animal contact. To describe workplace health and safety status and risk factors associated with hazards among veterinary clinical students in South West Nigeria, a cross-sectional survey was conducted using a semistructured questionnaire. Data on demographics, health and safety (HS) status, work-related hazards, healthcare facilities, and immunisation history were obtained. Of 167 students recruited, 100 (60.2%) were males, and >77.1% fell within the age group of 21-25 years. Many participants (77.0%) reported the lack of active HS committee. Exposures to various physical hazards (PHs) such as needlestick injuries (NSIs, 41.5%), animal scratches (42.0%), animal kicks (33.0%), falls/slips (25.0%), and, less frequently, animal bites (13.8%) were reported. Allergies (35.9%) and acute gastrointestinal infection (25.6%) mainly after contact with dogs presented with parvoviral enteritis were reported. For chemical hazards, 27.8% and 29.0% of participants indicated having had eye burn and choke on exposure to formalin. No adequate immunisation against either tetanus, rabies, or both was provided (<18%). An association between accommodation type and students' level of health and safety training was observed (OR = 0.46, 95% CI: 0.241-0.897, p=0.02), and frequencies of student contact with various animal types were strongly associated with exposures to different physical and biological risks (p < 0.05). This study revealed poor health and safety training, practices, and increased exposure of students to a wide range of hazards. Therefore, the development of mitigation programmes in veterinary schools becomes critical to safeguard students' wellbeing.

Farmers' Perceptions and Drivers of Antimicrobial Use and Abuse in Commercial Pig Production, Ogun State, Nigeria.

Antimicrobial resistance (AMR) in humans has been linked to non-judicious antimicrobial use (AMU) in food animals. To develop antimicrobial stewardship plans (AMSPs) for pig farmers, there is the need to understand the current status of AMU and the driving factors in the industry. Data on AMU, farmers' perceptions of associated drivers, and biosecurity were collected through a mixed-method study design with focus group discussions (FGDs) and questionnaire-based interviews. Antimicrobials (AMs) were mainly used for therapeutic and prophylactic purposes. Common AMs used were tetracycline (78.8%), gentamycin (53.8%), and tylosin (52.5%). Perceived drivers of AMU were linked to economic benefits, farmers' previous experiences, sick animals, expensive veterinary services, easy accessibility to over-the-counter drugs, poor farm practices, and poor disease prevention strategies. AMU was poor (average 40.2%), while knowledge on AMs and implications for animal and human health was considered averagely satisfactory (56.4%). The biosecurity level was also satisfactory (53.0%) and significantly associated with having a written farm health plan (p = 0.035). Good AMU was found to be strongly associated with farmers' use of veterinary services (p = 0.001). Diverse factors drive antimicrobial use among pig farmers in Ogun State, and these could be addressed by providing continuing education on antimicrobial stewardship and best farm practices.

Cultural, histochemical, and immunohistochemical detection of pathogenic Leptospira species in the kidneys of cattle slaughtered in two abattoirs in Southwest Nigeria.

The impact of leptospirosis on food animals and humans has not been fully elucidated. This study was designed to determine the prevalence of pathogenic Leptospira organism in renal tissues of slaughtered cattle from two major abattoirs in southwestern Nigeria. One hundred and seventy (170) kidney samples of different breeds, ages, and sexes were collected and examined using cultural isolation, microscopic agglutination test (MAT), Warthin silver (WSs) impregnation and immunohistochemistry (IH). Chi-square test was used with a confidence level set at 0.05 to ascertain associations between positive cases and sex, age, and breed. One hundred and thirty (76.5%) of the kidney samples were culturally positive while 83.3% (25/31), 41.6% (37/89), and 35% (7/20) were MAT, WSss, and immunohistochemically positive, respectively. Interstitial nephritis (87%, 94/108) and tubular nephrosis (77.8%, 84/108) were the most prominent and consistent microscopic lesions observed.Serovars Hardjoprajitno (29%) and Bratislava (22.6%) were the most prevalent serovars. To the best of our knowledge, studies on determination of pathogenic Leptospira serovars using cultural isolation, MAT, WSSs, and IH from kidneys of naturally infected cattle in Nigeria are rare. This study is the most comprehensive work in the detection of pathogenic Leptospira species from cattle in Nigeria.

Antimicrobial usage and presence of extended-spectrum ß-lactamase-producing Enterobacteriaceae in animal-rearing households of selected rural and peri-urban communities.

This study examined socioeconomic and cultural factors relating to animal husbandry, antimicrobial usage and household hygiene in 320 animal-keeping households of 16 rural and peri-urban communities of Ogun State, Nigeria. The occurrence of extended-spectrum ß-lactamase-producing Enterobacteriaceae in 457 samples from animal and environmental sources within the households was investigated. Chickens (41.6%), goats (35.3%), dogs (33.8%) and sheep (14.4%) were the most common household animals. Animals were reared mainly for income generation (73.9%) and for household consumption (18.3%). They were reared predominantly (60.2%-100%) under the extensive system with unrestricted access to human space, cooking utensils and foods. Households were assessed as having good (59.4%), fair (22.2%) and poor (18.4%) hygiene. The rate of household non-prescriptional antimicrobial usage was 69.4% in humans and 60.6% in animals. Overall, ESBL-producing Enterobacteriaceae were detected in 53 (11.6%) of 457 samples. The ESBL-producing isolates were identified as Escherichia coli (n = 49) and Klebsiella pneumoniae (n = 4). They harboured the ESBL gene variants blaCTX-M-15 (n = 49), blaCTX-M-14 (n = 2), blaCTX-M-27 (n = 1) or blaCTX-M-55 (n = 1). Forty-eight ESBL-producing E. coli were assigned into phylogenetic groups A (n = 17), B1 (n = 14), D (n = 13) and F (n = 4). All ESBL-producing isolates demonstrated multidrug resistance to antimicrobial agents belonging to at least three different classes of antimicrobials. Poor regulation of antimicrobial marketing and inadequate access to veterinary care contributed to non-prescriptional use of antimicrobials in humans and animals. Free-range household animals harboured ESBL-producing bacteria and may facilitate the dispersal of the organisms within the community.

Prevalence and renal pathology of pathogenic Leptospira spp. in wildlife in Abeokuta, Ogun State, Nigeria.

There is paucity of information on the prevalence of leptospirosis in wildlife in Nigeria. This study investigated the prevalence and renal pathology of leptospirosis in wild animals in Southwest Nigeria. One hundred and five kidney samples were examined from 10 different wildlife species (antelope) greater cane rat (GCR), hare, African giant rat (AGR), tree hyrax, civet cat, monitor lizard, python, bushbuck and partridge) using a combination of Ellinghausen McCullough Johnson Harris (EMJH) medium, microscopic agglutination test (MAT), Warthin- Starry silver stain (WSss) and immunohistochemistry. Chi-square test was used with confidence level set at 0.05 to ascertain associations between positive cases and sex and species. Eightytwo (78.1%) samples were culturally positive, while 67.7% (63/93), 57.0% (16/28) and 66.7% (8/12) were WSss, MAT and immunohistochemically positive, respectively. Interstitial nephritis (41.0%) and tubular nephrosis (81.0%) were the most prominent histopathological changes. Pathogenic Leptospira organisms were highest in GCR (32.1%) and antelope (14.3%). Serovars hardjo (11.54%), bratislava (3.9%), canicola (3.9%), icterohaemorrhagiae (15.4%), pomona (7.14%) gripptotyphosa (19.2%) and undetermined isolates were also detected in other animals. The result showed high prevalence of Leptospira infection in the wild and the possibility of domestic animals and humans contracting the disease. This study is the first documentation of evidence of pathogenic Leptospira species in wildlife in Nigeria.