Concerning figures. Since early May, more than 1,600 confirmed cases of monkeypox have been reported in 32 countries where the disease is not endemic. Less than a week after calling on states to “control the outbreak” of the virus, the director-general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, on Tuesday called the spread of the epidemic “unusual and worrying.” “, considering that “the situation requires a coordinated response”.
If at first only a few isolated contaminations were reported in the United Kingdom or Portugal, the number of identified cases and affected countries skyrocketed and now, “the risk of monkeypox settling in non-endemic countries is real” said the WHO. , which will convene a meeting of its emergency committee next week to assess whether the virus represents a “public health emergency of international concern.” So, like covid-19, can the monkeypox contagion turn into a pandemic?
A virus present on several continents
Discovered in Wuhan at the end of 2019, the Covid-19 very quickly crossed the borders of China and spread throughout the world in a few weeks. The first French case was identified in February 2020 and the following month, the WHO classified Covid-19 as a pandemic.
As for monkeypox, the first non-endemic cases were identified on May 6 in the United Kingdom. The following days other contaminations are recorded in several European countries and in the United States. In France, the first case was identified on May 19. And today there are more than a hundred. According to the latest figures reported Tuesday by Public Health France, “125 confirmed cases have been reported in France, including 91 in Ile-de-France.” For the WHO, the “sudden and unexpected appearance” of the virus in non-endemic countries suggests that it has been circulating for some time, without its transmission having been detected. “As for Covid-19,” says Dr. Benjamin Davido, an infectious disease specialist at the Raymond-Poincaré hospital in Garches (Hauts-de-Seine).
Does this mean the planet is experiencing a monkeypox pandemic? ” Caution must be taken. But in fact, we are facing a pandemic: the virus is present on several continents, and in a very unusual way, Europe is affected, points out the infectologist. If from a geographical point of view we are in a pandemic distribution “It is not yet the case in terms of figures, he assures. There is an increase in contamination, but we are not (yet) facing a rampant disease.”
Modes of transmission and specific symptoms
Surface or droplet contamination: “We groped a bit before stating that Covid-19 was transmitted mainly by aerosol, recalls Dr. Davido. With monkeypox we also grope to define the modes of transmission and the percentages they represent.” Like Covid-19, monkeypox is a zoonosis, a disease initially transmitted to humans by infected wild or captive animals, living or dead, such as rodents or monkeys.
In terms of symptoms, the two viruses differ. “Where Covid-19 has raised concerns about the risk of serious illness and lung damage, monkeypox is not associated with any cases of pulmonary or neurological complications, and is characterized by the appearance of skin lesions, describes the infectologist . However, while many publications illustrate monkeypox with black people with lesions on their hands, the approximately 1,000 cases registered in recent weeks mainly affect Western men who have sex with men (MSM) with genital lesions, emphasizes Dr. Davido , who at the end of May, took care of two affected French patients. An “anogenital rash” present in “77% of investigated cases”, indicates Public Health France.
The particularity of these non-endemic cases is based on “their unprecedented mode of sexual transmission, by direct contact with skin lesions or mucous membranes of a sick person. And all the cases present lesions located exclusively at the genital level, continues Dr. Davido, author of an article on this subject published this Tuesday in the Travel Medicine Journal. So we are in a very different mode of transmission than Covid-19, with a much slower rate of spread. And if, like Covid-19 (since the mass vaccination campaigns), the disease has a fairly low lethality, less than 1%, it is still very distressing for the sick. One of my patients told me: “I am afraid of losing my penis”.
Vaccines available, but…
Fortunately, a smallpox vaccine offers cross-immunity against monkeypox “with a high level of efficacy” of around 85%, said Sylvie Briand, director of WHO’s department of pandemic and epidemic diseases. As of early 2020, while we are talking about the “novel coronavirus”, there is still no vaccine. We will have to wait until the end of the year for the first anti-Covid vaccines to emerge -in record time- and begin to be administered.
But if laboratories have been able to produce millions of doses to protect against the coronavirus, to date the WHO does not know how many doses of smallpox vaccine are available worldwide. The organization seeks to inventory stocks and contact “(vaccine) manufacturers to learn about their production capabilities” and distribution, Sylvie Briand said. And “we may not have enough vaccines,” Dr. Davido worries. We do not know the status of the stocks, which enter the strategic reserve to deal with a bioterrorist threat”. But this Tuesday, the European Commission and the Danish laboratory Bavarian Nordic announced the conclusion of a contract for the purchase of more than 100,000 doses.
Unlike Covid-19, the WHO “does not recommend mass vaccination against monkeypox,” said Dr. Tedros. In France, the High Authority for Health (HAS) recommends “vaccination of contact cases”, or ring vaccination. A strategy adopted “in 1972 during the smallpox epidemic in Kosovo, which made it possible to put an end to it in a few weeks”, recalls Dr. Davido.
Reflexes to adopt to break the chains of transmission
Individually, as for Covid-19, reflexes must be adopted to break the chains of transmission of monkeypox. “We know that the disease can be very contagious, like chickenpox and smallpox by causing infectious scabs,” explains Dr. Davido. So, from the moment you have a rash illness, injuries on the body, you call 15 to get tested without delay and start tracing contact cases to vaccinate them. Then, patients should be isolated until the complete disappearance of the scabs, that is, about three weeks.
And with cases that are characterized by sexual transmission, “it is important to do prevention, as we do with other sexually transmitted infections (STIs), insists the infectologist. So, if the cases explode and the stocks allow it, it may be convenient to recommend the vaccination of the populations at risk”. At the moment, “we have all the elements to avoid the pandemic: we know the virus, it is less transmissible and we have a vaccine,” summarizes Dr. Davido.
But without a reinforced and fast-acting surveillance strategy around each identified case, the scenario could turn into a massive contagion, predicts a team of Dutch, Swiss, German and American researchers who conducted a study published in February in the journal Plos. Neglected Tropical Desires. on all the cases of monkeypox registered since the appearance of this virus and that he estimates that it could be the next great pandemic. Why ? “The decline in population immunity related to the cessation of smallpox vaccination has set the stage for a resurgence of monkeypox,” the researchers note. This is demonstrated by the increase in the number of cases and the median age of people who contract it. In addition, the appearance of cases outside of Africa highlights the risk of the disease spreading geographically, they warn. In light of the current pandemic threat environment, the public health importance of monkeypox cannot be underestimated.”
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