Can a monkeypox pandemic be prevented?

Can a monkeypox pandemic be prevented?

Increase in pollution. Three months after the appearance of the first Western cases of monkeypox, France has so far recorded 2,749 cases, according to the latest figures from Public Health France. That’s about 10% of the cases reported in recent months worldwide.

And if people at risk can opt for preventive vaccination, on the side of the associations, we consider that the vaccination campaign is too slow to contain the spread of the virus, with, in view, the fear that the epidemic will escape the control of the health authorities. . What about the next pandemic?

“Out of the count” on vaccination

In its opinion of July 7, the High Health Authority (HAS) recommends the preventive vaccination of people exposed due to their sexual practices or their profession. that is, a target audience estimated at more than 250,000 people, corresponding in particular to the population of men who have sex with other men and have multiple partners, sex professionals and, case by case, health professionals who care for sick people. However, for the moment, on August 15, “38,002” doses were administered, according to the Ministry of Health, without specifying the number of people vaccinated and the proportion of first and second doses. And “79,405 doses of vaccine were delivered by the Agency to the territories on August 16”, indicates French Public Health.

“At the current rate, all eligible people” will be vaccinated only “at the end of December, and with a single dose,” lamented in a press release associations that fight against LGBT+ discrimination, including Act Up-Paris, AIDES, Sidaction and the sex workers’ union STRASS. The epidemic will then be “out of control”, they fear, and they ask the government to speed up vaccination so that the entire target audience is protected before the end of September. According to them, “at least 37,000 people per week” should be vaccinated. But “we are very far from reality,” they estimate, specifying that currently “about 15,000 people per week” are vaccinated against monkeypox.

An achievable goal of “zero monkeypox”?

Accelerating the pace is also recommended by the immunologist Brigitte Autran, appointed this Wednesday “president of the committee for monitoring and anticipating health risks”, the new entity that succeeds the Scientific Council and that will be in charge of advising the Government in its management of the health crisis situations According to her, “a “zero Monkeypox” strategy is possible, unlike the “zero Covid” one. Due to its nature, its transmission routes, it is a virus that can be controlled.”

An achievable goal? “Zero Monkeypox” is theoretically possible when you have a few thousand infections in a territory as large and developed as France. That is, at the very beginning of an epidemic process. But only in theory”, analyzes Antoine Flahault, epidemiologist and director of the Institute for Global Health at the Faculty of Medicine of the University of Geneva. To achieve this, “it is necessary to test suspected cases, trace contacts, isolate positives and quarantine their contacts. But practice shows how difficult the task is: the test must be done at the slightest suspicion”, emphasizes the epidemiologist. It is not systematic in the case of insignificant symptoms or difficulties in accessing screening. “So contact tracing gets complicated when people who test positive report sexual contact with multiple, anonymous partners. Not to mention possible contamination from surfaces, contaminated white clothing, even from aerosols.”

The isolation of positive cases, a challenge

As Public Health France reminds us, among the suggestive symptoms, “monkeypox can cause a rash, made up of fluid-filled vesicles that evolve towards desiccation, crusting and then scarring”. Blisters that can itch and that “are more concentrated on the face, in the anogenital area, the palms of the hands and the soles of the feet or even on the trunk, extremities and mucous membranes.” A rash that may be accompanied by fever, headache, sore throat, and body aches, and the lymph nodes may be swollen and painful, under the jaw, in the neck, or in the groin. But the symptoms and their intensity vary from person to person.

Another great practical difficulty: “The isolation of positive cases and the quarantine of their contacts is easier to enact than to achieve, stresses Antoine Flahault. It should last until the last scab has fallen off after the blistering rash, which takes three to four weeks. It is a long isolation of 21 to 28 days alone at home, and social buffers have to be provided to allow people to survive during this period. In addition, it is necessary that the patients in question firmly adhere to the recommended measures. However, these are mainly young people, very active and very connected. As for the identified contact cases, they must be quarantined for the duration of incubation. [de 5 à 21 jours selon le ministère de la Santé], and self-isolate for an additional three to four weeks in the event of a positive test. We thus understand all the difficulty we face in the fight against this epidemic.”

Strengthen prevention and accelerate vaccination deployment

In this context, is a monkeypox pandemic inevitable? I hope not. “Unlike Covid-19, since the beginning of this Monkeypox epidemic process, we have had a vaccine and even an antiviral treatment, whose efficacy and safety certainly remain to be demonstrated, assures the epidemiologist. Furthermore, based on the lessons learned at the beginning of the AIDS pandemic, male homosexual circles are well aware of pre-exposure prophylactic methods and call for vaccination against monkeypox.”

Hence the importance of “rapidly deploying the vaccine to all people today at risk of becoming infected, if we hope to regain control of this epidemic, and to combine this vaccine proposal with accurate information” transmitted to target populations. Mobilized since the report of the first French cases, the association has published a list of practical tips to reduce the risk of contamination and has created a Telegram thread to follow news related to the virus. For this reason, it recommends, in addition to preventive vaccination, “reducing the number of partners and exposure to body fluids”, “self-monitoring” in the event of the appearance of suggestive symptoms.

In case of contagion, the association recommends “notify your partners”, “isolate yourself” and, “if isolation is not possible or limited, avoid exposing other people to the virus as much as possible”, covering the pimples and scabs with bandages, avoiding contact and cleaning “surfaces, tissues and handles”. As a maximum precaution, AIDES reminds that “even once cured, it is recommended to use a condom for 8 weeks because it is possible that the virus is (still) present in the semen”.

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