OMS: une Canadienne orchestre la lutte contre la variole simienne

Who: A Canadian coordinating the fight against monkeypox – Le Courier Sud

MONTREAL – The technical lead for monkeypox control under the WHO Health Emergencies Program is a Canadian who did her medical training at McGill University.

Growing up in Thunder Bay and Ottawa, Dr. Rosamund Lewis studied medicine in Montreal with a specialization in epidemiology and practiced family medicine there for a few years before joining the ranks of the World Health Organization.

She is joined by the Canadian Press in Geneva, Switzerland, where she is playing a leading role in the United Nations health agency’s response to an outbreak of a disease that 99% of the world’s population has never heard of. It happened two months ago.

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It’s as if monkeypox came out of nowhere. What can you tell us about this?

It’s so much fun. The disease did not come out of nowhere. This virus has been known in Central and West Africa since the 1970s, and monkeypox virus was first identified in 1958 in Denmark, in a colony of monkeys that were used for scientific research. That is why it was called “monkeypox”, because at that time (human) smallpox was still spreading; It was a similar disease, but in monkeys.

What do we know about the spread of the disease?

It is believed to be spread by rodents, but the reservoir is unknown. In Africa, the virus is found in Kuhl funisciura, savanna crictomes, glirids, and things like that. People hunt in the jungle and bring back this wild meat which they have to prepare. This is the traditional type of exposure (to the virus). The family can be eating undercooked meat. Hence this meat can also be put up for sale in the market, so even people who don’t have a personal exposure to the jungle can get it. Mais un autre facteur important est que la variole (humaine) a été éradiquée en 1980, donc les gens qui sont nés après 1980, ou dans certains pays dans les années 1960 ou 1970, n’ont pas eu la chance d’étre contre smallpox.

Was monkeypox seen in the West before?

There were two cases in the UK in 2021 and two cases in the US also in 2021. There was an outbreak in the US in 2003, but this is unrelated to the current situation. It was very strange. These were prairie dogs that were imported to sell as pets, and then the kids started getting sick from scratching or being bitten. It took about three months to figure out and contain the nature of the outbreak.

How does the disease usually appear?

Most people have a less severe presentation than the classic presentation. It is very annoying and annoying. It can be painful and may itch. It can leave large scars. But how many people have not had to leave their homes to seek care? we do not know. They often appear after seven or ten days because they want their symptoms to ease, but that may just be the tip of the iceberg.

How did the current outbreak start?

We have received information from the UK, again. She was a passenger returning from Nigeria and was found to have monkeypox. Then I said to myself, “Okay, here we go.” The UK found an outbreak within a family, which was completely unexpected because there were three members of one family. This was the first time monkeypox had been seen outside of Africa in someone who had not traveled recently, so this was new. Then (the British) found four samples in their laboratories that tested positive and came from men who had sex with other men. Then at the same time, Portugal reported outbreaks of people with undiagnosed pests. They were negative for herpes, and negative for syphilis, so the Portuguese looked for information and soon Portugal and the UK realized they were facing the same thing. It was about men having sex with other men, attending certain occasions, and then returning home. All the first cases were associated with travel from central Europe. And that’s kind of where we are, except we see a lot of cases and it spreads through this group of people who have frequent physical contact with more than one person, probably in a very short period of time, so the conditions are favorable for rapid transmission and spread.

What is the current status of the situation?

Countries are starting to see cases that are not in their contact lists, so not all transmission threads are disclosed. There are around 200 cases in the UK. People are starting to seek care, but they don’t necessarily know how they got infected.

What weapons do we have against this disease?

The first strategy is information, the second is contact tracing, and the third, obviously, is quarantine, but maybe vaccination as well, but it’s not clear because the vaccine isn’t available everywhere. There’s research being done and[this outbreak]was known to have occurred, but[the products]are new and they’ve just been on the market and some of the old smallpox vaccines can’t be used. I wouldn’t say that the outbreak is coming at the right time because we are not quite ready for our countermeasures, but the countermeasures are ready, they have been developed; It is not widely available yet. So it again becomes a matter of fairness, and knowing when countries will have access to the products they need when they need them.

This outbreak comes because we are barely two years out of the epidemic. Is there a risk that there will be a certain “stress” in the population, and people will say to themselves, “Oh no, not another virus again!” And that this would harm efforts to stop it?

Yes, of course. This outbreak developed in this way because people wanted to start traveling again to see other people. People are tired of staying indoors or being isolated. The desire to find our parents and friends is very human. Often the first lesions are in the genital area or in the anal area. They can obviously be very painful, but not all develop into the hands and feet, so sometimes the condition will not be visible to those you spend time with. You know, we don’t want to prevent events like Pride, but we do want to avoid other inflated events, as they seem to have happened in Western Europe. The virus appears to have spread in a population that can easily spread it. So we want to avoid new amplification events and we want people to have the information they need to protect themselves and protect others.

Cases appear to be increasing rapidly. What is it really?

This apparent explosion is partly due to all of these cases waiting (the diagnosis). As I explained earlier, the Portuguese raised their hands because they had all of these (unidentified) cases. When the information became available, the labs started testing the samples they had and contacting people, but then there were also people who started coming forward saying, “Maybe I had that.” So we may be two or three weeks late in analyzing the files. And obviously, during that time, people who didn’t know what they had were able to keep spreading the virus. It is not yet clear where exactly we are in the transmission chain, but there is a second wave. There is community transmission, an expression we’ve known all too well for the past couple of years. But transfers still happen mainly between men who have sex with other men, which is why we say there is a chance (to stop the situation). And now, we are actively working on popularizing information and developing technical diagnostic capabilities.

So there’s a business opportunity we shouldn’t miss?

Yes, and it is critical to take advantage of this before the virus reaches the general public, family members, children, and people at risk, such as people with HIV. But don’t be alarmed. The vast majority of cases are still being reported in this group, so there is a place of transmission, and it is not too late to stop the outbreak in this group, although it is difficult. However, there is still a lot we don’t know about this virus and we have to be honest and admit it. The virus itself may have undergone changes that make it more transmissible, but we certainly found that behaviors make it more transmissible. This disease manifests itself as an infectious disease that can spread through close contact, including sexual contact. So the message to the population is: Educate yourself, learn to recognize the signs and symptoms, know under what conditions you can become infected, protect yourself and others, and when in doubt, look for a diagnosis… The information is there, it’s there.

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Dr. Lewis’ comments have been shortened and condensed for brevity and clarity. The conversation took place on June 6, 2022.



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