Will monkeypox be the next post-Covid-19 pandemic?

Numbers worry. 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 countries to “control the outbreak” of the virus, the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, on Tuesday considered the spread of the epidemic “unusual and alarming”, considering that “the situation requires a coordinated response.”

The WHO said that if initially only a few isolated cases were reported in the UK or Portugal, the number of identified cases and affected countries exploded rapidly and now, “the risk of monkeypox settling in non-endemic countries is real” . , which will convene an emergency committee meeting next week to assess whether the virus constitutes a “public health emergency of international concern”. So, like Covid-19, could monkeypox infection turn into a pandemic?

Virus found on many continents

Covid-19 was detected in Wuhan at the end of 2019, and quickly crossed the borders of China and spread across the world in a few weeks. The first French case was identified in February 2020 and the following month, the World Health Organization classified Covid-19 as a pandemic.

Regarding monkeypox, the first non-endemic cases were identified on 6 May in the UK. In the following days, other contaminations were recorded in several European countries and the United States. In France, the first case was identified on May 19. Today there are more than a hundred. According to the latest figures reported by the French public health authority on Tuesday, “125 confirmed cases have been reported in France, including 91 in Ile-de-France.” For the WHO, the “sudden and unexpected emergence” of the virus in non-endemic countries indicates that it has been circulating for some time, without revealing its transmission. “For Covid-19,” notes Dr. Benjamin Davido, an infectious disease specialist at Raymond Poincaré Hospital in Garches (Hauts de Seine).

Does this mean the planet is suffering from a monkeypox pandemic? “You have to be careful. But in reality, we are facing an epidemic: the virus is present on several continents, and in an unusual way, Europe is affected, as the infection specialist points out. He stresses that if from a geographical point of view, we are on an epidemic distribution, this is not the case Yet on the numbers side. There is an increase in pollution, but we are not (yet) having a fast disease.”

The modes of transmission of the disease and its specific symptoms

Contamination by surfaces or droplets: “We touched on a bit before confirming that Covid-19 is primarily transmitted by aerosols,” recalls Dr. Davido. With monkeypox, we were also groping to determine the modes of transmission and what percentages they represented.” Like Covid-19, monkeypox is a zoonosis, a disease that is transmitted initially to humans by infected animals, wild or in captivity, dead or live, such as rodents or monkeys.

In terms of symptoms, the two viruses differ. The infectious disease specialist says: “In places where COVID-19 has raised concern about the risk and appearance of severe lung damage, monkeypox is not associated with any cases of pulmonary or neurological complications, and is characterized by the appearance of skin lesions. However, while many Publications showing monkeypox with black people with lesions on their hands, nearly 1,000 cases recorded in recent weeks mainly affect Western men who have sex with men (MSM) with genital lesions., confirms Dr. Davido who, in the end May , took charge of two affected French patients.The ‘anogenital eruption’ present in ‘77% of cases investigated’, refers to public health in France.

The specificity of these non-endemic cases depends on their “unprecedented method of sexual transmission, by direct contact with skin lesions or mucous membranes of a sick person. All cases show lesions localized exclusively at the level of the genitals,” continues Dr. Davido, author of an article on this topic published this Tuesday in the Official Gazette. travel medicine journal. So we’re on a completely different mode of transmission than Covid-19, with a much slower rate of spread. And if the disease is like Covid-19 (since massive vaccination campaigns), its mortality rate is rather low, less than 1%, it remains very unpleasant for patients. One of my patients told me, “I’m afraid of losing my penis.”

Vaccines are available, but…

Fortunately, a human smallpox vaccine provides cross-immunity against monkeypox with a “high level of efficacy” of about 85%, assures Sylvie Briand, director of the epidemiology and epidemiology department at the World Health Organization. At the beginning of 2020, while we are talking about the “novel coronavirus”, there is no vaccine yet. It will be necessary to wait until the end of the year for the first vaccines against Covid to appear – in record time – and start taking them.

But if laboratories are able to produce millions of doses to protect against the Corona virus, the World Health Organization does not yet know how many doses of smallpox vaccine are available worldwide. Sylvie Briand said the organization was seeking to inventory and distribute stocks and “contacts with (vaccine) manufacturers to know their production capacities”. And “we may not have enough vaccines, Dr. Davido worries. We do not know the status of the stocks that fall under the strategic reserve to deal with a bioterror threat.” But this Tuesday the European Commission and the Danish North Bavarian laboratory announced a contract to purchase more than 100,000 doses.

Unlike Covid-19, the WHO “does not recommend universal monkeypox vaccination,” Dr Tedros said. In France, the High Authority for Health (HAS) recommends “contact vaccination”, or circular vaccination. A strategy adopted “in 1972 during the human smallpox epidemic in Kosovo, which made it possible to put an end to it in a few weeks”, recalls Dr. Davido.

Feedback for adoption to break transmission chains

Individually, as with Covid-19, reactions must be adopted to break the chains of transmission of monkeypox. Dr. Davido explains: “We know that the disease can be highly contagious, such as chickenpox and human smallpox by causing infectious scabies. So from the moment you have eruptive disease, lesions on the body, call 15 to be tested without delay and start In tracing contact cases to get vaccinated. After that, patients must self-isolate until the crusts are completely gone, that is, about three weeks.”

And with cases characterized by sexual transmission, “it is important to do prevention, as we do with other sexually transmitted infections (STIs), the infectious disease specialist insists. Then, if cases explode and stocks allow, it may be appropriate to recommend vaccination of the at-risk population.” For now, “we have all the ingredients to avoid a pandemic: We know the virus, it’s less transmissible, and we have a vaccine,” Dr. Davido sums up.

But without an enhanced surveillance strategy and rapid action around each specific case, the scenario could turn into a massive contagion, envision a team of Dutch, Swiss, German and American researchers who conducted a study published in February in the journal Plos Neglected Tropical Deseases. For all monkeypox cases recorded since the emergence of this virus and who estimates that it could be the next biggest epidemic. why ? The researchers noted that “the decline in population immunity associated with stopping smallpox vaccination paved the way for the re-emergence of monkeypox.” This is evidenced by the increase in the number of cases and the average age of people infected with it. Moreover, the emergence of cases outside Africa highlights the risk of the disease spreading geographically, they warn. In light of the current epidemiological threat environment, the public health importance of monkeypox cannot be underestimated.”

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