At the moment, confirmed cases of monkeypox (monkey pox) are increasing, mainly in Europe. If the health authorities are monitoring the development of the situation, the situation should quickly be brought under control. Jean-Luc Guérin, professor at the National Veterinary School of Toulouse and research director at INRAE, discusses the state of knowledge of this virus.
According to the latest report from Public Health France as of June 3, 51 cases of Monkeypox have been reported in France : 37 in Ile-de-France, 6 in Occitanie, 4 in Auvergne-Rhône-Alpes, 2 in Normandy, 1 in Hauts-de-France and 1 in Centre-Val de Loire. All the cases investigated are men, aged between 22 and 63, said Public Health France. And, among the cases investigated, “two are immunocompromised, one was hospitalized but is no longer so to date and none died.”
As of June 2, 436 confirmed cases of monkeypox have been reported in 18 EU countries and 289 confirmed cases have been reported in ten non-EU countries.
The countries with the highest number of cases are Great Britain (207 cases), Spain (156 cases) and Portugal (138 cases).
Monkey pox, “a rare but well-known zoonosis”
Jean-Luc Guérin, professor at the National Veterinary School of Toulouse and director of the joint research unit “Host-pathogen interactions” (INRAE/ENVT), is not surprised. “Monkey pox is a classic zoonotic disease. [maladie transmise par l’animal, NDLR]he comments. This virus has been known to circulate for a very, very long time through rodents, such as squirrels and prairie dogs. This main animal reservoir is known even if still imperfectly: rodents become infected without necessarily developing symptoms, so we observe many healthy carriers among these small rodents.
The virus has been transmitted for a long time without causing lesions and at low noise, therefore in an almost “invisible” way.
And, from time to time, continues the specialist, “the virus passes from one species to another, in particular by contaminating monkeys in the tropical and equatorial forests of Central and West Africa”. In the latter, the clinical form of smallpox is then observed with characteristic lesions: pustules or blisters. “The monkey is therefore not the main host of the virus but an intermediate host. And the name ‘monkey pox’ is inappropriate”emphasizes Jean-Luc Guérin.
Human infections are occasional and not serious
Occasionally also “there may be human infections due to sporadic contact with rodents carrying the virus”, adds Jean-Luc Guérin.
Thus in 2005, a resurgence of cases was observed in the Democratic Republic of Congo and since then more than 1000 cases have been reported there each year. That said, as the WHO explains, these small outbreaks remain localized and “do not reach the entire population”.
In 2003, cases were identified outside Africa in the United States. “Here, people had been contaminated by contact with lesions (pustules, scabs, etc.) present on prairie dogs used as pets, and infected by imported African rodents”, details the specialist.
However, these human infections remain occasional and mostly benign and without comparison with human smallpox, eradicated in 1980 with the arrival of vaccination.
Indeed, the lesions heal spontaneously in a few weeks, even if more severe, even lethal forms can be rarely observed in immunocompromised people, in young children or pregnant women. In a recent press release, the European Center for Disease Prevention and Control specifies that the viral strain currently detected in Europe, originating from West Africa, presents a average fatality rate of 3.6%.
Why are there cases in so many countries at the same time?
If these sporadic infections are known, why are we now seeing an increase in cases outside Africa at the same time?
“Here, we observe a special case, with an amplifying effect, explains Jean-Luc Guérin. The virus passed from the animal reservoir to humans as it regularly does. The difference is that this time, an amplifying effect is added, explained by two reasons: a large gathering of people at a festive event in Spain and the resumption of international transportthereby allowing the virus to spread on a large scale.
The spread of the virus, observed in recent weeks, would therefore be, according to this specialist, exceptional and the result of a combination of circumstances.
Spain, which has the highest number of cases of monkeypox behind the United Kingdom, has not identified the origin of the contaminations. But the Spanish authorities are investigating the Maspalomas Pride, which took place from May 5 to 15 on the island of Gran Canaria, in the Canary Islands, which brought together tens of thousands of participants from several continents. According to the newspaper El País dated May 21, “among the 30 people who tested positive in Madrid, several went to the festival. But it is not yet possible to say if any of them is patient zero, or if they all fell ill there- down”.
For the time being, no event that has occurred in Europe or elsewhere has been identified as the initiator of the multiplication of cases, but the WHO has evoked the hypothesis, at the start of the chain of contaminations, of a “super-spreader” event, such as a cluster during which a large number of infections would have taken place, leading to chain contaminations.
In France, the cases identified occurred “mostly, but not exclusively, in men who have sex with men (MSM)”, notes Public Health France, and among the 43 cases investigated (as of June 3), 22 traveled abroad before their symptoms started, the majority of them (13) in Spain.
Attention, however, monkeypox is not a sexually transmitted infection. But, as Public Health France explains, “direct contact with damaged skin during sexual intercourse facilitates transmission.”
Why should cases decline?
After two years of the Covid-19 pandemic, should we fear a large-scale multiplication of cases?
On this point, the WHO is reassuring for the time being.. “It is not a disease that the general public should worry about. It’s not Covid or other fast-spreading diseases.” declared the director of the department of global preparation for infectious risks at the WHO, during a meeting with the member states of the organization, this Friday, June 3 in Geneva.
The strain at the origin of the cases observed is that of Nigeria, it is perfectly known by the specialists. Its transmission is by close skin contact and not by aerosols as is the case for Covid. The risk of transmission is therefore limited. Another positive point, adds Jean-Luc Guérin, “it is a stable virusin other words, which has less frequent mutations than the influenza virus or the SARS-CoV2 virus.
For the time being, health authorities recommend that infected people isolate themselves and take hygiene precautions to limit transmission.
British health authorities, in an advisory issued Monday, May 30, recommend that people who test positive for the monkeypox virus should abstain from sexual intercourse until symptoms disappear. The UK Agency also advises people who have been infected to use condoms for a period of eight weeks after the virus has cleared.
In addition, contact persons must be vaccinated, as recommended by the High Authority for Health. The vaccine to be offered “ideally within four days after the risky contact and at most fourteen days later with a two-dose regimen (or three doses in immunocompromised subjects), spaced 28 days apart”.
Vaccination is effective quickly and long-lasting. “If the people who become infected isolate themselves and take their precautions and the contacts get vaccinated, then we can consider an extinction or a regression of infections of monkeypox cases“comments Jean-Luc Gérin.
To sum up, the advice to remember:
- Consult in case of suspicious lesions.
- Then isolate oneself if the suspicion is verified (via PCR test carried out in the laboratory) for the entire duration of the disease (until the disappearance of the scabs, i.e. 3 weeks maximum).
- Follow the hygiene tips : wash your hands, do not touch the lesions, do not scratch yourself, favor showers rather than baths using water and soap or a hydro-alcoholic solution, wash your personal belongings separately, clean/disinfect regularly the surfaces affected, especially sanitary facilities (once a day), etc. Protect yourself in intimate relationships.
- Prevent his case contacts quickly so that they benefit from preventive vaccination.
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