Monkeypox: is the epidemic likely to spread to the general population?

“It’s a call to action, but it’s not the first.” The head of the World Health Organization, Tedros Adhanom Ghebreyesus, decided on Saturday, July 23, to activate the highest level of alert in an attempt to stop the outbreak of monkeypox (or monkey pox, according to the English term most used by health authorities). The last time the WHO triggered a public health emergency of this type of international interest dates back to January 30, 2020, seven weeks after the detection of the first cases of Covid-19, in Wuhan, China.

Anything that hints that the monkey pox could worry the almost 8 billion earthlings in the future, as Sars-CoV-2 did before? “Hard to predict today”, slides the epidemiologist Antoine Flahault, director of the Institute of Global Health of the University of Geneva. And to answer that question you have to look at the patients affected to date by the virus.

Some 18,000 cases of monkeypox have been detected worldwide since early May, outside of endemic areas in Africa. The disease has been reported in almost 80 countries and 70% of cases are concentrated in Europe. But monkey pox It does not attack indiscriminately at the moment: the epidemic essentially affects men, and more particularly those who have had sexual relations with other men (the so-called multi-partner MSM).

This is the case in France, where 1,837 affected by the disease have been officially identified. According to the data communicated by Public Health France, all the cases of monkeypox registered to date in the territory refer to adult men, “except twelve adult women and two children.” According to Public Health France, “96% of the cases in which sexual orientation is reported occurred in men who have sex with men” Y “74% report having had at least 2 sexual partners in the three weeks prior to the onset of symptoms”.

At the moment, it is impossible to explain with certainty why MSM with multiple partners are particularly affected by the monkey pox. “We lack complete information, but the data rather confirms a single introductory event and then spread, especially in the MSM community, after superspreading events”advances Yannick Simonin, specialist in emerging viruses, in The world. The evening paper notes that several clusters of cases were identified after Gay Pride in Maspalomas, in the Canary Islands, as well as at the Darklands festival in Belgium in early May.

Questions about the overrepresentation of men who have sex with men among those infected are even more acute since, in the current state of scientific knowledge, monkeypox is not considered a sexually transmitted disease. On its website, the Ministry of Health states that “Sexual relations, with or without penetration, meet the conditions for possible contamination.”

It also specifies that the virus can be transmitted by direct contact between healthy skin or mucous membranes and pimples or scabs of infected people, but also by “shared use of linen (clothes, sheets, towels)” or through “a long face-to-face, by droplets (sizzling, sneezing)”. Everyday situations that push Yannick Simonin to call The world a “Be careful not to stigmatize the gay community.”

“Monkeypox is not just a concern of this community, although cases are currently overrepresented there.”

Yannick Simonin, specialist in emerging viruses

in the world”

On social networks, some have pointed out that the modes of transmission of monkey pox could raise fears of contamination if the virus ends up leaving the currently affected population. And especially among the little ones in a back-to-school context.

Not because among those who lick the bar of the bus, those who always put their fingers in their mouths after having touched absolutely EVERYTHING, etc. It is summer, the establishments are closed and we mostly treat it as an STI.

– yare yare stun (@lydieinthetrain) July 27, 2022

In addition to transmission through contact with wounds… Have you ever managed to prevent a child from scratching when he had chickenpox?

– yare yare stun (@lydieinthetrain) July 27, 2022

On the subject of possible spread to the general population, Antoine Flahault attempts a parallel: “We have the example of the HIV epidemic that had started within the male homosexual communities before spreading to the entire population, but the spread was exclusively through sexual and blood routes.”

This time, the transmission of the disease “It seems to be mainly from contact between diseased skin and healthy skin, perhaps also from the sperm in which the virus was found,” adds this specialist. According to him, contamination by air or surfaces seems rare, “no caregiver [n’ayant] has become contaminated again during his professional activity”.

Antoine Flahault identifies several levers to contain the progression of monkey pox and prevent its spread to as many people as possible. First, get a “strong support from the people involved” respect the isolation of more than three weeks prescribed in case of infection. To achieve this adherence, health authorities must implement “social shock absorbers”such as adapted sick leave or remote monitoring to break the feeling of abandonment.

finally come “vaccines and antiviral drugs”. Since its opening on July 11 to the entire population at higher risk of contracting the disease, the French vaccination campaign against monkey pox got off to a slow start, before picking up speed from the end of the month. Worldwide, “The problem we are facing is a relative scarcity of vaccines”, says the epidemiologist. On the medication side, he deplores “lack of scientific certainty” about its effectiveness for “reduce the period of contagion and therefore the isolation of patients”.

To better estimate the risks of the spread of monkey pox For the general population, clinical trials on the efficacy of treatments, as well as further scientific research on the disease, are therefore essential. The observation may seem surprising, since the virus was first identified and isolated in 1958, but it does not surprise the specialist.

“Monkeypox remains poorly understood by scientists, like many neglected tropical diseases, as long as it doesn’t affect populations in rich countries.”

Antoine Flahault, epidemiologist

in franceinfo

And to point out that a similar situation had been observed for chikungunya or the Zika virus. Therefore, it is to be hoped that new discoveries will refine our understanding of the monkey pox in the coming weeks and months. “Transmission of this virus between men who have sex, for example, was not reported at all until the current episode”concludes the epidemiologist.