Monkeypox: the contribution of the scientific literature

Monkeypox: the contribution of the scientific literature

#Monkeypox #contribution #scientific #literature


Gabriel Steg – Good morning. Gilles Pialoux. I am delighted to meet you at Medscape France in early August to give you a brief update on monkeypox, as an infectologist at the Sorbonne University and also at the Tenon hospital in Paris, where we see around 10-12 cases per day and to vaccinate 20 to 40 people, therefore an indisputable reality for a very intriguing emerging phenomenon.

Epidemiological data

First, some epidemiological data. The latest French public health data from the end of July shows 1,955 cases, 96% in men who have sex with men -MSM- for an average age of around 36 years. We have around 18,000 cases worldwide, including 70% of the cases in Europe, 4,900 cases in Spain with two deaths that are currently under investigation and for which we would like to know the real causes of these deaths in patients youths.

So, we had some posts and some questions. Regarding the publications, we can refer to a very good clinical article by the New England Journal of Medicine dated July 23, where a European team, 16 countries, reports the clinical manifestations and sociodemographic data of 528 patients. Obviously, we find confirmation of a predominance of MSM, homosexual and bisexual men: 98%. Probably a magnification effect, since 41% of these cases, in this series of New England they are HIV-infected patients, so there is probably a magnifying effect due to the arrival of patients who are followed by HIV or by PrEP, for pre-exposure prophylaxis.

Second confirmation of the field in this document New England, is the diversity of clinical manifestations —totally different from what we were offered in the epidemics observed in West and Central Africa, and also in the United States, in 2003. Thus, with general manifestations: fever in 62% of cases, lethargy , neurological signs, headaches, significant lymphadenopathy, and not only pelvic. And then very varied mucosal and cutaneous manifestations with, in particular, an extremely confusing exanthema at the diagnostic level, which will require doctors to be trained to undress patients, who have a simple exanthema, which is a fairly frequent dermatological manifestation. And then very varied otorhinolaryngological manifestations.

Confirmation, also, of the presence of the virus almost everywhere and in all fluids, whether in semen, in blood, we even found something, in Tenon, in pleural fluid or in bronchoalveolar lavage, so it is a virus that spreads extremely. And a confirmation also, therefore, of a diagnosis that is quite easily made by PCR, the absence of deaths, apart from the Spanish deaths in this series of New Englandand the deaths occurred after publication, and the very low access to treatment, since less than 3% of patients had access, in particular, to an antiviral called técovirimat.

The dosage issue

So that’s the clinical setting. There is another issue that concerns us at the moment, and that is the issue of dosage. And we return to a debate on COVID-19, since you know that the recommendations refer to two doses, except in immunocompromised subjects for whom 3 vaccine doses of the third generation vaccine are recommended. But there is a vagueness where the defense secret is confused -since, as you know, the number of doses is a defense secret- and then the recommendations of the high health authority, which say that the second injection must be done at least at 28 days, which leaves an upper limit on time, so we don’t know if it’s one month, two months, three months, four months, then there’s a real problem.

And we, in the field, also have the problem of vaccinating immunocompromised people, especially HIV patients. And, there, we return to literature a little. So there are several trials: there are randomized trials that Overton published in 2020 in vaccinated which is very well done and which shows the interest of boosting with a third dose in patients with HIV who are somewhat immunocompromised – around 370 CD4, we had another older study, published in the Journal of Infectious Diseases 2013, by Greenberg, who also showed the good immune response in HIV patients, but at the moment we are in the dark, and at the French Society for the Fight against AIDS, we are thinking about the recommendations that we have to make.


Two other comments on previous posts: a very well done article, predating of course this resurgence of monkey pox on the question of the void left by the disappearance, the eradication of smallpox, and there is a question particularly in terms of bioterrorism, as you know that this is one of the obsessions of our governments and that smallpox —so, this time not it is monkeypox, smallpox, real, real smallpox, so to speak, it is classified as level 1 by the CDC and then by all European countries in bioterrorism agents, and that infinitely complicates the recommendations on the matter.

And there is a very good review posted on virus about this risk of bioterrorism, knowing that smallpox mortality was around 30% – the issue of monkeypox mortality, for the monkeypox, it is more complicated, since the data from the African publications oscillates between 0% and 10% and, for the time being, effectively, apart from the two cases mentioned above, we have a very low mortality rate, even close to zero.

a health

And finally, one last point: I think, like many, we will go back to the articles that were published during the resurgence, particularly in the United States, of monkeypox on the concept of A Healththat is to say, a management of these zoonoses not only from the medical aspect, but from the environmental aspect and also from the veterinary aspect, and that this concept of One Health, born in the 2000s, will obviously be, in the wake of COVID, extremely important in understanding what to do for these outbreaks of zoonoses. I thank you.

Thank you and see you soon on Medscape.

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