origin, transmission, contamination… A dangerous virus?


MONKEYPOX. While several cases of monkeypox have been identified in France, the virus is spreading in several countries around the world and should circulate even more, according to the WHO. Should we fear an epidemic?

The essential

  • Monkeypox – also “Monkeypox” – is spreading and worrying. It is the subject of particular attention by the WHO: to date, more than 100 cases of contamination have been identified in nearly 20 countries around the world. In Portugal (37 cases), Spain (34) and the United Kingdom (57) in particular, the virus is circulating more and more. The WHO has warned that the virus will spread more actively.
  • Three first cases of monkey pox have been identified in France. On May 23, the health agency indicates that these contaminations are “without direct links with people returning from endemic zones”, namely central and west Africa.
  • Monkeypox is often mild, but it can cause serious symptoms, especially in humans. It is potentially fatal in very rare and very serious cases. No vaccine exists.
  • Santé Publique France looked into the monkeypox virus and gave some information: “The monkeypox is a disease that is transmitted from animals to humans. Cases are often observed near tropical rainforests where there are animals carrying the virus”, indicates SPF, which adds: “Transmission takes place by direct contact with the blood, body fluids or lesions of the skin or mucous membranes of infected animals, for example by a bite or a scratch” . A clarification must be added on contamination: “Human-to-human transmission occurs during prolonged face-to-face contact by respiratory droplets or by direct contact with an infected person, through bodily fluids, skin lesions of the disease or the internal mucous membranes such as the mouth, as well as by objects that the patient has contaminated, such as clothing or bed linen”.
  • Transmission is seen “mainly in individuals who identify as gay or bisexual or in men who have sex with men,” the UK Health Security Agency (UKHSA) told the BBC on Sunday.

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11:09 – A monkey pox expert’s opinion

Antoine Gessain is the director of the epidemiology and physiopathology of oncogenic viruses department at the Institut Pasteur. As one of the only scientists to actually know about the virus, he is in the spotlight in the health sections of various media this week. With Le Figaro santé, he spoke about the contagiousness of the virus: “Generally, people are contagious one to two weeks after infection, when they develop skin lesions that are reminiscent of chickenpox”. He also explained that the confirmatory diagnosis was obtained “by a PCR test carried out on the fluid contained in the lesions”.

10:42 – Monkeypox infections closely monitored

At a time when more than 100 cases of monkeypox have been officially recorded worldwide, European countries are particularly affected, since the United Kingdom alone has 57 cases, Spain 34, and Portugal 37. In France, only three cases have been identified, which makes the situation less worrying. However, in its update on Monday, May 23, Public Health France affirms that these contaminations are the subject of “long-term monitoring” and “reinforced” in France by a compulsory reporting system. In addition, health professionals receive information and alert messages on the subject. SPF works in coordination with other European countries through discussions with the European Center for Disease Prevention and Control and the WHO.

10:13 – Are the cases reported on European territory worrying?

While monkeypox has reached nearly twenty countries, mostly located in Europe, the population is worried about an epidemic outbreak. At a time when the health restrictions linked to covid-19 have just been lifted, should we be worried about the circulation of this zoonosis? If the current context “constitutes an alert” according to Public Health France, precisely because recent contaminations always seem to occur in Europe even though the virus is usually absent from the continent, the seriousness of the situation remains relative. In its last point, SPF estimates that “at this stage, the cases reported in Europe are mostly mild, and there are no reported deaths”.

09:45 – Three confirmed cases in France

According to a situation report published on May 23 by Public Health France, three people are currently suffering from monkeypox in the territory. The most surprising is that these contaminations are apparently “without direct links with people returning from endemic areas”. Public Health France believes that the contamination could therefore have occurred in Europe, where the current context “constitutes an alert”, since this virus is usually absent from the continent.

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The General Directorate of Health (DSG) announced, on Monday May 23, 2022, the detection of two new cases of monkey pox in France, bringing the number of infected to 3. As during the very first contamination, the Ministry of Health clarified that “as soon as the suspicion of his infection, this person was taken care of. In the absence of gravity, he is isolated at his home”. The first patient was “a 29-year-old man with no history of travel to a country where the virus is circulating”. To stem the circulation of the virus, the health authorities announced that an “in-depth epidemiological investigation would be implemented by the teams of Public Health France” and that “the people who have been in close contact with these patients are being identified” .

According to the first findings of the World Health Organization (WHO), monkeypox originated in Central and West Africa. Countries such as Nigeria or Cameroon would be the main sources of origin. Known since the 1970s, this disease usually tends to develop in tropical areas. Seeing it develop in countries without this climate comes as a surprise to scientists.

Cases of monkeypox have been imported into Western countries since its discovery, including the United States, where they have remained “rare”, according to the US Centers for Disease Prevention and Control (CDC). Indeed, in the spring of 2003, cases had been confirmed in the country, thus marking the first appearance of this disease outside the African continent.

England was the first to sound the alarm. A first patient with monkeypox was identified there on May 7, it was a person returning from a trip to Nigeria. The British health security agency assures that with the exception of the first case detected, the transmission between the other cases would have taken place within the country. Since then, the number of cases has continued to increase: as of Tuesday, May 24, the number of cases recorded in the United Kingdom is 57.

Spain, Portugal, Canada and the United States have, in turn, reported having spotted the presence of monkeypox, or what appears to be, on their territory. Sweden and Italy followed. After the first French case on Friday May 20, two other contaminations were identified. This May 24, the number of cases recorded in the world exceeds one hundred. Nearly 20 countries are concerned.

According to the World Health Organization, monkeypox is contracted by “consumption of undercooked meat from infected animals.” Indeed, originally, it is an infectious disease caused by a virus transmitted by animals, mainly rodents. Human transmission would be the result of contact with a person already contaminated or with their organic fluids (saliva in particular).

But monkeypox can also be transmitted through close contact with infected respiratory tract secretions, skin lesions of an infected person, or objects recently contaminated with body fluids or material from a patient’s lesions. Sexual relations could thus spread the disease according to the British Health Security Agency. Protected intercourse is therefore recommended.

Symptoms resemble those of smallpox patients, but milder. In the first 5 days, the infection causes several symptoms: fever, headache, swelling of the lymph nodes (adenopathy), back pain, muscle pain (myalgia) and exhaustion (asthenia).

Within 1-3 days (sometimes longer) of the onset of fever, the patient develops rash symptoms that often start on the face and then spread to other parts of the body, including the palms of the hands , the soles of the feet and the mucous membranes (mouth and genital area). Itching is common. The lesions pass through different successive stages: macules, papules, vesicles, pustules and crusts. When the scabs fall off, people are no longer contagious.

The other mucous membranes (ENT, conjunctivae) may also be affected. “The incubation of the disease can range from 5 to 21 days. The fever phase lasts about 1 to 3 days. The disease, generally mild, most often heals spontaneously, after 2 to 3 weeks” emphasizes Public Health France .

If the symptoms seem virulent, especially in men, the mortality rate remains low. Indeed, the World Health Organization (WHO) affirms that “in general, the fatality rate has been between 1% and 10%, with most deaths occurring in the youngest”.

Two years after the start of the coronavirus epidemic, should we be worried about the spread of a new virus? According to Antoine Gessain, head of the epidemiology and physiopathology of oncogenic viruses unit at the Institut Pasteur, monkeypox presents only a low level of danger, as he explained to BFM-TV. No vaccine is necessary. He even wants to be reassuring: “there is not much risk of a major pandemic.”

Some countries quickly adopted measures to prevent the spread of the virus. The health authorities of Portugal and Spain have thus triggered a national health alert. Italy said the situation was “under constant surveillance” and Swedish authorities are “now investigating with regional infection control centers to find out if there are more cases”.

Spain decided to take the lead. The Iberian kingdom said on Thursday that it was preparing to purchase thousands of smallpox vaccines, normally intended to fight against smallpox, an extremely serious disease that the WHO had declared eradicated in 1980. “We must find a way to quickly buy these vaccines because it is a very valuable tool to stop the epidemic”, commented to the Madrid daily El Pais Elena Andradas, the director general of public health for the community of Madrid. This vaccine is not intended to be administered to the general population, but only to contacts of confirmed cases.

According to an article in La Tribune, at the end of 2012, France had a strategic stock of 1st generation vaccines of more than 82 million doses. These stocks have been kept for 40 years by the Army Health Service (SSA).

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