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Is the epidemic likely to spread to the entire 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 stem the outbreak of monkeypox (or monkeypox, according to the English term most frequently used by health authorities). The previous time such a public health emergency of international concern was triggered by the WHO dates back to January 30, 2020, seven weeks after the detection of the first cases of Covid-19, in Wuhan, China.

Anything to imply that the monkeypox could concern the nearly 8 billion Earthlings in the future, like Sars-CoV-2 before it? “Difficult to predict today”, slips epidemiologist Antoine Flahault, director of the Institute of Global Health at 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 the beginning of May, outside endemic areas in Africa. The disease has been reported in almost 80 countries and 70% of cases are concentrated in Europe. But the monkeypox does not strike indiscriminately for the moment: the epidemic essentially concerns men, and more particularly those who have had sexual relations with other men (so-called multi-partner MSM).

This is the case in France, where 1,837 people affected by the disease have been officially identified. According to the data communicated by Public Health France, all the cases of monkeypox recorded to date on the territory concern male adults, “except twelve female adults and two children”. According to Public Health France, “96% of the cases for which sexual orientation is indicated occurred in men who have sex with men” et “74% report having had at least 2 sexual partners in the three weeks before the onset of symptoms”.

For the time being, it is impossible to explain with certainty why MSM with multiple partners are particularly affected by the monkeypox. “We lack complete information, but the data rather confirms a single introductory event and then the spread, especially in the MSM community, following superspreader events”advances Yannick Simonin, specialist in emerging viruses, in The world. The evening daily 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 over-representation of men who have sex with men among infected people are all the more acute since monkeypox is not, in the current state of scientific knowledge, considered a sexually transmitted disease. transferable. On its website, the Ministry of Health states that “Sexual intercourse, with or without penetration, meets the conditions for potential contamination”.

It also specifies that the virus can be transmitted by direct contact between healthy skin or mucous membranes and the pimples or scabs of infected people, but also by the “sharing of linen (clothes, sheets, towels)” or way “a long face-to-face, by droplets (sputter, sneeze)”. Everyday situations that push Yannick Simonin to call in The world at “be careful not to stigmatize the homosexual community”.

“Monkey pox 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 noted that modes of transmission of monkeypox could give rise to fears of contamination if the virus ended up getting out of the population currently affected. And particularly among the youngest children in a back-to-school context.

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

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

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

finally come “vaccination and antiviral drugs”. Since its opening on July 11 to the entire population most at risk of contracting the disease, the French vaccination campaign against monkeypox got off to a sluggish start, before accelerating since the end of the month. Worldwide, “the problem we are encountering is a relative shortage of vaccines”, notes the epidemiologist. On the medication side, he deplores “lack of scientific certainty” about their effectiveness for “reduce the contagious period and therefore the isolation of patients”.

To better estimate the risks of the spread of monkeypox to all, clinical trials on the effectiveness of treatments as well as further scientific research on the disease are therefore essential. The observation may seem surprising, since the virus was identified and isolated for the first time in 1958, but it does not surprise the specialist.

“Monkey pox remains little known to scientists, like many neglected tropical diseases as long as they do not affect populations in rich countries.”

Antoine Flahault, epidemiologist

at franceinfo

And to note that a similar situation had been observed for chikungunya or the Zika virus. It is therefore to be expected that new discoveries will refine our understanding of the monkeypox in the weeks and months to come. “The transmission of this virus between men having sex was for example not reported at all until the current episode”concludes the epidemiologist.

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