Monkey pox: “we don’t know much about the transmissibility of the virus”

1 case, then 7, then 16… The progression of monkeypox in France has an air of deja vu. But unlike Covid-19, there are no deaths among nearly 400 cases detected worldwide. If the disease seems mild and lasts only three weeks, it has several unknowns according to Swiss epidemiologist Antoine Flahault. The director of the Global Institute in Geneva calls on health authorities to remain proactive, given the “insufficient” level of knowledge of the virus to date. Maintenance.

Capital: Reading you on Twitter, it seems like we don’t know anything about monkeypox. However, unlike Covid-19 which appeared at the end of 2019, this disease was discovered in the 1950s…

Antoine Flahault: It’s true, we’ve known about monkeypox since 1958. It was in a pet store that this virus was discovered. It was then necessary to wait until the 1970s for the first case to be identified in a child in the Democratic Republic of Congo (DRC). The virus then spread to West Africa. However, this is not enough to have a thorough knowledge of the virus.

Capital: Why?

Antoine Flahault: Because the countries of sub-Saharan Africa do not benefit from the same investment in research as the rich countries. Even in Nigeria, where the virus has been circulating regularly since 2017, we do not have expertise equivalent to that of the countries of the North. And since monkeypox has never hit the headlines in Europe or North America, developed countries have not invested in learning more about this disease.

Capital: You mean we don’t really know the characteristics of monkeypox in terms of transmissibility and/or severity?

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Antoine Flahault: An analogy could be made with the chikungunya virus. When it reappeared in 2006 on Reunion Island, we quickly realized that we did not know much about this disease, its contagiousness… Conversely, the flu and gastro- enteritis, responsible for epidemics each year in Europe, are well known. Aside from that, Ebola is a bit better known than monkeypox because it once worried Western countries. In fact, as long as the rich countries do not feel threatened, the research investment on the virus is neglected.

Capital: In France, the health authorities nevertheless seem reassuring in the messages they send to the general public…

Antoine Flahault: They are partly right. Of all the cases identified, no deaths are to be deplored. From this point of view, the disease seems benign. No reason therefore to be alarmist and to sow panic. But we must not overlook the fact that this virus had not circulated in metropolitan France so far. We must not believe that we know everything about the virus because we have 60 years of knowledge…

Capital: The majority of cases that have no direct link to countries where monkeypox is endemic are not explained at this time. Could the virus have mutated like that of Covid-19?

Antoine Flahault : The difference with Sars-CoV-2 is that it is not an RNA virus but a DNA one. And we know that DNA viruses mutate much less than RNA viruses. I think there is no reason to imagine that monkeypox can mutate every three to six months like the coronavirus. Moreover, for 60 years, only two variants of monkeypox have been distinguished: that of Central Africa and that of West Africa. That doesn’t mean the virus hasn’t mutated.

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Capital: But then, how to understand the cases that appeared in Europe and North America if they are not due to mutations and they have not been imported either?

Antoine Flahault : We can think of epigenetics. That is, the influence of the environment on the virus. A DNA virus like monkeypox does not necessarily need to mutate for its properties to change. The environment can influence the production of this or that enzyme and this or that protein to enhance the transmissibility of the virus, its severity or something else.

Capital: The number of cases of monkeypox has doubled in a few days in France where there are currently 16 infected people, including 12 in the Paris region. Should we expect an epidemic within a few weeks?

Antoine Flahault: This rapid development suggests that there are probably hotbeds of superpropagation in Europe. But that remains a hypothesis. Because historically, with monkey pox, we have had chains of transmission that do not exceed 6 or 7 positive cases. But again, not much is known about the transmissibility of the virus. The question that must be asked is what attitude to adopt now. Because we are reassuring, should we let the virus run? Or should we still try to stop its spread? To let it run is to take significant risks in the face of a virus that we know little about. In my opinion, it is better to do everything to break the chains of transmission.

Capital: Is it at least possible and easy to implement? We saw with the Covid-19 that the theory was difficult to put into practice…

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Antoine Flahault : It seems easier to break the chains of transmission with monkeypox because there are still very few cases. It’s still manageable. What is more, the incubation period is quite long, it lasts 21 days, which gives the possibility of dismantling the chains of transmission. For this, all positive people must be isolated, preferably in hospital as long as few of them are infected. Then, it is necessary to vaccinate contact cases at risk. Finally, we know that the rodent is in some way the reservoir of this disease. The health authorities have mentioned it little, if at all, but it is important that pets, dogs, cats and small rodents are kept away from infected people.

Capital: How to impose the isolation of positive people for three weeks in the hospital when the establishments are already under water, for lack of sufficient staff?

Antoine Flahault: We can understand that this option is not on the table when there are too many people, as for the Covid-19 for example. But there, France has only 16 cases. It’s manageable and you have to be proactive to break the chains of transmission.

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