2023-12-28 15:59:04
This article was originally published in English
As Congo faces its largest smallpox outbreak, scientists warn that discrimination once morest gay and bisexual men on the continent might make the situation worse.
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The World Health Organization (WHO) first reported in November that smallpox, also known as monkeypox, was spreading sexually in Congo.
This is a significant change from previous surges, in which the virus primarily affected people in contact with sick animals.
The Mpox virus has been present in parts of central and west Africa for decades, but it was not until 2022 that it was proven to spread sexually. Most of the approximately 91,000 people infected in around 100 countries that year were gay or bisexual men.
Reluctance to report symptoms might drive the epidemic underground, according to Dimie Ogoina, an infectious diseases specialist at the University of the Niger Delta in Nigeria.
“It may be that because homosexuality is banned by law in most parts of Africa, many people do not come forward if they think they have been infected with the Mpox virus.”confides Dimie Ogoina.
WHO officials said they identified the first cases of sexual transmission of the most serious type of smallpox in Congo last spring, shortly following the arrival in Kinshasa, the Congolese capital, of a Belgian resident who “identified as a man who had sex with other men.”
The UN health agency said five other people who had sexual contact with the man were later infected with smallpox.
“For years we have underestimated the potential for sexual transmission of Mpox in Africa”says Dimie Ogoina, who, with his colleagues, first reported in 2019 that Mpox might be spread sexually.
Gaps in surveillance make it difficult to estimate the number of smallpox cases linked to sexual intercourse, he adds. However, most cases of smallpox in Nigeria involve people who have no known contact with animals.
In Congo, approximately 13,350 suspected cases of smallpox, including 607 deaths, were recorded until the end of November, and only 10% of cases were confirmed by laboratories. The number of sexually transmitted infections is not clearly established. According to the WHO, around 70% of cases involve children under 15 years old.
During a recent trip to Congo to assess the outbreak, WHO officials found that health workers were “unaware” that smallpox might be transmitted sexually, which may have cause positive cases to go under the radar.
The WHO announced that health authorities had confirmed sexual transmission of smallpox “between male partners and simultaneously through heterosexual transmission” in different parts of the country.
Smallpox usually causes symptoms such as fever, rash, muscle sores and pain for up to a month. It is spread through close contact and most people recover without needing medical treatment.
During the major international epidemic of 2022, mass vaccination programs were implemented in some countries, including Canada, Great Britain and the United States, and targeted those most at risk, namely homosexual and bisexual men. But experts say this is unlikely to work in Africa for several reasons, including stigmatization of gay communities.
“I don’t think we will see the same demand for vaccines in Africa as in the West last year”says Dr. Boghuma Titanji, assistant professor of infectious diseases at Emory University School of Medicine in Atlanta.
She added that gay and bisexual men most at risk of contracting the smallpox virus may fear participating in a large vaccination program. Countries should work to find ways to administer vaccines – if they are available – in a way that does not stigmatize them, she adds.
Dr. Jean-Jacques Muyemba, director general of the National Institute of Biomedical Research of Congo, says two provinces in Congo have reported cases of sexual transmission of smallpox, which is worrying.
“There is no approved vaccine in Congo and it would be difficult to obtain enough vaccines for a large-scale programme”, specifies Jean-Jacques Muyemba. The country is trying to obtain a Japanese smallpox vaccine, but regulatory issues are complicating the situation, he adds.
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Worldwide, only one vaccine has been authorized once morest smallpox. It is manufactured by the Danish company Bavarian Nordic. Stocks are very limited and even if they were available, they would have to be approved by the African countries that use them or by the WHO. To date, the vaccine is only available in Congo through research.
Oyewale Tomori, a Nigerian virus expert who serves on several WHO advisory boards, said African governments probably have too many competing priorities to ask the U.N. health agency or donors to help them get results. vaccines.
“In Africa, Mpox is most likely considered a low priority nuisance”says Oyewale Tomori.
He stresses that closer surveillance, laboratory networks and better availability of diagnostic supplies would benefit the continent more than vaccines.
In the absence of increased efforts to stop outbreaks in Africa, Dimie Ogoina predicted that mpox would continue to infect new populations, warning that the disease might also trigger outbreaks in other countries, like the global emergency declared by the WHO last year.
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“When the HIV pandemic started, it affected gay and bisexual men in the North, and Africa thought it was not its problem”he confides. “Before we knew it, the virus arrived in Africa, but we still thought heterosexual populations would be protected.”
Women of childbearing age now represent more than 60% of new HIV infections in Africa.
“I fear the same thing will happen with Mpox”, he specifies. “If we don’t tackle these epidemics in Africa, the virus will keep coming back.”.
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