It’s back to school and it’s a good time to make a point of information: The Ministry of Health organized a meeting on Tuesday August 30 on the monkeypox epidemic raging since the end of May in many countries. Representatives of the Directorate General for Health (DGS), the National Agency for Research on like Acquired immune deficiency syndrome. In English, AIDS, acquired immuno-deficiency syndrome.hepatitis and emerging infectious diseases (ANRS MIE), the National Agency for the Safety of Medicines and Health Products (ANSM) and Public Health France took the floor to provide an update on the latest data on monkeypox.
A demonstration of mobilization of the institutions, and a tone which wants to show that the government and the health agencies take the problem seriously, and that no one has let the summer period pass without taking action.
Indeed, over the summer, much criticism emerged over what was seen as a lack of government response to a disease spreading almost exclusively among men who have sex with men (MSM Man having sex with other men. ).
LGBT+ and AIDS associations had called on the government to speed up vaccination once morest monkeypox so that all exposed people are protected before the end of September, judging that, on the trajectory taken in mid-August, the objective might not be achieved. It must be recognized that mobilizing additional caregivers, from the week of July 14, in a context of exhaustion and disarray of caregivers and a major crisis in the health system is a feat.
Still according to the associations, to prevent the epidemic from being “out of control”it was necessary “that all target people be vaccinated by the end of the summer”which meant to vaccinate “at least 37,000 people per week”. In mid-August, at the time of the interassociative press release, only 15,000 people per week were vaccinated once morest smallpox.
23,000 cases worldwide
After the summer, where are we with the outbreak that started in May? Worldwide, more than 23,000 cases have been identified as of August 23, and in 95% of cases, these are men who have sex with men (MSM). As of September 1, France had 3,646 confirmed cases, and here too, the vast majority of adult confirmed cases identified to date are men, except 59 women (1.6%) of whom unfortunately little is known. things because of the small number and the insufficient quality of the documented information. No deaths are to be regretted in France, but two people suffering from encephalitis died in Spain, and one in Belgium.
Professor Laëtitia Huiart, Scientific Director of Public Health France, recalled the importance of mandatory reporting (DO) in the face of this epidemic to obtain reliable epidemiological data.
A known virus, a particular epidemic
Professor Yazdan Yazdanpanah, director of the ANRS, recalled that direct contact in the presence of lesions during sexual intercourse was the main mode of transmission. The symptoms encountered are slightly different from the symptoms usually encountered, making the diagnosis all the more difficult: Unlike cases in the epidemic area, children are very little affected by this recent outbreak (only 9 cases), and the location of the lesions, at the genital or pharyngeal level, as well as the fact that they are often unique, also seems specific to this outbreak.
On the other hand, asymptomatic cases have also been identified, without it being known whether they can transmit the virus. For Yazdan Yazdanpanah, their charge viral The plasma viral load is the number of viral particles contained in a sample of blood or other container (saliva, CSF, sperm, etc.). For HIV, viral load is used as a marker to monitor disease progression and measure the effectiveness of treatments. The level of viral load, but even more so the CD4 count, participate in the decision to treat with antiretrovirals. being high, it is probable.
Decline in incidence
There are, however, reasons for hope. According to Professor Jérôme Salomon, Director General of Health, the mobilization of institutions and associations is beginning to bear fruit: “Global prevention allows for the first time a drop in incidence.” According to the World Health Organization, the incidence would have fallen by 21% at the global level, and the latest scientific modeling points in the direction of a reduction in the number of new cases.
This decline is to be credited to the use of vaccination, of course, but not only: screening, self-diagnosis, isolation in the event of symptoms are extremely important and constitute, with the vaccine, combined prevention. Thus, for Catherine Smallwood, in charge of monkeypox at the European office of the WHO, the recent slowdown in European cases might be due to earlier detection and isolation. Note, however, that it is not known to what extent sexual behaviors were affected by the fear of transmission. Indeed, no instructions were given to modify behavior, apart from isolation.
140,000 doses of vaccine in the field
More than 70,000 doses of the 3rd generation smallpox vaccine, which is said to protect up to 85% once morest the monkeypox virus, have been used since May. In most cases, this is a first injection, but this figure takes into account the second injections of some patients. In early September, a total of 140,000 doses were delivered to the field, distributed according to local needs, in the 220 vaccination centers. The epidemic is present in a disparate way on the national territory, and Île-de-France is much more affected than the others, with 2236 confirmed cases on December 1.
Do not relax the effort around vaccination
Faced with the drop in the number of new cases, the vaccination campaign once morest monkeypox will be maintained in France for several more months, probably until the beginning of the year 2023. The officials present insisted on the importance of remaining mobilize and properly carry out a complete vaccination schedule, with 2 doses at least 28 days apart.
Faced with the urgency of increasing vaccination coverage, official recommendations concerning the date of a second injection have been relaxed: appointments for a second dose have been postponed to a later date in the vaccination campaign. The associations of persons concerned had also reacted very unfavorably to this announcement. With the arrival of new doses, these appointments will be able to be made and honoured.
Some countries have authorized intradermal vaccination to inject the smallpox vaccine, with the aim of saving doses. Indeed, this technique uses a fifth of the dose of vaccine required for a conventional injection (subcutaneous). By injecting the vaccine under the first layer of the skin, it is possible to multiply the existing stock by five. In France, the ANSM is cautious regarding this, as Dr. Caroline Semaille, Deputy Director General of the Agency, explained: “This technique is more difficult to perform, and it is not done much anymore, so it would have been difficult to find people who might perform it. And above all, it is much more reactogenic, and causes many more local adverse effects.
Finally, the first feedback from the vaccination experimentation with pharmacists (5 pharmacies in 3 regions) is positive, but there are still real organizational challenges, with cold chain and storage issues. Jérôme Salomon suggests a “pragmatic enlargement”following assessments of local needs.
The day following the French press conference, the WHO declared that “Europe might eliminate monkeypox”, if it stepped up “[ses] urgent efforts”.
