2024-08-16 15:12:00
The World Health Organization (WHO) is changing tack. The highest level of alert was triggered in the country on Wednesday 14 August as cases of MPOX (previously known as monkeypox) re-emerged on the continent due to the emergence of new variants.
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Sweden has since reported cases of the variant imported into its territory. French Prime Minister Gabriel Attal announced on Friday, August 16, that although additional cases may soon be detected in Europe, France is putting the health system on “the highest alert”. The answer to the question raises the question.
What is mpox?
This is a viral disease. “It has zoonotic origins. That is to say, in the wild, it is an animal that serves as a reservoir for the virus, possibly,” said Professor Antoine Gssaisin, an expert and head of the epidemiology and pathophysiology of the Carcinogenic Viruses Unit at the Pasteur Institute. Squirrels. Usually, the typical African form of the disease is the result of the transition from animals to humans »
A child who plays with animals may contaminate those around him. But the epidemic outbreak quickly disappeared. So this is a classic and historical example of the disease. However, there have been cases of human-to-human transmission. This is what concerns us today.
Is this the same virus during the 2022 pandemic?
Not exactly. Historically, two clades containing two variants of the virus have been discovered. Clade I is found in central Africa. Type II clade is endemic in West Africa. While this is the second version of the virus causing the 2022 pandemic, the first alert is now in Africa, but in the form of a new variant. The virus mutated because it “jumped” and spread massively among humans, freeing itself from the animal world.
The victims of this branch, called Ib, have changed. Now, both teenagers and adults are affected. The first cases were discovered in September 2023 in a mining area in eastern Democratic Republic of Congo (DRC), among sex workers and their clients, including men who worked in the mines. Cases of the new variant have been detected outside the Democratic Republic of Congo since late 2023. The same has been true in Europe since Thursday 15 August.
How does mpox spread?
“Human-to-human contamination occurs through the skin, through contact with vesicles on the skin and their fluids containing the virus,” continued Professor Gssaisin. The Ib clade responsible for this epidemic is mainly transmitted through sexual intercourse and skin and mucous membrane contact. We can read everywhere that contamination in the air – through saliva droplets – is possible. This is not the case.
What are the symptoms?
Sometimes there isn’t one. “Viruses can be present in the body without causing symptomatic disease,” explains Karine Lacombe, an infectious disease specialist and head of the Department of Infectious Diseases at Saint-Antoine Hospital of the Sorbonne. After the incubation period, the first signs may appear. “It starts with flu-like symptoms: high fever, body aches, sore throat. Then comes swollen lymph nodes, which means disseminated lymph nodes,” she added. “A few days later, a rash appears, leading to blisters within two to three weeks.” Disappears without leaving any scars. » Severe pain may also occur during the 2022 pandemic (the impetus of which is also multi-partner sexual relations), resulting in mucosal (oral, genital and anal area) lesions.
African cases mediated by clade Ib appear to give a similar clinical picture. “We know next to nothing about the Swedish case,” Professor Lacombe carefully emphasized. The risk of complications is of two types. “First, what we call sepsis is an extremely severe inflammatory response caused by a virus that breaks through the immune defenses. Then there is bacterial superinfection of the skin lesions. »
Are MPOX’s new variants “dirtier”?
not sure. “Based on the clinical data we have in Africa, the virus appears to be more contagious and people infected with it become more seriously ill,” reports Karine Lacombe, who insists there are conditions. “This data is quite complicated to interpret because there is so little screening in Africa. Calculating the impact is really hard. But if we compare clade I, which historically existed in the Democratic Republic of Congo, with clade II, which comes from West Africa, we see that the mortality rate in the former Still higher. »
It is also difficult to extrapolate what is happening in Africa to what is likely to happen in Europe. Treatment opportunities and health outcomes are better in Western countries. “MPOX remains a disease in socio-economically disadvantaged areas, often in remote areas where medical care is poor. In these areas, children – often malnourished and sometimes dehydrated – pay the heaviest burden of the disease. At the cost, death is related to bacterial secondary infection of skin lesions. Other deaths occur in people who are immunocompromised due to HIV, especially if treatment is inadequate or inadequate,” Professor Gessain emphasized.
What are the treatments for MPOX?
There is an antiviral drug, tecoviramat, which is an inhibitor of the intracellular viral cycle. Is it effective? It is currently being evaluated in a clinical trial called “Unity” in Europe, specifically in France. “Currently, we have only included 250 patients during the 2022 epidemic,” explains Professor Karine Lacombe. These topics are not sufficient to draw any conclusions. » Similar trials are underway in the United States, but it’s too early to comment on the molecule’s effectiveness. Then the western cases are from clade II.
The only data on the benefits of tecoririmat on clade I come from treatment trials in African children. “The results show it doesn’t work,” the infectious disease expert reported. Arm I cases will still be treated with tecovirimat in France to enrich scientific knowledge of the drug. In addition to fluid care, pain relievers and antibiotics may be used if bacterial secondary infection occurs.
How to protect yourself from MPOX?
Infected people must self-isolate. If you’re willing to take the risk, it’s possible to get a dose of post-exposure smallpox vaccine. The two viruses are so close together that stimulating the immune system to fight smallpox could prevent two-thirds of smallpox cases. At St. Anthony’s, the strategy is now well established. When a case of MPOX is detected, vaccinations are offered to those around you and your sexual partners.
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