The article to read to understand the smallpox of the monkey whose virus is circulating in about thirty countries

One “unusual situation”, but no reason to panic. The World Health Organization (WHO) warns against a global pandemic of smallpox. Since the United Kingdom declared a confirmed case of the disease on May 7, more than 550 other diseases have been reported in 30 countries commonly spread by the virus. France had 33 identified cases on Wednesday, according to data released on Thursday, June 2 by Public Health France.

After two and a half years of the Covid-19 pandemic, new ones related to the spread of the smallpox virus can be investigated. But what are the symptoms? Can we die? Are there any treatments?

What is monkeypox?

It is a viral zoonosis, ie a disease that can be transmitted from animals to humans, caused byorthopoxvirus simien. He was first identified and isolated in 1958 from macaques arriving at the Danish Serological Institute in Singapore. “It’s a rather ill-named virus, because its natural host today is more like rodents, like Gambian rats.”warns Olivier Schwartz, director of the Virus and Immunity Unit at the Pasteur Institute.

This disease is not new. It has been circulating endemically since the 1980s. “In general, a few thousand cases are counted each year.”, details the specialist at franceinfo. The disease is present in two main forms on the African continent, in areas close to rainforests. Its first spread to the Democratic Republic of the Congo (DRC) and the Republic of the Congo, mainly in Nigeria, and spread to urban areas, which allowed the virus to leave the territory even more easily. “This is the second, less dangerous strain that is currently found in Europe and North America.”precisely in France 24 Matthias Altmann, epidemiologist at the University of Bordeaux and specialist in infectious diseases in Africa.

The WHO has been on the rise in recent weeks, with groupings of cases, not directly linked to endemic travel, emerging in countries where the disease is not common.

Is it the same as traditional smallpox?

Monkeypox belongs to the same family as human smallpox, eradicated worldwide in 1980. It was first identified in humans in 1970 in the DRC. Both viruses “90% share the same genetic sequence”, said Olivier Schwartz. They are cousins “Infections may appear less pathogenic with monkeypox than with human smallpox”adds the virologists.

„The West African strain [de la variole du singe] has already made a foray into the United States in 2003, following the importation of infected animals. “Camille Besombes, an infectiologist at the Institut Pasteur, recalls in an interview with The Conversation. “American patients were infected after contact with infected prairie dogs, bought in pet shops, where they had contacted Gambian rats imported from Ghana and monkeypox carriers.”, continues the specialist. A total of 47 suspects were named, but no human-to-human transmission occurred.

Why does the disease circulate outside the usual homes?

This is the main shadow zone of the recent wave of contamination. “Analysis of recent samples in Europe shows that the circulating virus is identical to the strain in West Africa. This suggests that this is not a new, more communicable variant of the disease.”, as was the Omicron variant with respect to the Sars-CoV-2 strain, says Olivier Schwartz. Specialist notes that the monkeypox virus is a more stable and less mutable DNA virus than an RNA virus such as Sars-CoV-2.

Another way of explaining would be the existence, at the beginning of the contamination chain, of a “super-propagating” event, during the course of a large number of infections. The patients could then have infected other individuals.

Paul Loubet, an infectiologist at the Nîmes University Hospital in Gard (Gard), says that these many contaminations have also benefited from fertile soil. general. The absence of a vaccination campaign may have lowered the immunity of younger patients against this family of viruses.

What are the symptoms?

The incubation period of the virus generally varies from six days. The symptoms that appear later are very close to those caused by human smallpox. Initially, the infected patient suffers from fever, severe headache, muscle aches, and inflammation of the lymph nodes. There can also be big two and a lot of fatigue.

Photo from 1997 provided by the US Centers for Disease Control and Prevention.  It shows a patient's right arm and torso, whose skin had a number of lesions due to monkeypox.  (CDC / AP / SIPA)

Characteristic buttons then appear. “The blisters are more focused on the face, palms and soles of the feet. The mucous membranes are also affected, in the mouth and genital area.”, described Public Health France. The disappearance of symptoms takes, in most cases, two to three weeks.

Can we die?

While human smallpox mortality could be close to 30%, monkeypox as we know it usually heals spontaneously. Severe cases are more common in children and are related to the extent of exposure to the virus, the patient’s health, and possible complications.

In African countries where the disease is endemic, the mortality rate varies from 1 to 10%. European Center for Disease Prevention and Control (in English) states that the viral strain detected in Europe from West Africa has an average lethality rate of 3.6%.

“We do not know to what extent this rate is transposable in our country: we generally have very little information on the characteristics of infected patients in epidemics in Africa and our health systems are very different from those of the countries concerned.”, comments for franceinfo the infectiologist Paul Loubet. A reward in adequate medical care considerably reduced the risks and the majority of people who healed spontaneously. In countries where the disease has recently been identified, no deaths have been reported.

How is the disease transmitted?

Houses of smallpox are commonly reported in African countries as a result of direct contact with blood, biological fluids or skin or mucosal lesions of infected animals. Eating undercooked meat from infected animals is also considered a risk.

The so-called secondary transmission, that is, between humans, is more complex. “There is a risk of intermediate transmission of droplets (postillions, sputum), but the predominant mode of contamination is close and prolonged skin contact with an infected person.”, adds Paul Loubet. This conclusion allows the European Center for Disease Prevention, in a report published on May 23 (PDF in English)which risks being posed in Europe by smallpox in the east “reusable” in the general population.

In addition, experts point out that the virus can be attracted during sexual activity, which is not the case with so many sexually transmitted diseases. This transmission could be due to intimate contact during sexual intercourse, not to sexual intercourse itself.

To date, cases have been reported in Europe “Mainly, but not exclusively, in men who have sex with men”relieves SPF. “It is inaccurate to say that it is a disease that affects only gay men.”prevent however in the columns du World Matthew Kavanagh, Deputy Director of UNAIDS, United Nations Program on HIV. According to him, the homophobic comments that sometimes accompany publications on this risky disease, including deterring patients „To consult their caregiver, for fear of being identified with a group”.

Are there any treatments or vaccines?

There is no specific treatment or vaccine for monkeypox, but drugs and vaccines designed for smallpox can be used for monkeypox. In the case of vaccines, „It has been shown, through several studies, that vaccination against smallpox [humaine] 85% effective in preventing smallpox, recalls the WHO. One “Very good efficiency”according to virologist Yannick Simonin, a specialist in emerging viruses, interviewed by franceinfo.

To limit epidemic risks in France, the High Health Authority recommended vaccinating adults on Tuesday (May 24th), including health professionals, who have been in contact with a disease risk. “We have strategic stocks and it will be targeted vaccination. We are not talking about total vaccination.”The Minister of Health, Brigitte Bourguignon, told RTL the next day.

On the treatment side, certain antiviral drugs, especially those designed for smallpox, can also be used to treat or limit the effects of smallpox, such as tecovirimat.

I was tired of reading everything, can you give me a summary?

The smallpox virus is already well known and has been circulating in some parts of Africa since the 1980’s. Unlike Covid-19, no expression can vary greatly from one individual to another. , the symptoms of monkeypox are very identifiable: fever, headache, muscle aches for the first five days, followed by a large number of rashes on the face, palms of the hands, or soles of the feet . Patients usually heal spontaneously and the symptoms last two to three weeks. In countries where the disease has recently been identified, the cases observed are mostly benign and no deaths have been reported.

Also, the virus does not spread is very different from that of Sars-CoV-2. “Closer contact than with Covid-19 is necessary to become infected. The likelihood of an airborne infection exists, but the risks are greater with saliva or postillion than with aerosols.”, enumerates Olivier Schwartz, director of the Virus and Immunity Unit of the Pasteur Institute. Several studies show that smallpox vaccination [humaine] is 85% effective in preventing monkeypox. In France, at-risk contact cases are invited to be vaccinated to stem the spread.

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