Since its importation into Europe in May, monkeypox appeared to be quietly circulating. But in recent days, testimonials from people with the disease are increasing on social media. A sign that the epidemic continues to grow – as of June 30, 498 cases have been recorded in France, a figure more than ten times higher than at the beginning of the month. As in other Western countries, smallpox mainly affects men who have homosexual relationships. The fear of labeling this pathology as a “gay virus” is now accompanied by the certainty of the relevance of a prevention policy focused on these at-risk populations. “Researchers realized from the beginning the need to communicate in a targeted way to these communities, and today this is done well, in partnership with local authorities and associations. But we may have wasted time because there was reluctance linked to this fear of stigmatization,” he said. laments Professor Xavier Lescure, an infectious disease specialist at the Bichat hospital in Paris.
Manifested by fever, headaches, body aches and then pimples, but also by intraoral lesions, proctitis and urethritis, monkeypox or simian orthopoxvirus, it can sometimes go unnoticed and be confused with other pathologies such as chickenpox or genital herpes. “Smallpox can represent a diagnostic trap because French doctors did not know about this disease a few weeks ago, but also because of the wide spectrum of ways in which it can manifest, which does not always resemble what is portrayed in books, highlights Professor Lescure. Can monkeypox therefore be characterized as a sexually transmitted infection? The debate is more complex than it seems. Simian orthopoxvirus, as it has been known since the 1970s in Africa, was transmitted more by hunting or eating infected animals than by human-to-human contact. In this part of the world, the disease manifests itself more on the face and arms, and affects children greatly. A clinical picture totally different from what we have seen in recent weeks in Europe, where monkeypox is quite revealed by lesions at the genital level.
opening of nine vaccination centers
“Smallpox can be an STI (Sexually Transmitted Infection – Editor’s Note), but not only”, summarizes Xavier Lescure, who notes that the virus can be qualified as such due to viral persistence in genital fluids. “But it can also be transmitted by perigenital friction, so condoms don’t protect. To avoid contamination, total abstinence is required until the lesions are completely healed, about three weeks. highlights the infectologist, who estimates that it would be necessary in addition to the use of condoms in the next eight weeks because of this famous viral persistence in the fluids. The virus can also be spread by aerosol, but with less contagiousness.
“Between these strict isolation recommendations and the fact that contact tracing is very difficult to carry out, it is questioned whether, in a pragmatic way, the recommendations in terms of vaccination should not be changed”, adds the researcher. In fact, until now, health authorities recommended the use of the smallpox vaccine – a cousin of smallpox – only for cases of contact, therefore post-exposure, within four to fourteen days after the last contact with an infected person. The regional health agency of Ile-de-France also announced on Tuesday the opening of nine vaccination centers. There are also symptomatic or antiviral treatments. While the disease often remains mild—the low case fatality rate in Africa is essentially due to lack of treatment and secondary bacterial infections—scientists remain vigilant. “Fortunately, today the disease mainly affects young, healthy men, but if it starts to spread to children or pregnant women, it could be a problem.” says Professor Lescure. In rare cases, smallpox can cause encephalitis and there is a risk of fetal malformation. The High Authority for Health, which is considering amending recommendations to move towards preventive vaccination, is also expected to issue an opinion at the end of the week. For scientists, the urgency is transparency about France’s vaccine capabilities: the state claims to have large stockpiles of smallpox vaccines to prevent possible bioterrorist attacks. But, for reasons of secrecy, neither their number, nor their location, nor their composition – these are three generations of smallpox vaccines – are disclosed. “However, if we have enough and well-tolerated third-generation vaccines, a preventive injection might be interesting, but if we mainly have first-generation vaccines, which have a less favorable risk-benefit ratio, we have to ask ourselves. question “, warns Professor Xavier Lescure.