Since mid-July, the contamination curve has dropped significantly (AFP / Patrick T. FALLON)
The monkeypox epidemic is in full decline, but be careful not to declare victory too soon, warn experts and health authorities: we must not forget the many African countries where it circulated well before this year.
“We are moving towards the end, but we are not there yet,” virologist Jean-Claude Manuguara told AFP. With more than 70,000 cases in a hundred countries since May, “an epidemic of + monkeypox + so important in such a short time, it is unheard of”, recalls this head of the Environment and infectious risks unit at the Institute. Pastor.
Main — but not only — concerned: men who have sex with men.
Since mid-July, the contamination curve has dropped very markedly, particularly in Western Europe and North America. But some Central and Latin American countries are still on the rise.
And monkeypox, declared an international public health emergency on July 23 by the WHO, still retains this status, like Covid for that matter.
“A slowing epidemic can be more dangerous, because we can think the crisis is over and lower our caution,” warned Tedros Adhanom Ghebreyesus, director general of the WHO, in mid-October.
– Four scenarios –
However, if the epidemic is declining, several experts point out, it is largely thanks to the change in behavior within communities at risk, although vaccination has also played a role.
More than 70,000 cases in a hundred countries since May is unheard of, according to a virologist from the Pasteur Institute (AFP / JULIEN DE ROSA)
Behaviors have notably been able to evolve thanks to the role “of associations, perhaps more listened to than the authorities and closer to the ground”, suggests Jean-Claude Manuguera.
Surveys indicate that more than half of men who have sex with men have reduced their number of sexual encounters.
As for vaccination, “it has helped, but the number of vaccines available remains low”, reminds AFP Carlos Maluquer de Motes, professor of virology at the British University of Surrey.
The vaccine is still recommended for prevention and post-exposure. Its clinical efficacy is not yet supported by “hard data”, according to the European Agency for Disease Control (ECDC), but it shows positive preliminary results.
In any case, “significant uncertainties remain about the evolution of the epidemic”, underlines the European agency.
Its experts draw four scenarios. Battery: rebound of the epidemic, linked in particular to the return of risky behavior, or reduced circulation of the virus with sporadic outbreaks. Face: persistent decline in the epidemic, even elimination of the disease in Europe.
– No border –
The goal remains to prevent monkeypox (caused by a DNA virus, which is larger and less susceptible to abrupt genetic changes than an RNA virus) from becoming more dangerous, or even taking hold in countries where it does not. is not. At present, it is “endemic” in about ten African countries.
Vaccination against monkey pox in Lille, August 10, 2022 (AFP / FRANCOIS LO PRESTI)
Admittedly, the monkeypox virus is much less contagious than, for example, that of Covid. Cases therefore tend to progress much more slowly. But “the more infection cycles there are, the more likely (the) + monkeypox + is to change and infect more”, points out Carlos Maluquer de Motes.
This episode is also a reminder: viruses have no borders and the response must be global, insist the defenders of an approach combining human, animal and environmental health (“One Health”).
In the endemic areas of Central and West Africa, the epidemic, which is more lethal, stems mainly from contact with wildlife in rural areas.
“The African source remains present and, in a context where there may be population movements, we may have new exported cases and a new epidemic wave at any time”, warns Steve Ahuda Mundeke, head of the virology department at the Institute for Biomedical Research in the Democratic Republic of Congo and member of an IRD/Inserm team.
In recent months, “we have again seen that global strategies are only deployed when the countries of the North are affected – which does not at all clear the African health authorities”, he notes.
“African countries are an integral part of the global response”, assured Rosamund Lewis, WHO’s main expert on monkeypox, in early October, welcoming their commitment to better surveillance (detection of the virus) and to studies on treatments and vaccines. .