Monkeypox is a rather very rare and little known disease. In most cases, spontaneous recovery takes 2 to 3 weeks, sometimes more with regard to contagiousness, and with a low estimated mortality, especially with the West African strain currently circulating in Europe.
But in 2022, uncertainty lies on several points, and it is therefore imperative to stay informed:
- Why an increase in cases in Europe as observed for two decades in Africa?
- How big will the epidemic we face be?
- Why is an overrepresentation of men who have sex with men (HSH Man having sex with other men. )?
What is monkey pox?
Monkey pox (Orthopoxvirus simien or monkeypox (MPX) in English) is a zoonotic viral disease caused by a virus, similar to that of smallpox. It was first identified in monkeys, in 1958, in crab-eating macaques in captivity. These monkeys, from Singapore were intended for the Statens Serum Institut in Copenhagen. But its natural reservoir is probably in rodents. The first identified human case dates back to 1970, and since then several cases have been reported in its endemic area, i.e. several West and Central African countries.
The first outbreak outside of Africa dates back to 2003 and took place in the United States. More recently, two travelers from the UK, one to Israel and one to Singapore, both with travel history to Nigeria, were diagnosed, in 2018 and 2019.
What is the origin of the current epidemic?
Unlike previous European cases, most of the current cases have no recent history of travel to areas of West and Central Africa. Some of those affected, in particular men who have sex with men (MSM), attended the same events in different countries of the European Union, where they had close or sexual contact. For example, a cluster of MonkeyPox cases has been described in the huge gay pride of Yumbo de Maspalomas in the Canary Islands (May 5 to 15, 2022) with a group of 100 cases for an attendance estimated at 80,000 people. A gay sauna has also been closed in Madrid for the same reasons. Further investigations and sequencing are needed to understand the exact circumstances under which people became infected.
Should we be worried about this disease?
Monkeypox does not spread easily in society. The likelihood of spread to the general population is low and most current cases have mild symptoms.
This disease is not a sexually transmitted infection strictly speaking, but it is likely to be spread by close contact, and therefore particularly during sexual activities, with infectious material from skin lesions of an infected person, by respiratory droplets during prolonged face-to-face contact and through infected surfaces. The risk of transmission can therefore be considered high among people with several sexual partners, and therefore including some MSM, who are therefore exposed to this infection.
The disease is usually mild, as in most cases reported in Europe to date. During the small epidemic of 2003 in the USA and in the current European data, no deaths were reported. Most of the data available in the literature come from contexts other than the current epidemic (Nigeria, DRC). In Nigeria, with a different strain, the infection was observed to have a case fatality rate of 1–3.3%. Mortality is higher in children and young adults, and immunocompromised people are particularly at risk for severe forms of the disease. The vast majority of sufferers recover within a few weeks. The likelihood of transmission between individuals without close contact is considered very low. It is through contact with its lesions and through droplets that the virus is transmitted. Unlike Sars-cov-2, responsible for the covid-19 A coronavirus disease, sometimes called covid (after the English acronym of coronavirus disease) is a disease caused by a coronavirus (CoV). The term may refer to the following illnesses: Severe Acute Respiratory Syndrome (SARS) caused by the SARS-CoV virus, Middle East Respiratory Syndrome (MERS) caused by the MERS-CoV virus, Coronavirus disease 2019 ( Covid-19) caused by the SARS-CoV-2 virus.there is no aerosol transmission.
What are the symptoms of monkeypox?
Monkeypox often begins with a combination of the following symptoms: fever, headache, chills, exhaustion, asthenia, swollen lymph nodes, back pain, and muscle pain. A rash usually develops one to three days after the fever starts, first on the face and before spreading to other parts of the body, including the hands and feet. Skin lesions often first appear as spots, progressing to papules, vesicles, pustules and crusts. In the United Kingdom, a greater presence of lesions affecting the genital mucosa has been reported in MSM patients.
How can I protect myself and others from monkeypox?
Infected people should stay isolated until the scabs fall off and should especially avoid close contact with immunocompromised people, pregnant women and young children, and pets. It is also advisable to abstain from all sexual activity and close physical intercourse until the rash heals. Sufferers should stay in their own room when at home and use designated household items (clothing, bedding, towels, cooking utensils, plates, glasses), which should not be shared with others members of the entourage and be washed separately.
People who have been in close contact with cases of monkeypox should self-monitor for the development of symptoms for 21 days after the last possible exposure contact.
Caregivers and relatives should avoid touching skin lesions with bare hands, wear disposable gloves and observe strict hygiene.
How is monkey pox treated? Is there a monkeypox vaccine?
The treatment is mainly symptomatic, that is to say that the symptoms of the infection are treated, but not the infection directly. Management should also prevent and treat possible secondary bacterial infections. The smallpox vaccine can provide around 80% cross-protection against the monkeypox virus and anyone born before 1979 is advised to consult their vaccination record. Vaccination stopped in 1978 when the WHO announced the eradication of smallpox. The vaccine can be used before and after exposure to the virus. In particular, the third-generation smallpox vaccine given within four days of exposure to infection with the monkeypox virus can have an important protective effect. HAS recommends the implementation of a reactive vaccination strategy, i.e. around a confirmed case: adults whose contact with an infected person is considered to be at risk, including exposed healthcare professionals without personal protective measures. This vaccination should be performed only with the third generation vaccine. (IMVANEX)
In the United Kingdom, researchers have announced that they have developed a potential specific antiviral treatment for smallpox, in particular monkeys, according to the British newspaper The Independent, (May 25, 2022). According to the first data, this treatment, Tecovirimat, could shorten the symptoms and reduce the duration of contagion of a patient. A study published in The Lancet Infectious Diseases focused on seven cases treated between 2018 and 2021, therefore unrelated to the current epidemic. The latter spent more than three weeks in quarantine and then the doctors prescribed them two antiviral drugs against smallpox: Brincidofovir, which proved to be ineffective, and Tecovirimat, which reduced the duration of the disease and therefore hospitalization. Also tested are Cidofovir, an antiviral which has proven itself in cytomegalovirus infection and specific immunoglobulins.
Why avoid contact with pets?
It’s not just a monkey disease. Some pet mammals, especially rodents, are susceptible to monkeypox virus. If these pets transmit the disease to wild animals, the disease could become endemic in Europe in these animal populations.