2023-12-17 17:48:00
Can cases of monkeypox spread throughout the world? The World Health Organization (WHO) is concerned about this, after an outbreak of contamination in recent weeks in the Democratic Republic of Congo (DRC). What new observations were made? What is the profile of the patients? Le Parisien takes stock.
What a situation ?
The worry is real. “We fear that there is international transmission” from the DRC, said Friday Dr. Rosamund Lewis, specialist in mpox at the WHO – preferred term, replacing monkeypox – during a press briefing in Geneva. Because the observation is alarming: “the epidemic is spreading rapidly in the country”. More than 13,000 suspected cases were observed, “more than twice the number of contaminations reported in previous years,” she warned. Above all, “more than 600” people died.
Until then, around ten regions of the DRC were identified as “endemic”, which means that the virus was circulating there on a more or less permanent basis. Now, 22 provinces in the country have been affected by mpox cases, according to a WHO bulletin dated November 23. People “who traveled to endemic regions were at the origin of a chain of human-to-human transmission in unaffected provinces,” points out the UN agency.
Why are these contaminations more worrying than before?
There are two known clades (or variants) of mpox: 1 and 2b. The current epidemic in the DRC is carried by clade 1 of the virus, while that which struck Europe and the United States last year was due to clade 2b, which could be transmitted mainly during sexual intercourse. . “Until now, clade 1 present on the African continent was transmitted to humans through contact with certain animals, such as rodents. These cases remained rather confined to rural areas. However, for the first time, sexual transmission among patients suffering from variant 1 has been observed,” explains Dr Éric D’Ortenzio, epidemiologist at ANRS Emerging Infectious Diseases.
This new route of transmission is worrying, because the epidemic is now spreading to regions that were until now considered spared from the tropical disease. “Semi-urban or very urban areas like Kinshasa”, or the province of Lualaba and South Kivu are now affected, he observes. The profile of patients has also changed, with more women infected than men.
Another concern is that variant 1 circulating in the DRC presents a more worrying level of severity than variant 2b. “Historically, we estimate the mortality rate of clade 1 to be around 10%, compared to 1% for clade 2,” observes Yannick Simonin, specialist in emerging viruses at the University of Montpellier, even if these figures depend on the health context of the country and the quality of its support.
What context?
The monkeypox virus has been endemic in parts of Africa since the 1970s. The disease is transmitted from animals to humans, but is therefore also capable of being transmitted through close contact and sexual contact. Last year, an outbreak of cases (linked to variant 2b) was observed as early as May 2022, in Europe and the United States.
Symptoms start with fever, fatigue or even muscle pain. Then, spots and lesions may appear on the skin (including the genitals). A PCR test then makes it possible to confirm – or not – the presence of the virus. Faced with the outbreak of cases in 2022, several countries such as France and the United States had strengthened their vaccination campaign. The epidemic is also considered “under control” in France. The fact remains that contaminations are now on the rise in several regions of the world, particularly in Asia, with cases in Japan, Vietnam, China and Indonesia.
What prevention?
To curb any epidemic outbreak, efforts must first be directed towards detection campaigns, which are still considered too fragile. “The diagnosis is not easy to make because the symptoms of mpox can easily be confused with those of other illnesses: it ranges from a simple flu-like illness to measles for skin rashes,” notes Yannick Simonin, who believes that a “large proportion of positive cases” still goes under the radar. And to summarize: “The lack of detection constitutes a favorable breeding ground for the spread of the virus”.
Supporting research projects and accentuating ongoing studies will make it possible to better identify the populations likely to be most affected, adds Dr Éric D’Ortenzio, participating in one of them, the Panafpox project with the ANRS. The challenge is not small. “Last year, we observed very localized circulation of the virus among men. But in the DRC, we are seeing a wider spread within the population, which encourages caution and the avoidance of any stigmatization of the homosexual community, points out Yannick Simonin.
Finally, a strengthening of vaccination campaigns – “almost non-existent” in Africa – could fight against the spread of mpox. Around a million doses have been administered globally, including around two thirds of first injections, according to the researcher. Coverage still considered “insufficient” to, according to him, prevent a potential epidemic resumption in France as in other countries.
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