an expert from the Institut Pasteur decodes a “really unusual” disease

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That smallpox of the monkey goes on progress in France And in the world. At last count there were 91 cases confirmed in France and almost as many are examined. To have all the keys to understanding this disease is emergence and its direction, Futura spoke to India Leclercq, teacher and researcher at the Department of Biological Emergency Response at the Institut Pasteur and at the University of Paris-Cité. Together with her colleagues, she investigates and monitors emerging infectious diseases in France and responds to biological emergencies 24 hours a day, 7 days a week.

Do we know where the strain of monkeypox that has been circulating outside of Africa since early May came from?

India Leclerq : We recently received a number of complete sequences of the genome. Even if the data needs to be consolidated, the first analyses indicate that the strain is not currently circulating in regions endemic similar to that which circulated in Nigeria in 2017-2018 and was the starting point of a notable epidemic. In addition, there were already a few cases of introduction into non-endemic areas.

The number of cases of monkeypox outside of Africa is unprecedented. Is this a sign that this strain is more easily transmissible than the others?

India Leclerq : It’s really unusual, there have never been so many cases outside of Africa. But it’s a bit early to say that the strain is more transmissible than strains circulating in West and Central Africa. We need some more epidemiological data to better characterize the dynamics of transmission and spread virus. Given the direct contact and transmission route through respiratory droplets, the number of cases worldwide is still relatively low. This suggests that the strain circulating today is not necessarily more transmissible than that spreading across Africa.

Do you really know how monkeypox is transmitted and who can get it? Julie Kern takes stock in this episode of Health on Listening. © Futura

Is there some form of sexual transmission of the disease, as some media outlets claim?

India Leclerq : It all depends on what you consider sexual. We have no data showing that the virus is transmitted through semen and vaginal fluid. However, it is transmitted through close contact. If you kiss, caress someone, you are in close contact and therefore possible transmission. Sexual intercourse can even promote transmission of the virus. The homosexual community has often been stigmatized, but any sexual relationship can encourage transmission, whether heterosexual or homosexual.

How is the evolution of cases monitored in France?

India Leclerq : That monkeypox virus has already been monitored and identified as potentially emerging. The disease is now notifiable. It is therefore necessary to contact the health authorities as soon as a case is confirmed for the monkeypox virus. It allows you to quickly trace infected people, and subsequently there is a whole system of information and large-scale alerts. There are messages addressed to healthcare professionals to warn precisely about this new disease, let’s say rather this disease that is relatively unknown to doctors at the moment.

The virus is understood to have been circulating quietly, a little under the radar, for a number of months

Cases are diagnosed quickly to allow isolation of those infected and avoid spread as much as possible. We think, that the virus circulated quietly, a little under the radar for several months. Doctors are now better informed about this relatively rare and easily confused condition chickenpox or the syphilis. It is very likely that there have been unidentified cases of monkeypox.

The smallpox vaccine is also recommended by the Haute Autorité de Santé to limit the spread of monkeypox.

India Leclerq : Yes, it is recommended for post exposure. It is effective when administered within four days of the onset of symptoms, but it still needs to be vaccinated fairly quickly the adopted strategyI think that’s the one vaccination in a ring, that is to vaccinate infected and very close people to limit the spread of the virus and contain the source of infection more quickly.

Also, are people who are vaccinated against human smallpox protected from monkeypox?

India Leclerq : Very likely since vaccination against smallpox would protect between 80 and 85% from getting infected, so people who have been vaccinated against smallpox are more or less protected against it monkeypox virus. And also, if we look at the age group of those infected, it’s mostly people in their 20s to 50s, people who haven’t had a smallpox vaccine.

How are the sick cared for?

India Leclerq : Currently we only process the symptoms of the disease : Primarily, skin lesions are treated to prevent and alleviate secondary bacterial infections Pains of the patient. They are still very rare in immunocompromised people or small childrenepidemic In the current situation, more advanced treatments may be recommended. Of antivirals exist, but they target the smallpox virus.

Finally, the question everyone is asking: could the monkeypox virus cause a global pandemic?

India Leclerq : I don’t have a crystal ball. If we refer to what theWorld Health Organization, it assesses the global risk as moderate. The circulation dynamics are not the same as during the Covid-19. with le SARS-CoV-2we had a virus that was airborne but over a long distance and that was extreme contagious. Currently, people infected with the monkeypox virus transmit it mainly when symptoms have appeared. The asymptomatic are very little contagious.

Control measures are therefore much easier to implement. Once the person develops symptoms, it is easy to isolate them. This was not the case with the SARS-CoV-2. In addition, there is already a vaccine and antivirals that are not specific to the virus, but have nevertheless shown their effectiveness. It is also a virus that mutates a priori less than an RNA virus, the viruses DNS less susceptible to mutations. Let’s be careful, viruses are inherently unpredictable.

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