Monkeypox: Cases are on the rise worldwide. Should we be worried?

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Part of the world is just emerging from an unprecedented SARS-CoV-2 crisis, while others are seeing an explosion in cases and a new epidemic appears to be looming. Across the planet, several countries report cases of monkeypox among their populations. The WHO says it is concerned about this global and unprecedented situation with the spread of this pathology, which in almost 10% of cases leads to death. What are the symptoms, danger and treatment? Should we be concerned about this rapid spread?

Today, following Britain, Spain, Portugal, Sweden, Italy, Canada and the United States, France in turn confirms the first case of monkeypox in Ile-de-France. The emergence of many cases of this disease in North America and Europe is alarming, while it is usually limited to the African continent.

Monkeypox is a viral zoonosis, also called monkeypox or monkeypox. This virus is transmitted to humans from animals – monkeys and rodents, as well as from person to person and can be transmitted back to animals. He is very selective in relation to the owners. Pathology is usually manifested by fever, headache or back pain, muscle pain, swollen lymph nodes, and skin rashes similar to those that cause chickenpox.

With the eradication of smallpox, officially declared by the WHO in 1980 following a massive vaccination campaign, and the subsequent cessation of smallpox vaccination, this orthopoxvirus became the most important virus of its kind. In addition, Spain is working to replenish its stock of vaccines. In France, a decision was made in 1979 to no longer introduce primary vaccination against smallpox before mandatory vaccination was finally abolished in 1984.

The virus is from Africa

The first historical case of monkeypox in humans dates back to 1970 in the Democratic Republic of the Congo in a 9-year-old boy living in an area where smallpox has been eradicated since 1968. cases in rural and rainforest areas in the Congo Basin and West Africa, including the Democratic Republic of the Congo, where it is considered endemic.

In the spring of 2003, cases of monkeypox were confirmed in the United States of America, marking the first appearance of the disease outside the African continent. Most patients had contact with domestic prairie dogs infected with imported African rodents.

For all confirmed cases so far, tests have identified a virus belonging to the West Africa clade of the MKP virus, suggesting an initial link to Nigeria, a country where the virus has been circulating regularly since 2017. Apart from the case reported in the United Kingdom on 7 May imported from Nigeria, the new reported cases do not involve travel to Africa or association with a person returning from Africa. However, at this stage, reported cases are mostly mild and there are no reports of fatalities.

Should I be afraid of illness?

The incubation period – the time between infection and the onset of symptoms – is usually 6 to 16 days, but can vary from 5 to 21 days. The infection can be divided into 2 periods. The initial invasive period (0–5 days) is characterized by fever, intense headache, lymphadenopathy (swollen lymph nodes), back pain, myalgia (muscle pain), and severe asthenia (fatigue/lack of energy).

Second, the rash period begins within 1-3 days of the onset of the fever, with the various stages of the rash often beginning on the face and then spreading to other parts of the body. The face is most affected (in 95% of cases), palms and soles of the feet (in 75% of cases). The rash develops over ten days from maculo-papules (flattened lesions at the base) to vesicles (small fluid-filled vesicles), then to pustules, and finally to crusts. The complete disappearance of the latter can take up to three weeks.

A skin rash can occur in people affected by monkeypox. © WHO

The number of lesions ranges from a few to several thousand, affecting the oral mucosa (in 70% of cases), the genitals (30%), the conjunctiva (eyelids) (20%), and the cornea (eyeball). Some patients have severe lymphadenopathy (swollen lymph nodes) before the rash appears, which is a hallmark of monkeypox compared to other comparable diseases.

Severe cases are more common in children and are related to the degree of exposure to the virus, the health of the patient, and the severity of complications. The WHO estimates the mortality rate to be less than 10%. There is no specific treatment, but monkeypox usually clears up on its own and symptoms persist for 14 to 21 days. There is no need to panic or worry too much at this time.

Despite eradication of the disease in 1980, many laboratories continued to work on smallpox vaccines to eliminate the side effects of first-generation vaccines. In addition, a strategic reserve of vaccines was created in France in case of a bioterrorist attack. If the area were to see an alarming increase in cases, this population would represent the first reaction.

Not to mention, some antivirals, such as cidofovir and brincidofovir, may be effective against this type of virus in animal models, according to the CDC (Centers for Disease Control and Prevention), the United States’ top federal agency. protection of public health. Unfortunately, there is no evidence of its benefits to humans.

Global problem and distribution of zoonoses

Of course, de facto monkeypox has nothing to do with the COVID-19 pandemic. However, health authorities are deeply concerned about its sudden worldwide spread. This has never been reported before. As with the recent pandemic, the WHO warns that these zoonotic diseases are likely to multiply in the coming years due to our activities.

Indeed, whether due to the globalization of trade causing the importation of alien species potentially carrying viruses or intensive deforestation pushing species out of their natural environment, contact between humans and wildlife is increasing. These zoonotic risks are also linked to climate change, another result of our anthropocentric behavior as species leave regions that have become inhospitable. A study published in the journal Nature last April estimated more than 10,000 types of viruses capable of infecting humans, but the vast majority are currently circulating unnoticed among wild mammals.

This global emergence of smallpox cases, together with findings from zoonotic disease research, highlights the urgent need to combine surveillance and virus detection efforts with biodiversity research. This is done in order to monitor changes in the distribution ranges of species, in particular in tropical regions with the highest number of zoonoses and with rapid warming.

Even if the WHO wants to be reassuring about monkeypox, caution must be exercised. Raising public awareness of environmental issues is crucial. The question is no longer the simple disappearance of a symbolic species that causes excitement, but the future of man and his health. Think of this smallpox outbreak as another wake-up call that needs to be heard.

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