‘We mustn’t shout victory too soon’: monkeypox epidemic is receding, but…

There are definitely encouraging signs. The monkeypox epidemic continues to slow worldwide, although new cases are emerging in some hitherto avoided countries, such as Egypt and Ukraine. According to a WHO dashboard listing all confirmed cases, as of September 7, there have been 54,709 cases and 18 deaths in 125 countries, 98% of them in Europe and North America.

According to the latest data provided by Santé Publique France, published on 15 September, there were 3,898 confirmed cases of monkeypox in France, an additional 113 cases since the 8 September estimate. The epidemic is marking time: if at the beginning of summer almost 500 cases were detected per week, now it is just over a hundred. However, the authorities feared the consequences of the summer with its massive gatherings of people.

What explains this rather blatant decline in monkeypox cases? For virologist Yannick Simonin, a specialist in new viruses at the University of Montpellier, the main reason is “probably the information and communication campaign around monkeypox.” “The authorities and the media rightly talked a lot about this epidemic. As a result, the most vulnerable populations were very widely informed, and this likely led to a decrease in risky behavior with more caution and screening,” he explains. L’Express.

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On the other hand, according to Yannick Simonin, vaccination did not play a big role in the ongoing drop in the number of detected cases observed over several weeks, even if “we have no prospect” in this matter: “We can rule out a mass effect of vaccination because the campaign started relatively late and we don’t have enough feedback on the effectiveness of the vaccine after one or even two doses.

Proportion of infected women, data for “close observation”

So far, the epidemic has mostly been limited to men who have sex with men. Thus, the vast majority of confirmed adult cases identified to date are in men, with 86 cases (2.2%) in women, Public Health France reports in its latest update. In addition, 9 cases have been reported in children under 15 years of age.

In its previous advisory dated September 12, the French Public Health Service indicated that “among all confirmed cases reported in week 36, 12.9% are women compared to 5.7% in week 35, 7. 5% at 34 weeks and 5.8% at 33 weeks. if “these data should be interpreted with caution” due to the small number of cases identified in women, these data nevertheless “should be closely monitored,” emphasizes Yannick Simonin, who wonders: “Is this the beginning of a somewhat more general the spread of monkeypox?

The virologist urges “to remain cautious” and “not to announce victory too soon.” “The virus is still circulating and mitigating behavior with fewer vaccinations and fewer screenings could help spread the virus more widely and could potentially help restart the epidemic,” he warns. He adds: “We are not yet in a situation where we can say that everything is under control.”

“We are seeing a decrease in injection doses, so we have probably reached the people most in need of vaccination. And if the number of cases decreases, as it currently does, vaccination may be disrupted,” notes this new virus specialist. In addition, the vaccination campaign “plays an important role in the long term” to control the epidemic, he recalls. “The more vaccinations there are, especially for the populations most at risk, the more we reduce the risks of persisting the epidemic in these populations.”

Animal tank risk

Monkeypox has not yet revealed all its secrets. Thus, a specialist in new viruses from the University of Montpellier recalls that “we do not yet know whether the virus is transmitted through sexual intercourse itself or through prolonged contact during sexual intercourse.” “If it is a sexually transmitted virus, then it is present in seminal fluid or vaginal secretions, and therefore, this means that people who have no or few symptoms can potentially transmit it.”

If monkeypox is “not known to be a disease with a significant percentage of asymptomatic course”, then here again specialists do not have reliable data on this issue, which, nevertheless, is important for a better understanding and, therefore, better control of transmission dynamics. “Does the proportion of asymptomatic people play a role in the dynamics of virus transmission? We don’t have clear answers yet,” sums up Yannick Simonin.

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Another “source of vigilance and concern” of health authorities: the question of the reservoir of the virus in the animal population. Even if at present “transmission occurs from person to person,” the virologist reminds, monkeypox can be transmitted both from person to animal and vice versa. “The more the virus circulates, the greater the risk of infecting animals,” recalls Yannick Simonin. “Domestic animals have the potential to transmit smallpox to wild animals, which then become a reservoir of the virus in the animal population and could allow it to become endemic,” he explains. An alarming scenario, unlikely, but impossible to rule out.


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