Variole du singe : l’épidémie est-elle déjà hors de contrôle ?

Variole du singe : l’épidémie est-elle déjà hors de contrôle ?

06:00, August 16, 2022

Having turned the Covid-19 pandemic into Sunday epidemiologists, but without giving ourselves the certainty of correctly interpreting the incidence curves, we sent this burning question to our address book: “Is the progression of monkeypox exponential? » In other words, should we, in the middle of summer, raise the level of concern about a still unknown virus? Well, according to specialists, the answer is not simple.

Some indisputable figures to put together the equation: more than 27,800 cases have been reported since the beginning of the year, with an acceleration since the arrival of the disease in Europe and North America in May, according to the WHO; On Thursday, 2,673 confirmed contaminations were identified in France. So what do the experts say? “It is not exponential at the moment”, devastates one of the pilots of crisis management, although Public Health France has been in charge of settling this mathematical controversy.

Read also – Monkeypox: vaccine tested in several pharmacies in France

Epidemiologist Antoine Flahault, director of the Geneva Institute for Global Health, detects in it the index of a worrying flight: “The number of cases is doubling globally every fortnight and the growth has not slowed down in the last month. It is exponential: we can go to infinity very slowly. » A former Minister of Health also urges vigilance: “People don’t understand what an exponential is. Even if the number of cases remains low, there will be a moment of acceleration. We can’t stop the progression of the virus, so here we go. »

How far ? Hard to know as projections are still dangerous. Antoine Flahault estimates that at this rate there could be more than 80,000 cases worldwide by the end of August. “We cannot circumscribe the outbreaks that, however, are restricted, he watches We may be witnessing the beginning of a pandemic. » More cautious, the infectologist and director of the National Agency for Infectious Diseases Research, Yazdan Yazdanpanah, also assures that “It is not a virus that should be allowed to circulate.”

Fear of contamination in children

First stumbling block: the difficulty of tracking contamination chains. Because monkeypox, which seems to be transmitted primarily through close contact, is spread primarily among gay, bisexual, or trans people with multiple, often anonymous, partners. This mode of spread through backrooms and saunas, which defeats contact tracing, is still prevention. To protect yourself and, in case of symptoms, refrain from contaminating lovers, always or one night. “It really is the number one tool, explains Professor Yazdanpanah. To promote self-diagnosis, it is necessary to explain what the lesions are like, often located on the penis, anus or mouth. »

Second stumbling block: the vaccination campaign for groups at risk is not advancing fast enough. At the current rate, all eligible persons “They will be vaccinated only at the end of December, and with a single dose”, tackles Act Up Paris, Aides, Sidaction and Le Strass (sex work union). The situation would then be ” out of control “argue these associations that fight against discrimination against LGBT+ and seropositive people. “The vaccine is the base, complete Fabrice Pilorgé (AIDS). We have to pick up the pace because there is a real risk that things will escalate at the end of the summer, particularly during holiday events. » Highly mobilized, these activists still hope, as evidenced by messages posted in a Telegram group dedicated to monkeypox (the disease’s English name), to see the virus confined to their communities. “The health emergency is that it does not affect the rest of the population”, This is how Fabrice Pilorgé sums it up.

Also read – Monkeypox: “We still have a lot of uncertainty about the future dynamics of this epidemic”

An epidemic that would change face in the fall with massive contamination among children, as in the African cradle of the virus, such is also the government’s fear. “We fear that it will sneak into the general population,” indicates a high range source. The study of a recent family grouping around a heterosexual couple at a campsite in Fréjus (Var) has also focused all attention. “Contact tracing has almost been abandoned among men, says another speaker. But we continue when it comes to women or outliers. »

Mutations of “unknown significance”

While waiting to find out if the gay community, and more generally that of men who have sex with other men, may have been the gateway to the virus or a providential dead end, experts reassure themselves that this disease, a cousin of the fire. the terrible smallpox, it does not seem “very severe”. But epidemiologist Antoine Flahault warns: Monkeypox is not benign. 10% of patients have complications, 5% are hospitalized*. The load is heavy. »

The last unknown is related to the pathogen itself. “If the future is so uncertain, it is in particular because we still do not know if this virus, endemic to Africa, has evolved, specifies Anne-Claude Crémieux, professor of infectology. Whether the outbreak is due primarily to human factors (holiday gatherings) or immune factors (the discontinuation of smallpox vaccination in 1980, which offered cross-protection against monkeypox), it is controllable. But if the virus has mutated to better adapt to humans by becoming more transmissible, it is of much more concern. » In the words of the British authorities, the mutations recently detected by the researchers have “an unknown meaning”. All we know is that we know almost nothing. Like two and a half years ago, when Sars-CoV-2 appeared.

* And not 40% and 20%, as stated above. In fact, only half of the hospitalized patients are there for serious forms, the rest are for isolation.

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