The 21st century, that of epidemics? ‘Scary dynamic’ for monkeypox, not just an STI: ‘Condom won’t stop it’

What to fear?

An underestimation of the risk. For the moment, this epidemic seems without great danger because mortality is very rare and the hospitalization rate is low. But this is because it mainly affects young and healthy individuals, who are therefore unlikely to have complications. We can fear an evolution similar to that of HIV, which was initially limited to the gay community and then very quickly affected the entire population. Especially since it is not a question here, I insist, of a disease which would only be transmitted via sexual contact. The virus can be transmitted through any skin contact and also through contaminated objects such as clothing.

It is also feared that the virus will find an animal “reservoir” in Europe, especially in rodents. Rats could, for example, be contaminated via wastewater, as we have already seen for other viruses. It would then become impossible to eradicate this virus in Europe.

If we do not manage to control its spread, this virus will become endemic and we will then be confronted in Europe with a new disease which will threaten us on a daily basis.“.

Can monkeypox be treated like a classic STI (sexually transmitted infection)?

No, it is very important to understand. It is sexually transmitted but not exclusively. A condom will not stop its transmission, for example, because it requires close contact, but not necessarily sexual. In addition, it is a virus that is more resistant than SARS-CoV-2, it can persist on objects. An infected individual therefore has a good chance of contaminating his relatives if he does not isolate himself.

What should be done?

It’s not simple. The WHO has recommended testing and especially tracing contact cases. But because of the risk of stigmatization, under-reporting of cases is expected. We also know that vaccination alone will not be enough. Because who to vaccinate? All homosexuals? All caregivers? No one is going to try to impose that. And anyway, in practice, we are not able to set up mass vaccination today because we only have a few thousand doses of vaccine in Belgium, whereas hundreds of thousands are needed. to protect all individuals at risk.

Personally, I find it worrying that there is no concerted attempt in Europe to more systematically trace contact cases or to impose isolation. strict to the sick. I can obviously understand the reluctance in view of the populations affected, but it still raises questions in terms of public health. If this infectious agent becomes endemic in Europe, it will represent a risk for everyone and could have a significant cost in the long term. In short, I find that we make the same mistakes as with the Covid, let it circulate the virus and then end up with “living with” as the only option. “

We hadn’t seen an epidemic for a long time, and then, barely out of the Covid, we are faced with a new threat. Is this likely to continue?

This is one of the obvious consequences of globalization, we are also globalizing pathogens. So far, vaccination against “common” smallpox has protected Africans against monkeypox. And until a few years ago, it was a population that was still poorly connected with the rest of the world. But we no longer vaccinate against smallpox and the interconnection with Africa is growing.

All the experts in eco-infectiology affirm that the 21st century will be that of epidemics, in connection with the interconnection of populations and especially climate change. We see the more and more frequent appearance of new pathogenic agents but also of resistance factors among the old ones. The WHO, for example, is very alert to resistance to antibiotics, which have so far effectively protected us from many bacterial infections.

The price to be paid by our societies for this globalization of epidemics is likely to be very high in the long term. As we have seen with Covid, epidemics affect all aspects of our existence. It is very worrying that this is not taken more seriously by policy makers. Negotiations for an “international pandemic treaty”, which would be legally binding on the 194 member states of the WHO, began this year. But Europe should try to adopt a solid common health policy as soon as possible. It is essential for the future.

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