“Zero Monkeypox” objective, but vaccination considered too slow… Can we avoid the pandemic?

Increasing contamination. Three months after the appearance of the first Western cases of monkey pox, France has so far recorded 2,749 cases, according to the latest figures from Public Health France. That is about 10% of the cases reported in recent months worldwide.

And if people at risk are eligible for preventive vaccination, on the side of associations, we consider the vaccination campaign too slow to contain the spread of the virus, with, in sight, the fear that the epidemic escapes the control of the authorities. sanitary. What about the next pandemic?

“Away from the count” on vaccination

In its opinion of July 7, the High Authority for Health (HAS) recommends preventive vaccination of people exposed through their sexual practices or their profession. i.e. a target audience estimated at more than 250,000 people, corresponding in particular to the population of men who have sex with other men and have multiple partners, to sex workers and, on a case-by-case basis, to health professionals taking care for sick people. However, for the time being, “38,002” doses were administered on August 15, according to the Ministry of Health, without specifying the number of people vaccinated and the proportion of first and second doses. And “79,405 doses of vaccine were delivered by the Agency to the territories on August 16”, indicates for its part Public Health France.

“At the current rate, all eligible people” will be vaccinated only “at the end of December, and with a single dose”, lamented in a press release associations fighting against LGBT + discrimination, including Act Up-Paris, AIDES, Sidaction and the union STRASS sex workers. The epidemic will then be “out of control”, they fear, calling on the government to speed up vaccination so that the entire target audience is protected before the end of September. According to them, it would be necessary to vaccinate “at least 37,000 people per week”. But “we are very far from the mark”, they estimate, specifying that “about 15,000 people per week” are currently vaccinated against Monkeypox.

An achievable “zero Monkeypox” goal?

Accelerating the pace is also what immunologist Brigitte Autran recommends, named this Wednesday “president of the committee for monitoring and anticipating health risks”, the new entity which succeeds the Scientific Council and which will be responsible for advising the government in its management of health crisis situations. According to her, “a “zero Monkeypox” strategy is possible, unlike that of “zero Covid”. By its nature, its routes of transmission, it is a virus that can be controlled”.

An attainable goal? “Zero Monkeypox” is theoretically possible when you have a few thousand infections in a territory as large and developed as France. That is to say at the very beginning of an epidemic process. But only in theory”, analyzes Antoine Flahault, epidemiologist and director of the Institute of Global Health at the Faculty of Medicine of the University of Geneva. To achieve this, “it is necessary to test suspected cases, trace contacts, isolate positives and quarantine their contacts. But practice shows how difficult the task is: the test must be done at the slightest suspicion, ”underlines the epidemiologist. This is not systematic in the event of non-significant symptoms or difficulties in accessing screening. “Then, contact tracing is complicated when people who test positive report having had sexual contact with multiple and anonymous partners. Not to mention the possible contamination by surfaces, contaminated linens, even by aerosols”.

The isolation of positive cases, a challenge

As Public Health France reminds us, among the suggestive symptoms, “monkey pox can cause an eruption, made up of fluid-filled vesicles which evolve towards drying out, the formation of crusts and then scarring”. Vesicles that can itch, and which “are more concentrated on the face, in the anogenital area, the palms of the hands and soles of the feet or even on the trunk, the limbs and the mucous membranes”. A rash that may be accompanied by fever, headache and sore throat, and body aches, and the lymph nodes may be swollen and painful, under the jaw, in the neck, or in the fold of the groin. But the symptoms and their intensity varies from person to person.

Another major practical difficulty: “The isolation of positive cases and the quarantine of their contacts is easier to promulgate than to achieve, underlines Antoine Flahault. It should last until the last scab has fallen off after the blistering eruption, which takes three to four weeks. It’s a long isolation of 21 to 28 days alone at home, and you have to provide social shock absorbers to allow people to survive during this period. In addition, there needs to be strong adherence to the recommended measures on the part of the patients concerned. However, these are mainly young people who are very active and very connected. As for identified contact cases, they must go into quarantine for the duration of the incubation period. [de 5 à 21 jours selon le ministère de la Santé], and self-isolate for three to four more weeks in the event of a positive test. We thus understand all the difficulty we face in the fight against this epidemic.

Strengthening prevention and accelerating the deployment of vaccination

In this context, is a monkeypox pandemic inevitable? Hopefully not. “Unlike Covid-19, from the start of this Monkeypox epidemic process, we have a vaccine and even an antiviral treatment – ​​the efficacy and safety of which certainly remain to be demonstrated, reassures the epidemiologist. Moreover, on the strength of the lessons learned at the start of the AIDS pandemic, male homosexual circles are very aware of pre-exposure prophylactic methods, and are calling for vaccination against Monkeypox”.

Hence the importance of “rapidly deploying the vaccine to all people today at risk of being infected, if we want to hope to regain control over this epidemic, and combine this vaccine proposal with precise information” relayed with the target populations. Mobilized since the report of the first French cases, the association has published a list of practical advice to reduce the risk of contamination and set up a Telegram thread to follow news related to the virus. She thus recommends, in addition to preventive vaccination, “to reduce the number of partners and exposure to bodily fluids”, to “self-check” in the event of the appearance of suggestive symptoms.

In the event of contamination, the association recommends “warning your partners”, “isolating yourself” and, “if isolation is not possible or limited, avoiding as much as possible exposing other people to the virus. virus”, covering pimples and scabs with bandages, avoiding contact and cleaning “surfaces, fabrics and handles”. Ultimate precaution, AIDES recalls that “even once cured, wearing a condom is recommended for 8 weeks because it is possible that the virus is (still) present in the semen”.

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