As the World Health Organization has just triggered its highest level of health alert on an international scale, the time has come for prevention on the French side. Infectious disease specialist Romain Palich takes stock of the situation.
Paris Match. What are the developments of the virus?
Dr Romain Palich. Currently, two facts are merging. On the one hand, the Mpox epidemic [ou variole du singe] that we experienced in 2022 all over the world, and particularly in France, with a virus that belongs to a clade called 2b. On the other hand, we are now seeing an epidemic outbreak of the virus that belongs to clade 1b in Africa. The continent has recorded some 19,000 cases and 548 deaths since the beginning of 2024. The Democratic Republic of Congo remains the most affected country. The resurgence of the virus is proving very different with, for the moment, only one case imported into Europe. In France, the epidemic almost ended in the winter of 2022. Around a hundred cases presented themselves in hospitals this year but with the virus that we already knew. We have had an effective vaccine since July 2022 and the majority of the population that we consider to be at risk has been able to benefit from it.
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Is the new clade more dangerous than the 2022 clade?
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The severity and lethality of the infection comes from African data. It is impossible to extrapolate from what is happening there, given that their health system is not the same as in France. The big difference is that the vaccine is not available in these regions. We are also launching a plea for the most affected countries to receive it as soon as possible.
What are the symptoms?
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This virus manifests itself in a cutaneous way, it causes lesions on the skin and mucous membranes: pimples which are the main symptoms. They can be painful when they are near the mouth or genitals. We also note the appearance of lymph nodes (signs of a generalized infection), and fever (39 ° C), the day before their appearance, and therefore cause fatigue, we call this “being altered”. But the sign that persists the longest is the pimples. It looks like chickenpox with more impressive pimples.
The vaccination recommendation in France concerns people with multiple partners
Which populations are at risk?
The vaccination recommendation in France concerns people with multiple partners. It is estimated that the more sexual relations we have, the greater the risk of contracting and transmitting the infection.
How does the virus spread?
The mode of transmission remains almost exclusively by contact: when you touch the lesions. All activities with skin-to-skin friction, close together. Concerning the respiratory mode of transmission, the scientific body thinks that it can exist but in a minimal way. As a precaution, we recommend wearing surgical masks. The last problem lies in indirect transmission, by surfaces that we touch (door handles, etc.), so, as with the flu, we must wash our hands regularly.
What should I do in the event of contamination?
Mpox is a skin disease, so it has the “advantage” of being visible. You can examine yourself in the event of suspicious, unusual lesions on the skin. And when there has been a risky contact, you must consult a doctor in an infectious diseases department, or in the Cegidd (Free Centers for Information, Screening and Diagnosis of Sexually Transmitted Infections). A PCR test is carried out on a spot. The results are available two days later.
What treatments are available?
When someone presents with lesions, we do not vaccinate them, it is too late, but we vaccinate those around them as post-exposure prophylaxis as quickly as possible to block the symptoms. For the lesions, they must be cleaned with an antiseptic. It is a viral disease that heals on its own. People are asked to isolate themselves so as not to transmit the virus during the entire period when the skin lesions are visible.
Are there any precautions to take when returning from vacation?
We are on alert, even though there are no cases in France at the moment. The fear is that a person who has travelled to a risk area and contracted the disease will bring it back to France. The recommendations, when you go to areas where the virus is circulating: avoid unnecessary contact and follow basic hygiene rules such as washing your hands regularly. When you return from a trip, if you have a fever, make an appointment with a doctor in an infectious disease department.
Are there any new treatments?
In 2022, the global epidemic has made it possible to advance research, with ANRS-emerging infectious diseases we have set up research projects to describe, understand the disease and evaluate the real effectiveness of antiviral treatments, such as tecovirimat (Tpoxx). The vigilance decided in France allows hospital services to organize themselves, ensure vaccine stocks and circulate information to doctors, caregivers and the population. We do not fear an epidemic, just very specific and sporadic cases of importation.
