TO REMEMBER
The World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC) on August 14, 2024, following an outbreak of mpox in Africa, caused by a form of the virus responsible for this disease called “clade 1”.
Cases of this disease had already been detected in Europe, since a previous epidemic in Africa in 2022, caused by another form of the virus, clade 2. Since then, clade 2 has continued to circulate weakly in Europe.
While the disease can be fatal for some patients (young children, pregnant women, immunocompromised people), its case fatality rate depends on the quality of medical care. This rate seems low for clade 2 (estimated at 1 per 1000) in countries with an effective health system. For clade 1a of 2024, it is not yet possible to conclude for these countries.
The WHO has not declared this a pandemic.
ANALYZED ELEMENT
Affirmation :
WHO speaks of a mortality rate of 3.5 for mpox when it is normally 0.01, WHO says that we are in a global pandemic situation
Source : YouTube, Idriss Aberkane, August 18, 2024
DETAILS OF THE VERDICT
The figures given concern the MPOX lethality rate in the Democratic Republic of Congo in 2024 and that in African countries not endemic for this disease in 2022.
A case fatality rate of 3.5% in the Democratic Republic of Congo does not mean that, in general, 3.5% of COPD patients die.
full statement
“the WHO which tells us about a mortality rate of 3.5 when it is normally 0.01”, “this 3.5% because I insist it is really this which makes the WHO say that we are in a situation of a global pandemic”
Verification
On August 14, 2024, the World Health Organization (WHO) declared a Public health emergency of international concern (USPPI), concerning “mpox”, also known as simian pox (the term “monkey pox” is no longer used), in response to a significant increase in the number of cases in the Democratic Republic of the Congo (DRC) and a growing number of other African countries.
A PHEIC is a formal declaration to draw attention to an ongoing health threat and mobilize resources (e.g., increased testing, vaccine stockpiles) to respond. For example, WHO declared PHEICs for Ebola in 2014 and 2019, and for COVID-19 in 2020.[1].
The organization had already declared MPOX as a USPPI during a previous epidemic episode in 2022 in Africabefore ending this declaration in 2023, once the epidemic is under control.
Since this episode, cases of MPOX have also been detected outside Africa, in North and South America and in Europe. Thus, over the period between January 1, 2022 and August 18, 2024, in France, 4283 cas were confirmed by laboratory analyses. The virus has indeed continued to circulate weakly in Europe after the end of 2022.
On August 18, 2024, a video was posted on YouTube by Idriss Aberkane, which had more than 600,000 views a week after it was posted. This one presents itself on his site as a “multidisciplinary expert with varied areas of expertise» and “brilliant teacher”». However, the degrees and titles he claims have been criticized.
In this video, Idriss Aberkane talks with microbiologist Didier Raoult, former director of the Mediterranean Infection University Hospital Institute in Marseille, who notably promoted the use of hydroxychloroquine to treat COVID cases in 2020, a molecule whose effectiveness on this disease has been denied by numerous research studies.
Idriss Aberkane talks about MPOX in particular « ces 3,5 % [de mortalité, note de l’éditeur] pBecause I insist, this is really what makes the WHO say that we are in a situation of a global pandemic.”. This statement is incorrect. The WHO did not declare a “global pandemic” on 14 August 2024. Moreover, mpox does not currently have all the characteristics of a pandemic, which is distinguished in particular by an appearance in many regions of the world and an “explosive” spread (a large number of cases in a very short period of time).[2]A monitoring system has been set up in Europe and in particular in France. But the urgency of the epidemic is in Africa.
The following section clarifies this confusion of numbers and explains what they correspond to.
Two different forms of the disease
MPOX is caused by a virus from the Orthopoxvirus family.[3]to which the smallpox virus also belongs. The first cases were observed in 1958 in a colony of monkeys in a laboratory. The disease is endemic in the Congo Basin and West Africa. In humans, it is transmitted by physical contact, especially during sexual intercourse. Symptoms include a painful rash, swollen lymph nodes and fever. Of the complications are possible and the disease can be fatal, especially for young children, pregnant women and people with compromised immune systems.
As with all living beings, the genetic material of the virus is subject to mutations. The result is that different forms of the virus can appear and coexist: clades, distinguished by a number. Within each clade, variants are possible (distinguished by letters). In 2022, the epidemic episode was caused by clade 2b. In 2024, these are clades 1a and 1b which are responsible for the majority of cases in the DRC. In other African countries, clades 1a or 1b are present, as is clade 2, which has not disappeared.
In its press release, the WHO does not give the “mortality rate” that Idriss Aberkane is talking about, but announces “more than 15,600 cases” reported and “537 deaths” (as of 8/14/24) in the Democratic Republic of Congo. Dividing this number of deaths by the number of cases gives a result equal to 0.0344, or approximately 3.5%. In a bulletin dated August 11, 2024 and concerning the Africa region, the WHO indicated a similar figure (3.6%) for the DRC.
However, this is a case fatality rate, that is, the number of deaths reported to the number of known cases. It is different from a mortality rate, which represents the frequency of deaths in a total population over a given period of time.
As for the figure of 0.01, this is the case fatality rate of the 2022 episode, in African countries where the disease is not endemic.[4].
The comparison of the two figures by Idriss Aberkane is therefore not relevant because these figures relate to different clades of the virus and the WHO has not claimed that the detection rates of people infected by the virus are the same in 2024 and in 2022.
A fatality rate that depends on the health system
The case fatality rate is an indicator that can vary, in particular, depending on the efficiency in detecting cases, which is better in countries with a quality health system and analysis laboratories, and the quality of care, also dependent on the health system, which helps reduce the number of victims.
Daniel Bausch is a professor of tropical medicine at the London School of Hygiene & Tropical Medicine, and a member of the International Health Regulations Emergency Committee on the Monkeypox Resurgence, a group of independent experts set up to advise the WHO. When contacted by Science Feedback, he explained:
“There are currently insufficient data to draw firm conclusions about the different clades and subclades. I would say, however, that we have sufficient evidence to say that the case fatality rate for clade 2b in high-income countries is relatively low, probably in the order of 0.1%. I can say this because surveillance is generally good in these countries, where we have seen many cases since 2022, and the cases we might miss are probably the milder ones.”
In Europe, A case of clade 1b was reported on August 15, 2024. According to the European Centre for Disease Prevention and Control, the appearance of a certain number of cases of clade 1b in Europe is likely, due to travellers from Africa. But the fatality rate of 3.5 estimated so far for the DRC does not mean a priori that 3.5% of those infected will die from the disease if it were to spread more widely.
Feedback from scientists
Reaction of Daniel Bauschprofessor of tropical medicine at the London School of Hygiene & Tropical Medicine, and member of the International Health Regulations emergency committee on the resurgence of monkeypox:
“Although higher case fatality rates have been reported for some cases of COPD in some parts of Africa, I think it’s hard to say what the real numbers are because surveillance varies greatly by country and region. If you’re only detecting the sickest people with the most severe disease, who are the ones who will seek treatment and therefore be recognized, your case fatality rate will look very high.
We also need to remember, regarding the spread among MSM, [hommes ayant des relations sexuelles avec des hommes – note de l’éditeur]that there is significant stigma around homosexuality in many African countries, including in many cases homosexuality being illegal and punishable by long prison sentences or even the death penalty. It is therefore likely that few MSM will be willing to come forward for treatment.
So, in conclusion regarding the case fatality rate, for me, there is currently insufficient data to draw any firm conclusions regarding the different clades and subclades. I would say, however, that we have sufficient evidence to say that the case fatality rate for clade 2b in high-income countries is relatively low, probably in the order of 0.1%. I can say this because surveillance is generally good in these countries, where we have seen many cases since 2022, and the cases that we might miss are probably the milder ones.
