Two deaths in Spain, one death in India, another in Brazil and one in Peru. For the first time, five deaths caused by monkey pox, or Monkeypox, have been recorded outside Africa, where the disease is endemic and was first detected in humans in 1970. A total of ten deaths are to be deplored across the globe at the moment – but none, at this stage, in France. According to the latest report from Public Health France, Tuesday August 2 at noon, 2,239 cases have been identified, the majority of which (1,375) reported in Île-de-France. A total of 45 people were hospitalized, including 37 for complications related to monkeypox.
An increase in the number of deaths linked to monkeypox is to be expected, estimated on July 30 the WHO Regional Office for Europe, after the announcement of the first deaths outside Africa. “Given the continued spread of monkeypox in Europe, we expect more deaths,” said Catherine Smallwood, an emergency officer at WHO Europe, in a statement. “The reporting of monkeypox-related deaths does not change our assessment of the epidemic in Europe. We know that, although self-limiting in most cases, monkeypox can lead to serious complications,” a- she noted.
Two strains of Monkeypox, including a more dangerous one
Often the disease heals on its own, without the need for treatment. “It is a benign virus in most cases. It can cause fatal complications but it is rare”, specifies to L’Express Yannick Simonin, virologist and specialist in emerging viruses. He too expects in the future, with the rise in cases, “an increase in the number of deaths” across the globe.
Such a situation is all the more possible since one of the two listed strains of Monkeypox, from Central Africa, has an “estimated mortality rate of between 6 and 11%”, indicates virologist Hervé Fleury, professor emeritus at the CNRS and the University of Bordeaux. The other strain, from West Africa, is less deadly: between 1 and 3%. It is the latter that is spreading throughout the planet. “So far, the Central African subtype has not been identified outside of Africa. Nothing tells us at this time that it could spread outside of Africa, but it is not impossible “, advances Yannick Simonin.
Hervé Fleury explains that Japanese scientists working in fundamental biology carried out tests on monkeys about twenty years ago in order to compare the two African strains. The results of their study showed that while the West African strain gave “classic monkeypox with a rash and involvement of the lymph nodes”, on the other hand “the Central African strain also induced an attack of the lungs, digestive tract and genitourinary system. “If this were to spread around the world, many more deaths would then be recorded,” he warns.
Pneumonia, encephalitis… Sometimes serious complications
Concerning the five deaths recorded at the end of July and the beginning of August, all do not seem – for the moment – directly linked to monkeypox. The deceased Brazilian, a 41-year-old man, was immunocompromised with heavy comorbidities. He died of septic shock, according to O Globo. Same thing for the Peruvian victim, aged 45, who had stopped his treatment against HIV. In Spain, on the other hand, the two patients are said to have died of encephalitis associated with monkey pox, reports El País. Finally, the 22-year-old Indian “did not have symptoms of monkeypox and was admitted to hospital with symptoms of encephalitis and fatigue”, the Minister of Health said on July 31. Health of Kerala, Veena George, quoted by the daily Indian Express.
Patients affected by monkey pox can develop pneumonia, that is to say severe respiratory inflammation and encephalitis (inflammation of the brain). “Potentially very serious bacterial superinfections” can also occur, “but when the patient is taken care of sufficiently early, he can be prescribed antibiotics which considerably improve his condition”, explains Yannick Simonin.
Immunocompromised people have a higher risk of serious forms of Monkeypox, but also “young children and pregnant women, insofar as the virus can potentially be transmitted to the fetus”, specifies the virologist. And to add: “Healthy adults can also potentially have serious or even fatal complications, but this is extremely rare”. “A young and healthy person has no reason to die of Monkeypox”, underlines Hervé Fleury.
His colleague Yannick Simonin warns, however, that “if in the weeks and months to come the spread of the virus is not controlled” and that the most fragile people come to be infected because of this “wider spread” of smallpox monkey, “then the risks of having serious and fatal cases will be greater”.
The virologist also recalls that the more a virus “circulates in the environment, the more there is a risk that it will accumulate mutations”. “It is a DNA virus and not an RNA virus, like Covid-19. This type of virus tends to mutate less than RNA viruses and is therefore more stable. However, a recent study has shown that monkeypox currently circulating in Europe has evolved more than expected compared to the virus circulating in Africa, and has therefore already mutated. Clearly, the priority is “to try to quickly limit the spread of the virus in order to prevent it from mutating and becoming more contagious or more virulent”, insists Yannick Simonin. “There is little risk that the virus will evolve genetically because it mutates little, but it is still to be watched”, abounds Hervé Fleury.