More than 6000 cases in 58 countries. Tedros Adhanom Ghebreyesus, the head of the WHO, reiterated his concern over the outbreak of monkeypox and announced that he will convene the Emergency Committee, which should help him judge the seriousness of the crisis, at the later the week of July 18. “I continue to be worried about the scale and spread of the virus,” he said on Wednesday July 6 during a press briefing in Geneva. On June 25, he felt that the outbreak did not, however, justify triggering the organization’s highest level of alert.
An unusual upsurge in cases of this viral disease has been detected since May 2022 outside of Central and West African countries where the virus is endemic. In France, according to the last bulletin published, which dates from June 30, 498 cases have so far been confirmed (including three women), the majority in Ile-de-France (336).
The majority of cases identified outside endemic areas concern men who have sex with men, although cases of immunocompromised people and some children have been identified. Monkeypox presents with flu-like symptoms and rashes, and usually clears up on its own after two or three weeks. One tool is effective against this virus: vaccination.
- Who can be vaccinated in France?
The High Authority for Health (HAS) was seized to issue an opinion on an extension to homosexuals of vaccination against monkeypox, today reserved for contact cases, AFP learned on Tuesday July 5. The HAS was seized at the end of last week, indicated the Ministry of Health. Its opinion should be given within a few days. The weekly Stubborn had announced an imminent referral at the beginning of last week. LGBTQI + associations and certain health professionals questioned the ministry on a possible enlargement to homosexuals. In this disease transmitted by very close contact, 99% of cases currently concern young men (20 to 40 years old), mainly homosexuals, according to the WHO.
In France, the HAS recommended on June 20 to administer a single dose of vaccine to at-risk contact persons vaccinated against smallpox before 1980, except for immunocompromised persons. In May, the HAS recommended vaccinating adults at high risk of monkeypox. It was then called upon by the Ministry of Health to specify the vaccination strategy to be implemented around a confirmed case of monkeypox for two population groups: first-time vaccinators, i.e. people vaccinated against smallpox in childhood, and children.
For the first group, it recommended the administration of a single dose of the Imvanex vaccine (Bavarian Nordic) for at-risk contact persons who had received smallpox vaccination with a first-generation vaccine before 1980. In the particular case where contact persons at risk are immunocompromised, previous vaccination with another smallpox vaccine does not modify the schedule initially recommended in this population, ie three doses of Imvanex. For minors, although the Imvanex vaccine is currently authorized only in adults, several studies concerning other vaccines using the same platform as Imvanex, at higher doses, have demonstrated good tolerance in children under more than four months, underlined the HAS.
She thus recommended that reactive vaccination of child contacts at risk “could be considered, to protect children exposed and possibly more likely to develop severe forms of the disease, in particular the most fragile and the immunocompromised”. However, in the absence of clinical data on the safety of third-generation vaccines, the HAS recommended that the vaccination of people under the age of 18 “be considered on a case-by-case basis, by specialists only and after a strict evaluation of the benefits. and risks for the minor concerned”.
- Where can you get vaccinated in France?
The Ile-de-France regional health agency (ARS) announced on Tuesday July 5 on its website the gradual opening of nine post-exposure vaccination sites (within hospitals in Paris) by July 11 .
These establishments are located in Paris, such as the Bichat hospital and the Pitié Salpêtrière, in the Hauts-de-Seine, in Seine-Saint-Denis or in the Val-de-Marne.
- What vaccine is used?
The European Medicines Agency (EMA) announced on June 28 that it has started a review of a human smallpox vaccine to expand its use against monkeypox. The European regulator said it had “started a review of the data” of the Imvanex vaccine from the Danish company Bavarian Nordic, authorized since 2013 against smallpox in the EU, in order to include the protection of people against monkeypox. The EMA had not said when it might make a decision, adding that it is still awaiting an official clearance request from the manufacturer. “Imvanex stocks are currently very limited in the EU,” the EMA said.
The only laboratory to manufacture a vaccine already approved specifically against monkeypox, Bavarian Nordic saw orders soar with the outbreak of the virus, but claims to be able to honor them all, even with a single production plant. “With the current demand, we can easily supply the world market. We have a few million doses in bulk, we can bottle them and ensure that the current epidemic is treated”, explained Rolf Sass on June 23 to AFP. Sorensen. According to the vice president of Bavarian Nordic, the vaccine is “in stock in many countries” and it can be applied before or after exposure to the disease. “If you are vaccinated a few days after being exposed, you can also be protected,” he points out.
Bavarian Nordic has an annual production capacity of 30 million doses at its factory north of the Nordic capital. Its smallpox vaccine is a 3rd generation serum, ie a non-replicating live vaccine (which does not replicate in the human organism). If it is marketed under the name of Imvanex in Europe, it is under the name of Jynneos in the United States and Imvamune in Canada.
- Spain, United States… What about other countries?
Within the European Union (EU), the Hera health authority, created in the wake of the Covid-19 pandemic, purchased 109,090 doses of vaccine which are made available to the Twenty-Seven as well as to Norway and Iceland. The contract was concluded with Bavarian Nordic. On June 28, the EU made a first delivery of 5,300 doses of vaccine against monkeypox to Spain, one of the most affected countries, under this contract concluded on behalf of European states. According to Health Commissioner Stella Kyriakides, the next deliveries will go to Portugal, Germany and Belgium.
In the United Kingdom, the British health agency recommended on June 21 the vaccination against monkeypox of gay men considered “at risk”, for example because they have multiple partners, a public particularly affected by the recent spread. British authorities recommend vaccination with the Imvanex vaccine for men considered at risk by doctors. This concerns in particular “those who have several partners, participate in group sex or frequent establishments” where they have relationships, it is specified.
On July 1, the Danish laboratory Bavarian Nordic announced a new delivery of 2.5 million doses of the Jynneos vaccine to the United States. These are in addition to a first order for 500,000 doses from the American authorities made a few weeks ago for this vaccine. On June 29, US health authorities announced the immediate distribution of 56,000 doses of monkeypox vaccine – five times the number of doses already distributed – in areas of high transmission. Previously, vaccination was only offered to people with known exposure to this disease. But it is now recommended that these vaccines also be administered “to people recently exposed to monkeypox who may not have been identified through investigations and the search for contact cases”, announced Rochelle Walensky, director of the Prevention Centers and Disease Control (CDC), the country’s main health agency.
Local authorities can also order the older generation ACAM2000 vaccine, which authorities have in larger quantities, but which is not recommended for all audiences due to its side effects. The United States also has 100 million units of another smallpox vaccine from French company Sanofi.