On Wednesday, August 14, 2024, the active circulation of lineage 1 monkeypox virus (MPXV) in Central Africa and the recent spread of a subtype (1b) considered to be more lethal and contagious in East Africa led the World Health Organization (WHO) to declare a Public Health Emergency of International Concern (PHEIC), paving the way for enhanced coordination between regional health systems and active involvement of stakeholders to address this global outbreak. The following day, Thursday, August 15, Sweden reported the first positive case of MPXV lineage 1b in Europe. In response, the French government placed the French health system on maximum alert on Friday, August 16, and French authorities are now starting to reevaluate health recommendations established during the previous MPXV outbreak in 2022, in preparation for the possibility of cases emerging in the country.
In this situation, the Institut Pasteur is contributing to the national response by implementing three emergency measures:
1. The Ministry of Health's Public Health Department has activated the Institut Pasteur's Biological Emergency Response Laboratory (CIBU) and, since the weekend, at the request of the French health authorities, has been working with reference medical institutions and, in collaboration with the National Reference Center Specialized Laboratory for Orthopoxviruses (CNR-LE), to analyze samples taken from suspected cases in Paris hospitals and the Institut Pasteur Medical Center to confirm the diagnosis of MPOX.
2. The Institut Pasteur Medical Center, specializing in travel medicine (tropical infectious diseases, including skin diseases) and which treated MPOX patients during the previous epidemic in 2022, has activated an internal protocol to ensure that patients with typical MPOX symptoms who come to their appointment can be tested in an optimal safety environment. Samples are taken in an isolated negative pressure room and proven procedures are applied for handling, packaging and transporting them to the biosafety level 3 laboratory. In case of a positive test result, the patient is treated in collaboration with a medical institution with which the Institut Pasteur works closely.
3. The Institut Pasteur Medical Center has informed health authorities that it is ready to vaccinate all members of the groups covered by the health recommendations on MPOX (currently being revised), as it did in 2022 when it vaccinated more than 1,500 people at high risk of infection.
“As this new type of MPOX is actively circulating in several African countries and has recently appeared in Europe, French people may also be affected. This is a serious health situation that requires great vigilance. The Institut Pasteur is therefore responding proactively, drawing on its many years of research on this virus and the experience gained during the 2022 outbreak. We are ready, at the request of the authorities, to apply health protocols and collaborate with reference health institutions to test and vaccinate patients.”
Yasmin Belkaid, Director of the Institut Pasteur
The Institut Pasteur has also decided to intensify the research it has been conducting on MPOX for several years, particularly in Central Africa, to help prevent and contain MPOX epidemics in the long term.
• The aim of this research is to identify the animal reservoir of the virus, the mechanisms of animal-to-human and human-to-human transmission, and the resulting epidemic dynamics. The expertise developed in this field will be used by local health authorities to determine appropriate public health measures to combat the spread of the virus.
• This study strengthens our diagnostic capabilities with the help of tests available in the field and knowledge of the virus subtypes through sequence analysis. The ongoing efforts at French and international level to diagnose MPOX and isolate the different circulating strains have benefited from this study.
• Research is underway at Institut Pasteur that could result in long-term improvements to treatments and vaccines against different strains of mpox. Institut Pasteur is currently leading an extensive study to analyze the function of the main antiviral drug on the market, tecovirimat, to determine its effectiveness against different epidemic strains, and to identify additional drugs that may be effective against strains that tecovirimat does not work against. Institut Pasteur, in collaboration with Inserm, is also characterizing new monoclonal antibodies and “nanobodies,” small antibodies with neutralizing activity against mpox, for use in antiviral therapy. Finally, Institut Pasteur is exploring how its unique antigens can be used to improve existing vaccines (called third generation vaccines) or vaccines in development (messenger RNA vaccines).
“This new event is a reminder that the risk of epidemics is unfortunately part of our life and that dealing with it requires a comprehensive, sustained, long-term response. This risk becomes more imminent every day due to increasing ecological disturbances and the continued development of international trade and travel. We must play our role by supporting scientific research on infectious diseases in the fields of virology, immunology, vaccinology, epidemiology, ecology and anthropology, and by working on the ground tackling disease outbreaks, especially in the Global South, so that local peoples and local and regional authorities can act sovereignly to prevent and manage this risk themselves,” said Yasmin Belcaid, Director of the Institut Pasteur.
