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HEALTH

French doctors reveal the ‘psychological harm’ to monkeypox patients

The monkeypox virus may cause intense pain but the psychological scars of the illness can be just as devastating, say sufferers in France and those who are treating them.

French doctors reveal the 'psychological harm' to monkeypox patients
Monkeypox information at a health centre in Montpellier, southern France. Photo by Pascal GUYOT / AFP

“You do not come out unscathed from a disease that has hurt you so much… as well as the additional burden of discrimination,” said Corentin Hennebert, one of the first cases in France.

Since May the virus has rapidly spread across the world, overwhelmingly among men who have sex with men, provoking fears of a repeat of the stigma faced by gay men seen during the AIDS epidemic.

Nathan Peiffer-Smadja, an infectious disease specialist at the Bichat-Claude Bernard Hospital in Paris, who has coordinated research on monkeypox patients, said the “psychological distress is linked to several aspects” of the disease.

Monkeypox can be very painful, particularly due to lesions which commonly appear on the genitals, anus or face.

READ ALSO Who is eligible for the monkeypox vaccine in France?

The “after-effects, particularly aesthetic”, are distressing for many who fear they could be left with long-lasting scars, Peiffer-Smadja said.

Then there is the impact of being suddenly hit by “a disease people had never heard of” after two years of the Covid pandemic, with the three-week monkeypox isolation period reviving bad memories of lockdowns.

A small number of patients can develop internal lesions, particularly inside the anus, which can be “extremely painful”, Peiffer-Smadja said.

That was unfortunately the cases for Hennebert.   

“I constantly had the impression that razor blades were being thrust into me – I can’t think of any other comparison, (the pain) was so strong,” the 27-year-old told AFP.

Before he was given the powerful painkiller tramadol, he lost seven kilos in just three days because he was not eating.

“All I could think about was the pain,” he said.

“And I’m not the only one, others have contacted me to tell that they were at the end of their tether, that they were crying all the time.”

After recovering, Hennebert went on to become the spokesman for a group of monkeypox patients demanding swifter action against the disease.

Sebastien Tuller, a 32-year-old LGBT activist, said he was “very anxious” when monkeypox lesions began to appear on his face.

“It was really ugly and I didn’t know what to do,” he said.

Michel Ohayon, head of the Paris sexual health centre 190, said that “as soon as a disease is visible, it is frightening because it becomes potentially stigmatising.”

He compared the monkeypox lesions to those from kaposi sarcoma cancer, a visible “symptom of AIDS”.

The global monkeypox outbreak has “reawakened the trauma of HIV” despite the disease being far less deadly, said Nicolas Derche of the French LGBT group SOS.

“For HIV-positive people, this has revived some very rough things,” from fear of a diagnosis to reliving past discrimination, said Vincent Leclercq of the French group AIDES.

Tuller said he received a torrent of insults and derogatory comments when he went public about having monkeypox.

“There is a lot of residual homophobia and this has a real impact on mental health,” he said.

“Many don’t say they have – or have had – monkeypox, fearing being stigmatised,” he added.

Young people who have not yet come out are put in a particularly difficult position, as are those afraid of having their sexual orientation revealed to their employer because they have to isolate for three weeks, he said.

Nearly a quarter of the calls to a French monkeypox helpline this month were about psychological issues, the group that manages the line told AFP.

Some gay men have avoided any sexual activity for months out of fear of the disease, further impacting mental health, LGBT groups said.

France has been at the forefront of the vaccination campaign for monkeypox, vaccinating more than 50,000 people so far and offering the vaccine to a relatively wide group of at-risk people.

Recently vaccination centres close to the border have seen an influx of people travelling from Belgium, Switzerland, Italy and Spain, where vaccination policies are more restrictive and supplies of the vaccine lower.

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HEALTH

How serious is the threat from dengue fever in France?

As tiger mosquitoes are now present in over 80 percent of mainland France, health authorities are worried that local transmission of tropical diseases, like dengue fever, will increase.

How serious is the threat from dengue fever in France?

As of January 2024, tiger mosquitoes – known for their ability to carry diseases such as dengue, chikungunya and Zika virus – had been detected in 78 of France’s 96 mainland départements, including the Paris region.

This has left public health authorities concerned about the spread of dengue fever in France, particularly this summer as large crowds are expected amid the Olympic Games.

READ MORE: MAP: Tiger mosquitoes reach northern France

How common is dengue fever in France?

In the first four months of 2024, 1,679 cases of dengue fever were identified in mainland France, a number that is 13 times higher than the same period last year, Le Parisien reported.

Crucially, however, none of these are believed to have been contracted in mainland France – they were all reported among patients who had recently travelled from the tropical regions where dengue fever is common.

The majority of cases were from people who had visited the Caribbean islands of Martinique and Guadeloupe – where the disease is endemic.

These islands are for administrative purposes part of France – so often show up in French health data – but they are roughly 7,000km away from Paris.

So far, there have not been any indigenous cases (autochtone – or people infected on mainland French soil) yet this year.

Local transmission of the disease remains relatively rare. In 2023, nine separate outbreaks of indigenous dengue transmission were identified, one of which occurred in the Paris region. These led to 45 cases of local transmission (in mainland France).

Most were in southern France – in the Provence-Alpes-Côte d’Azur, Occitanie and Auvergne-Rhône-Alpes regions – though one outbreak occurred in the Paris region, according to French public health authorities.

This is less than 2022, which was a notable year with 66 total cases of indigenous dengue fever were recorded. In comparison, between 2010 and 2021, only 48 cases (total) were recorded.

What to expect for 2024

Experts believe that the number of cases in France, including indigenous ones, will grow this year, as tiger mosquitoes now occupy more territory in mainland France.

On top of that, the number of cases has increased significantly in Martinique and Guadeloupe.

“What we see in France is a mirror image of what is happening in the French Caribbean, and more widely in Latin America and the rest of the Caribbean, where dengue fever has been circulating since the start of the year at unprecedented levels”, the head of Santé Publique France, Dr Caroline Semaille, said during a press conference.

The Olympic Games will also bring an influx of tourists from all over the world, and weather conditions are expected to be conducive to mosquitoes – a year with a lot of rainfall, and potentially high temperatures. 

What is dengue fever?

The disease is spread to people from bites by infected mosquitoes.

The most common symptoms are high fever, chills, abdominal, joint and muscle pains, and vomiting. It can also cause a skin rash that resembles measles, according to France’s Institut Pasteur.

Symptoms usually begin three to 14 days (with an average of four to seven) after being bitten.

However people are asymptomatic in 50 to 90 percent of cases (depending on the epidemic), which can make monitoring difficult.

At-risk groups include the immunocompromised, children and the elderly, who are more likely to suffer from severe forms of the disease.

Deaths from the disease are very rare, occurring in around 0.01 percent of all cases, almost all in countries that have poor healthcare systems.

How can I avoid tiger mosquitoes?

Female tiger mosquitoes lay their eggs in water, and they can lay several hundred eggs at once. Therefore try to avoid having any standing water outside your home and be aware of the items that might collect rainwater.

This includes regularly emptying vases, flower pots, as well as watering cans and pots. If you want to collect rainwater, you could cover water butts with mosquito nets or fabric to keep the mosquitoes from getting inside.

READ ALSO 5 plants that (allegedly) repel mosquitoes

You can also keep your gutters clean – this helps to keep the water flowing when it rains, and it avoids any stagnant pools from building up.

To protect yourself, try to wear long, loose and light-coloured clothing, in addition to insect repellent. You might also consider wearing a mosquito net head gear.

The main difference between tiger mosquitoes and other species would be getting a bite during the day, and the fact that tiger mosquitoes are likely to bite several times. You can tell for sure if it was a tiger mosquito by seeing the insect itself. They are also silent.

There is no immediate cause for alarm if you are bitten, in almost all cases the bites are just itchy and annoying. In very rare cases, tropical diseases can be spread by the mosquitoes – seek medical help if you develop a high fever and rash.

READ MORE: How to prevent the spread of tiger mosquitoes in France

What do tiger mosquitoes look like?

They are very small, about 5 mm, and they have a highly contrasting colour, with black and white stripes on their body and legs.

If you believe you have spotted a tiger mosquito, you can report it to public health authorities online.

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