Monkeypox: Urgent need to change the name of the virus and disease

 Monkeypox: Urgent need to change the name of the virus and disease

Stained transmission electron micrograph image showing monkeypox virus particles grown and purified from cell culture. © NIAID.

The World Health Organization (WHO) announced Tuesday (June 14) that it is considering "renaming monkeypox." "We will announce the new names as soon as possible," Director-General Tedros Adhanom Ghebreyesus promised at a press conference. The issue is becoming more urgent as all French-language media speak of "monkeypox," believing they are correctly translating what the English call "monkeypox."

This name was used when the virus was isolated in 1958 from Asian macaques (Macacus fascicularis) imported to Denmark for a research center in Copenhagen. Some of these monkeys had a rash that resembled human smallpox and is known as monkeypox. In September 1959, Preben Von Magnus and his colleagues at the Statens Serum Institut reported their discovery in the journal Acta Pathologica Microbiologica Scandinavica, describing in their article the isolation of what they called "monkeypox virus."

The following year, in May 1960, the term "monkeypox virus" was used in an article published in the Annals of the New York Academy of Sciences by scientists from the pharmaceutical company Merck Sharp & Dhome (MSD) and the University of Pennsylvania. These virologists and veterinarians reported on the prevalence of smallpox in macaques (Macaca mulatta and M. philippinensis). Since then, no one has tried to change the name of the virus in question.

There have been very few outbreaks of monkeypox, except for one in 1959 in an EBA colony. In 1962, the disease reappeared in a group of squirrel monkeys that had been fully irradiated at the Walter Reed Institute Military Research Center. In 1964, a serious incident occurred at the Rotterdam Zoo in which several orangutans, chimpanzees, gibbons, macaques, guenons, squirrels, and marmosets became infected. Of the 23 monkeys affected, 11 died, and four more outbreaks occurred in research centers around the world that same year. Finally, in 1968, two chimpanzees imported from Sierra Leone were infected with monkeypox in a Paris laboratory and developed a generalized rash.

All this shows that the monkey itself was rarely affected by monkeypox. It should be noted that smallpox is very rarely caused by signs.

In a study published in 1968 by two World Health Organization (WHO) scientists, only seven cases of smallpox were found in monkeys. Only one case was subjected to virologic testing. This was a decade before the discovery of monkeypox. This case of monkeypox (literally), in which the virus was isolated, occurred in 1949. Two orangutans at the Jakarta Zoo developed a varioliform rash during a smallpox epidemic in the region. Both animals developed typical lesions on the face, hands, and feet. One monkey died.

Previously, a case of smallpox had been reported in rhesus monkeys in Bengal, India, in 1936. Smallpox in monkeys in the Brazilian jungle was also reported in 1922. In 1861, a smallpox epidemic was described in a monkey population in Panama. Finally, in 1767, a resident of Saint-Germain-en-Laye observed that a monkey playing with smallpox-infected children later contracted the disease. As early as 1842, cases of smallpox were observed in monkeys (location not mentioned). Finally, cases were reported in wild primates in Trinidad in 1858. Considering the prevalence of smallpox in Asia, Africa, and the Americas, areas where nonhuman primates are abundant, "it is remarkable that there are so few reports of smallpox infections," according to the authors of the study, which was published in the Bulletin of the World Health Organization in 1968.

Before discussing smallpox and the monkey, I would like to recall the origin of the term varicella, which means smallpox in English. This digression is necessary to understand the crucial importance of semantics.

The popular origin of the term chickenpox

Where does the term "chickenpox" come from? The term can be mistakenly translated as "chicken pox". No one has ever thought of calling chickenpox.

One theory is that the chickenpox rash resembles chicken bites. Other possible explanations are that there is a similarity between the disease and chickenpox and that chicken (which should be pronounced chicken) means chicken in Old English, or that the name chickenpox was because the red spots on the skin resembled chickpeas, which translates to chickpea in English. Finally, some see a similarity between the word chicken and the word given, which means itch in Old English.

In any case, the term chickenpox has been used in England since the 17th century. Despite the literati of the time, there was some confusion about the use of the terms chickenpox and smallpox.

The famous French physician Armand Trousseau addressed the subject in the first volume of his Clinique médicale de l'Hôtel-Dieu de Paris (1865), in which he made a clear medical distinction between varicella (then also called smallpox) and smallpox. "In general, chickenpox, apart from its anatomical features, differs so clearly from modified smallpox that it is not clear how this confusion could have occurred" (...) Chickenpox is a disease with a nodular eruption, while smallpox and modified smallpox have a pustular form: In short, the epidemic conditions, the general symptoms, the origin of the outbreak, and the form of the outbreak distinguish chickenpox from smallpox. No physician ever saw a child die of smallpox unless it was a complication unrelated to exanthematous fever.

It was difficult, however, for an English physician to argue, as Armand Trousseau did, that chickenpox and smallpox were so closely related in Shakespeare's language. It was not until the famous Canadian physician William Osler (1849-1919) stated in his book The Principles and Practice of Medicine (1892), "There is no doubt that chickenpox is at present an entirely distinct and unrelated disease," that things became clearer.

So when doctors use an ambiguous colloquial term instead of a medical term, it can cause confusion among the public.

I'm sure you'll agree that the etymology of the name chickenpox is rather folkloric: would an English-speaking virologist or infectiologist give this viral disease a similar name today? Which French-language media dare to use the term "chickenpox" for this childhood disease that everyone knows?

Chickenpox, horse pox, cow pox, mousepox, rabbit pox.

It is important to note that the English name pox is derived from the English rock (then French: smallpox), so the term "smallpox" refers to pustules, rashes, or simply blisters. It was used as a convenient and inaccurate epithet for various human and animal diseases. For example, the term smallpox is used for a disease caused by a virus isolated from sick Mongolian horses in 1976.

There is also the cowpox virus (or CPXV). Contrary to what the name suggests, the disease affects relatively few cattle, although early descriptions of human infections refer to bovine infections from the udders of cows during milking. Its reservoir is primarily small rodents, which vary from region to region. In most cases, the cowpox virus is transmitted to humans from infected cats or rodents. The virus is found in many species of animals. No one would call a human infection "cowpox." French-speaking scientists speak of smallpox, sometimes smallpox, but never smallpox.

Mouse pox virus (also known as ectromelia virus or ECTV) causes an acute, widespread disease in mice with a high mortality rate. The disease is very similar to human smallpox.

There is also rabbit plague, which occurs in rabbits. The name rabbit pox comes from the fact that this virus was responsible for an epidemic that caused widespread infection similar to human smallpox in a colony of rabbits in a Rockefeller Institute laboratory in New York City in 1932-34, while scientists were working on rabbits in an adjacent room with a different virus (Neuro-VACV).

Rabbit poxviruses, like smallpox viruses, belong to the orthopoxvirus genus, which also includes the cowpox virus, rat pox virus, monkeypox virus, and vaccinia virus (commonly known as "cowpox"). The latter was isolated by Jenner in 1798 and made smallpox vaccination possible.

Should we give in to the ease with which viral diseases are reported?

Is it necessary to refer every time to human disease (which has now disappeared thanks to vaccination) to describe a virus belonging to the genus Orthopaxis and which causes pustules (smallpox)?

The fact that the English language uses smallpox for everything does not mean that the French translation should automatically follow suit and make the mistake of translating smallpox with smallpox every time. In fact, smallpox does not mean smallpox either, but pastel, pastel, or even smallpox in Old French, and in English human smallpox is called by a different term, pox.

It is therefore obvious that the argument that monkeypox should be translated as monkeypox is not valid.

Monkeypox in humans

I, therefore, prefer to use this term, or rather the expression "human monopartite", to describe this infection in humans caused by an orthopatitis virus first isolated from macaque tissue in 1958. Some experts call the disease simian orthopoxviruses. I believe this only adds to the confusion, as it suggests that the virus is transmitted from monkeys to humans.

Unknown animal reservoir

The recent outbreak of the simian virus in humans has no proven link to Africa. In fact, most of the patients in the current outbreak have no history of travel to endemic areas in West and Central Africa. So why talk about a monkey? Above all, the animal reservoir for monkeypox in humans is unknown.

Serum from a large number of wild animals caught in the forest, mostly non-human animals (monkeys) and rodents, was tested for the presence of antibodies to orthopoxvirus, suggesting that these animals were or had been infected.

Monkeypox virus was isolated from a tree crow (Funisciurus anerythrus) in the Democratic Republic of Congo (DRC), which had been shot by a hunter and had a variegated rash. Another study showed that the virus was present in a mangabey monkey (Cercocebus atys). The animal was found dead with smallpox-like lesions in Tai National Park in Côte d'Ivoire. In addition, a seroprevalence study carried out during the 1997 monkeypox epidemic in the Democratic Republic of Congo showed a positivity rate of 39-50 % in squirrels of the genus Funisciurus and 50 % in squirrels of the genus Heliosciurus. In addition, 16% of the giant vulture rats (Cricetomys Emini) tested in this study had antibodies against the monkey virus.

In April 2021, researchers from the Universities of Antwerp (Belgium), Kisangani (Democratic Republic of Congo), and the Robert Koch Institute in Berlin reported the presence of a complete or nearly complete virus genome in a weasel (Crocidura littoralis) and shorter sequences in two squirrels (Funisciurus anerythrus, Funisciurus baryonic) and two rats (Stochomys longicaudatus, Cricetomys sp. 2). This suggests that some rodents, as well as some squirrels and ferrets, may be potential reservoirs of the simian virus. It appears that in most cases the monkey is of little importance for virus transmission to humans and apparently of no importance for human-to-human transmission. Studies of wild monkeys captured in areas where human cases of monkeypox have occurred did not lead to the conclusion that these wild primates carried the virus.

This is another reason to avoid using the term "monkeys" when referring to the current human monkeypox outbreak. In addition, human-to-human transmission occurs through close contact with skin lesions of an infected person, through respiratory droplets in prolonged contact, or through infected inert surfaces (so-called fomites). Again, no monkeys are involved.

As with any new or re-emerging disease, it is the media that determines how it is used. This has been clearly demonstrated in the case of the disease caused by the new coronavirus SARS-CoV-2, which the vast majority of French people call "it" Covid-19, although it should be "it" Covid-19, as this name is an abbreviation for three English terms: coronavirus, disease, 2019. Disease means illness, a feminine noun in French*.

Semantic problem

I conclude this post by stating that it is not the role of medical journalists to continue to promote malpractice, but to use their privileged position as careful readers of the scientific literature and as informants of the public, both lay and informed, to promote correct and understandable language that respects both our language and the current state of scientific knowledge.

I have therefore deliberately chosen to call my blog monkeypox or human monkeypox, although I admit that my first long post on this topic (May 27) included the term "monkeypox" in the title and first paragraph, I then used (for lack of a better term) just the term monkeypox. My second entry (June 4) included that term in the title.

So it is not snobbery on my part to use an English term, but simply my desire not to contribute to the proliferation of a French term that seems inappropriate to me for all the reasons mentioned above. However, I preferred to use it in the title of this post (perhaps for the last time) ..... To put it more clearly.

But what term can be used to speak of ape plague without more or less recall smallpox (even if only with the suffix "smallpox" systematically associated with that terrible human disease, now completely eradicated) and without systematically referring to the ape?

It is said that WHO could opt for hMPXV (h for human and MPX for MonkeyPoXVirus), which is not easy to pronounce in English or French. The proposal was submitted on June 10 to the virological.com website by a group of scientists from Nigeria, Congo, Cameroon, the United States, Switzerland, the United Kingdom, and South Africa.

Christian Happi (Nigeria), Tulio de Oliveira (South Africa), and colleagues call for a new classification of monkeypox that is "neutral, nondiscriminatory and non-stigmatizing." They propose a "unique and practical" name for the virus that caused this outbreak: hMPXV, to distinguish this virus in humans from the monkeypox virus originally isolated in monkeys. "We believe there is a way to abandon the monkeypox name and the historical associations associated with it," they add, before concluding that a decision and a new name are urgently needed.

In France, the journal Virologie, the official organ of the French Society of Virology (SFV), will publish in the coming days an editorial entitled "Quand l'infection par le virus monkeypox se traduit malencontreusement en variole en français." This text is already available on the SFV website.

Jean-Nicolas Tournier, a researcher at the Army Biomedical Research Institute (IRBA) and the Institut Pasteur, writes: "Since the word monkeypox has little meaning for the average Frenchman unfamiliar with the language of Shakespeare, it was decided to translate MKPXV infection in the media with the neologism monkeypox.

"This translation is unfortunate in every way," says Jean-Nicolas Tournier, "because it refers to smallpox, an extinct human disease whose devastation has nothing to do with the changes seen" in the current epidemic of monkeypox (MKPXV). Moreover, "MKPXV itself is probably a misnomer since it is probably not a primate virus that appears to be an additional cost." He added, as I did, that "the animal reservoir of MKPXV is probably quite large, including African squirrels, particularly of the genus Funisciurus, and the Gambian giant rat [Cricetomys gambianus], although the reservoir cannot be precisely defined."

The scientist concludes, "The scientific community must respond very quickly before the term 'pest,' dictated by the media and accepted by the scientific community out of laziness or consensus, becomes commonplace. This will further degrade the reputation of science and increase the difficulties for scientists trying to spread the word to as many people as possible.

But isn't it too late for the entire press and most physicians and scientists to stop referring to 'asepsis' in the media? We know that the media can force the use of a term by using it for more than four weeks. As everyone knows, it is really difficult to break bad habits.

The Germans speak of monkeypox, the Dutch of monkeypox, the Italians of monkeypox, but unlike the articles in the French press, the term monkeypox is systematically bracketed in the headlines and used several times in the text.

As with any new or reemerging disease, it is the media that spreads the news, especially the television networks. It is therefore desirable that WHO quickly select an acronym for the disease caused by hMPXV that can be easily pronounced in all languages without any link to its origin, in the context of a global epidemic**. In this context, the WHO Emergency Committee will meet on June 23 to consider whether human monkeypox is a "public health emergency of international concern."

Just as SARS-CoV-2 is now the name of the virus that causes Covid-19 (a term derived from COronaVIrus Disease), will virus taxonomy experts and WHO officials are wise enough to declare hMPXV as the virus that causes Poxvid-22 (short for POXVIrus, Disease and 2022)?

* In French-speaking countries in Europe, the media usually refer to "the" Covid-19 and use the masculine gender. Quebecker, on the other hand, says Covid-19 without hesitation.

** To avoid stigma, WHO renamed the English, South African, Brazilian, and Indian variants of SARS-CoV-2 to Alpha, Beta, Gamma, Delta, and Omicron at the end of May 2021.

Referred by Marc Gozlan doctor by training, a journalist by vocation.

You can read also:

Monkeypox: What to know about the disease

Monkeypox: Is there a vaccine?