Cases of monkey pox (Monkeypox) not directly linked to travel to Central or West Africa or people returning from travel have been reported in Europe and around the world since the beginning of May 2022. Since this date , the epidemic is affecting a growing number of countries and the disease is the subject, in France and in Europe, of heightened surveillance.
The Director General of the WHO announced on Saturday July 23 that he was declaring a public health emergency of international concern regarding this epidemic. This is the organization’s highest level of alert to trigger a series of actions by member countries.
In France, orthopoxvirus infections are subject to long-term monitoring through the mandatory notification system. Given the current epidemic, surveillance of these infections has been reinforced by Public Health France and information and alert messages have been sent to healthcare professionals and the populations most at risk.
Update in France
As of August 2, 2022 at 12:00 p.m., 2,239 confirmed cases have been identified in France. The cases most frequently resided in Ile-de-France (845 cases, or 50% of cases whose region of residence is known), in Occitanie (196 cases, or 12%) and in Auvergne-Rhône-Alpes (173 cases, i.e. 10%).
The distribution of cases by region of residence (when known) is shown in Figure 1 for cases residing in France. That by reporting region is shown in Figure 2.
The region of residence is not given for 543 cases and 7 cases live abroad.
Figure 1. Confirmed monkeypox cases (n=1,689 cases) by region of residence, France, May-August 2022 (data as of 08/02/2022 – 12:00 p.m.)
Figure 2. Confirmed monkeypox cases (n=2,234 cases) by reporting region, France, May-August 2022 (data as of 08/02/2022 – 12:00 p.m.)
The distribution of cases by symptom onset date (when known) is shown in Figure 3. The case symptom onset date ranges from May 7, 2022 to July 27, 2022. diagnosed a median of 6 days (between 0 and 23 days) after the onset of symptoms; as a result and given the reporting deadlines, the data for the last few weeks is not consolidated.
The reports received do not always mention the date of onset of symptoms or the date of diagnosis of the patient. As an alternative to this information, the distribution of cases according to their date of reporting is presented in Figure 4.
Figure 3. Confirmed cases of monkeypox (n=1,578 cases) by week of onset of symptoms, France, May-August 2022 (data as of 02/08/2022 – 12:00 p.m.). The data for the last few weeks (in grey) are not fully consolidated.
Figure 4. Confirmed cases of monkeypox (n= 2,087 cases) by reporting week, France, May-August 2022 (data as of 02/08/2022 – 12:00 p.m.).
All cases identified to date are adult males, except 15 adult females and 2 children (under 15). Adult cases have a median age of 36; 25% of adult cases are under 30 years old and 25% are between 43 and 84 years old.
Among the cases investigated, 75% presented a genito-anal rash, 71% an eruption on another part of the body, 76% a fever and 72% lymphadenopathy.
Forty-five cases (2.9%) were hospitalized because of their Monkeypox virus infection, including 37 (2.6%) for complications related to this diagnosis. In France, no deaths have been reported to date.
The median time to use the test by date of onset of symptoms has decreased since the start of the epidemic: it fell from 13 days in S18-2022 (May 2 to 8) to 5 days in S27-2022 (4 to July 10).
Of the cases investigated, 67 are immunocompromised (5.0% of cases responding); 358 are HIV positive (i.e. 26% of cases knowing their HIV status). Among the non-HIV carriers, 662 are on pre-exposure prophylaxis or “PrEP”* (i.e. 66% of the non-HIV carriers who answered the question).
To date, in France, 96% of cases for which sexual orientation is reported have occurred among men who have sex with men (MSM). Among the cases for which information is available, 72% declare having had at least 2 sexual partners in the 3 weeks before the onset of symptoms.
Most of the cases questioned declare that they cannot identify the person who allegedly infected them; 24% are secondary cases, ie they report having been in contact with a case of monkeypox in the three weeks preceding the onset of symptoms.
The next update of this report will take place on Friday, August 5, 2022.
*PrEP is an HIV preventive treatment for people who do not have HIV and are particularly at risk.
Information and prevention actions
Given what has been observed in Europe on the disease, targeted communication was quickly implemented towards MSM people. The website sexosafe.fr, dedicated to the sexuality of MSM people, is regularly updated with a summary of knowledge on the subject and prevention measures. The messages recalling the symptoms and what to do in the event of symptoms were relayed via a digital campaign. Since June 17, the digital campaign has generated nearly 507,085 clicks on the banners and more than 429,991 visits to the Sexosafe site.
This device was supplemented with a poster campaign in places of conviviality with nearly 1,350 poster spaces. And for the past few weeks, by broadcasting spots on community radio stations. At the same time, posters, flyers and advice sheets were distributed thanks to associations, ARS and Sexosafe teams present in the field, as part of pride marches and in places where MSM meet. To date, 2,842 posters and 91,400 flyers have been ordered.
A digital campaign on preventive vaccination began on July 25 and tools for the field will also be made available in the coming days, following the publication of theopinion of the High Authority of Health of July 07.
Prevention actions are continuously adapted to the evolution of the situation and the state of knowledge.
- Access prevention documents
In France, the long-term monitoring of monkeypox through the mandatory notification system is reinforced and information and alert messages are sent to health professionals.. Exchanges are also continuing with other European countries, the WHO and the ECDC.
Monkeypox info service: a listening device to answer questions about monkeypox
Since Wednesday, July 13, a listening device has been open to answer questions raised by monkeypox. Subsidized by Public Health France and supported by SIS Association, the “Monkeypox info service” telephone line is accessible every day from 8 a.m. to 11 p.m., on the toll-free number 0 801 90 80 69 (free, anonymous and confidential call and services). The device is in charge of accompanying prevention messages and protective measures, of providing information on symptoms, treatments and vaccination, of advising and directing towards the care devices.
- Since the line opened, 3,679 interviews have been conducted on Monkeypox info service (median age: 39).
- 1647 interviews were carried out this week (versus 1153 the previous week)
- 60% of calls come from Île-de-France (and mostly from Paris)
- 146 callers declared themselves affected by Monkeypox (versus 141 the previous week).
- In order of importance, the interviews essentially concern means of prevention (and particularly access to vaccination), then symptoms and psychological and relational issues.
- More women contact the line (190 vs. 130 the previous week). Their concerns are linked to a feeling of vulnerability because they are in contact with people at risk.
Preventive vaccination against monkeypox
Faced with the spread of the Monkeypox virus (monkey pox), the High Authority for Health, seized by the Directorate General for Health, recommended in its opinion of July 7, 2022 that preventive vaccination be offered to the groups most exposed to the virus.
Regarding the deployment of vaccination, 37,005 doses of 3rd generation vaccine were delivered by the Agency to the territories on 02/08/2022.
Since July 11, 2022, in addition to people who have had risky contact with a sick person, people falling within the indications retained by the HAS can make an appointment to be vaccinated throughout France:
- Men who have sex with men reporting multiple sex partners.
- Trans people reporting multiple sexual partners.
- Sex workers.
- Professionals working in places of sexual consumption.
Vaccination can also be considered on a case-by-case basis for health professionals who have to take care of sick people.
For more information on vaccination and access to vaccination sites:
What is monkey pox (Monkeypox)?
Monkeypox is an infectious disease caused by an Orthopoxvirus. This zoonotic disease is usually transmitted to humans in forest areas of Central and West Africa by wild rodents or primates, but human-to-human transmission is also possible, particularly within the family home or in the care setting.
How is it transmitted?
The monkeypox virus can be transmitted by direct contact with lesions on the skin or mucous membranes of a sick person, as well as by droplets (saliva, sneezing, sputter, etc.). Sexual intercourse, with or without penetration, meets these conditions for contamination, and having several partners increases the risk of being exposed to the virus. In particular, direct contact with damaged skin during sexual intercourse facilitates transmission.
Contamination can also occur through contact with the patient’s environment (bedding, clothing, dishes, bath linen, etc.). It is therefore important that the patients observe isolation throughout the duration of the disease (until the disappearance of the last scabs, most often 3 weeks).
In Central or West Africa, humans can also become infected through contact with animals, wild or in captivity, dead or alive, such as rodents or monkeys.
What are the symptoms ?
Infection with monkeypox virus can cause a blistering rash, made up of fluid-filled blisters that progress to drying, crusting and then scarring. Itching may occur. The vesicles are more concentrated on the face, in the ano-genital area, the palms of the hands and soles of the feet, can be present but also on the trunk and the limbs. The mucous membranes are also affected, in the mouth and the genital area. This rash can be accompanied by fever, headache, body aches and asthenia. Lymph nodes may be swollen and painful, under the jaw, in the neck or in the fold of the groin. Sore throats are also reported.
The incubation of the disease can range from 5 to 21 days. The fever phase lasts about 1 to 3 days. The disease most often heals spontaneously, after 2 to 3 weeks but sometimes 4 weeks.
Is monkeypox serious?
The disease is more severe in children and in immunocompromised people. It can be complicated by superinfection of skin lesions or by respiratory, digestive, ophthalmological or neurological disorders.
In Europe, 2 deaths (Spain) have been reported to date.