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 that date, the he epidemic concerns a growing number of countries and the disease is the subject, in France as in Europe, of reinforced 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 organisation’s highest level of alert, supposed to trigger a whole 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, prevention and alert messages have been sent to healthcare professionals and the populations most at risk.
Update in France
As of August 9, 2022 at 12:00 p.m., 2,601 confirmed cases have been identified in France. The cases resided most frequently in Ile-de-France (885 cases or 47% of cases whose region of residence is known), in Occitanie (230 cases, or 12%) and in Auvergne-Rhône-Alpes (192 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 per signaling region, when this is known, is shown in Figure 2.
The region of residence is not given for 699 cases and 10 cases reside abroad.
Figure 1. Confirmed monkeypox cases (n=1,892 cases) by region of residence, France, May-August 2022 (data as of 08/09/2022 – 12:00 p.m.)
Figure 2. Confirmed monkeypox cases (n=2,600 cases) by reporting region, France, May-August 2022 (data as of 08/09/2022 – 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 August 4, 2022. diagnosed at a median of 6 days (between 0 and 36 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=1,766 cases) by week of onset of symptoms, France, May-August 2022 (data as of 08/09/2022 – 12:00 p.m.). The data for the last few weeks (in grey) are not fully consolidated.
Figure 4. Confirmed monkeypox cases (n=2,600 cases) by reporting week, France, May-August 2022 (data as of 08/09/2022 – 12:00 p.m.). Data for the last week (in grey) is not fully consolidated. Data for the last few weeks (in grey) is not fully consolidated.
The reporting low observed in week 28 (July 11 to 17) can be explained by the public holiday (July 14).
All cases identified to date are adult males, except 23 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 43 to 77 years old.
Among the cases investigated, 75% presented a genito-anal rash, 70% an eruption on another part of the body, 76% a fever and 72% lymphadenopathy.
Fifty-one cases (3%) were hospitalized because of their Monkeypox virus infection, including 43 (2.7%) 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 (Table 1).
Table 1. Median time to use the test in days (n=1,519 cases) by date of onset of symptoms, France, May-August 2022 (data as of 08/09/2022 – 12:00 p.m.)
*DDS: Symptom onset date. The data for the last few weeks (in grey) are not fully consolidated.
Among the cases investigated, 74 are immunocompromised (5.1% of the cases having responded); 385 are HIV positive (i.e. 25% of cases knowing their HIV status). Among non-HIV carriers, 701 are on pre-exposure prophylaxis or “PrEP”** (i.e. 64% of non-HIV carriers who answered the question).
To date, in France, 95% 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, 71% 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 12 August.
**PrEP is an HIV preventive treatment intended for people who do not have HIV and who are particularly at risk.
As of Thursday, August 11, surveillance is changing, only female, pediatric and serious cases will be investigated. Therefore, information on symptomatology and case profiles will no longer be updated at the next review.
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 622,565 clicks on the banners and more than 491,314 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 a few weeks by broadcasting spots on community radios. 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 94,400 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.
To facilitate access to information for vulnerable people in precarious situations, a pictorial tool, translated into 6 languages, developed with professionals working with these people is available on Santé Publique France.
The MOBCO newsletter n°7 compiled with actors in the field brings together a series of questions/answers on the subject of Monkeypox/monkey pox. It is aimed at professionals or volunteers in contact with people in precarious situations.
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). This 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, 5,007 interviews have been conducted on Monkeypox info service (median age: 39).
- 1,328 interviews were conducted in week 31 (versus 1,647 the previous week)
- 58% of calls come from Île-de-France (and mostly from Paris)
- As in previous weeks, the 25-39 age group remains in the majority among callers, but there is an increase in the proportion of people over 55 (19% of interviews vs 16% the previous week) and that of under 25 (9% vs. 7%)
- Emergence of calls from healthcare professionals seeking help to obtain information and better guide their patients diagnosed positive for monkeypox (2% of calls in week 31)
- In order of importance, the interviews always primarily concern means of prevention (66% of interviews) and more particularly access to vaccination and the difficulties encountered by callers in obtaining an appointment, then general issues. psychological and relational (22% of interviews), and symptoms (21%)
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. .
Concerning the deployment of vaccination, 54,585 doses of 3rd generation vaccine were delivered by the Agency to the territories on 08/09/2022.
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:
