The Director General of WHO announced on Saturday July 23 that he was declaring a public health emergency of international concern over the outbreak of monkeypox. 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. Alert messages were sent to health professionals and the populations most at risk and a prevention and information system was deployed from the start of the epidemic.
Update in France
As of July 28, 2022 at 12 p.m., 1,955 confirmed cases have been identified in France. The cases most frequently resided in Ile-de-France (814 cases, i.e. 53% of cases whose region of residence is known), in Occitanie (170 cases, i.e. 11%) and in Auvergne-Rhône-Alpes (161 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 406 cases and 7 cases live abroad.
Figure 1. Confirmed monkeypox cases (n=1,542 cases) by region of residence, France, May-July 2022 (data as of 07/28/2022 – 12:00 p.m.)
Figure 2. Confirmed monkeypox cases (n=1,951 cases) by reporting region, France, May-July 2022 (data as of 07/28/2022 – 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 22, 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=1,452 cases) by week of onset of symptoms, France, May-July 2022 (data as of 07/28/2022 – 12:00 p.m.). The data for the last few weeks (in grey) are not fully consolidated.
Figure 4. Confirmed monkeypox cases (n= 1,796 cases) by reporting week, France, May-July 2022 (data as of 07/28/2022 – 12:00 p.m.). Data for the last week (in grey) are not fully consolidated.
All cases identified to date are adult males except 12 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, 76% presented a genito-anal rash, 72% an eruption on another part of the body, 76% a fever and 72% lymphadenopathy.
Forty-two cases (2.9%) were hospitalized because of their Monkeypox virus infection, including 35 (2.6%) for complications related to this diagnosis. No case died.
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 S26-2022 (June 27 to July 3).
Among the cases investigated, 56 are immunocompromised (4.5% of the cases having responded); 338 are HIV positive (i.e. 26% of cases knowing their HIV status). Among the non-HIV carriers, 631 are on pre-exposure prophylaxis or “PrEP”* (i.e. 67% 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, 73% 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 Wednesday August 3, 2022.
*PrEP is an HIV preventive treatment intended for people who do not carry the virus and who are particularly exposed to it.
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 452,389 clicks on the banners and more than 375,882 visits to the Sexosafe site.
This device was supplemented with a poster campaign in places of conviviality with nearly 1,350 poster spaces. And since a few days 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 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
In France, 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 Santé publique France and supported by SIS Association (Sexualités info service 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 call and services, anonymous and confidential). 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, 3,035 interviews have been carried out on Monkeypox info service.
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, 32,486 doses of 3rd generation vaccine were delivered by the Agency to the territories on 07/27/2022.
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.