Case of monkey cups: update June 23, 2022

Cases of Monkeypox (Monkeypox) not directly related to travel to Central or West Africa or people returning from travel have been reported in Europe and around the world, suspected cases are being investigated in many countries and the situation is changing therefore very fast. In France, infections with this virus are subject to long-term surveillance through mandatory reporting. Given the current alarms, the monitoring of these infections is being stepped up by Public Health France and information and warnings are being sent to healthcare professionals.

Case of monkey pox: update in France

From 23 June 2022 at At 14.00, 330 confirmed cases of monkey pox have been reported in France: 227 in Ile-de-France, 22 in Occitanie, 21 in Auvergne-Rhône-Alpes, 19 in New Aquitaine, 14 in Hauts-de-France, 14 in Provence-Alpes -Côte d’Azur, 6 in Normandy, 3 in Brittany, 1 in Center-Val de Loire, 1 in Burgundy-Franche-Comté, 1 in Pays de la Loire and 1 in Grand-East.

Out of the 302 cases that were confirmed per. June 22, 2022 at 14.00, 287 have been investigated, four are still unattainable and 11 are under investigation.

Among these cases, a first case concerns a young woman whose partner (untested) reported that he had a rash 3 weeks before.

Confirmed cases per. June 22, 2022 at 14.00 is between 19 and 71 years (median age: 35 years).

The dates of onset of symptoms are between 7 May 2022 and 18 June 2022 (Figure 1). Cases were diagnosed a median of 7 days (range 0-22 days) after symptom onset; therefore, data for the last week are not consolidated.

Figure 1. Confirmed cases of monkey pox (n = 302), by date of onset of symptoms, France, May-June 2022 (data as of 22/06/2022)

Among the cases examined, 77% showed a genito-anal rash, 73% an outbreak on another part of the body, 71% fever and 69% lymphadenopathy.

Among the cases examined, 13 are immunocompromised; no one died.

To date, as in other European countries, these cases have mainly, but not exclusively, occurred in men who have sex with men (MSM), with no direct connection to people returning from endemic areas. Most cases report multiple sexual partners.

Most of the cases investigated declare that they cannot identify the person who allegedly infected them.

Finally, 52 of the cases examined are secondary cases.

Among the cases examined, 75 traveled, stayed or worked abroad before their symptoms began, some of them in several different countries: 39 trips have thus been reported in Spain, 9 in Belgium, 6 in Germany, 4 in the United Kingdom. , 4 in Switzerland, 4 in Portugal, 2 in Netherlands, 2 in Denmark, 2 in Mali, 2 in Greece, 1 in Luxembourg, 1 in India, 1 in USA, 1 in Colombia, 1 in Morocco, 1 in Cyprus, 1 in Serbia and 1 in Canada. These journeys do not systematically constitute the source of the pollution, and the list of cited countries may change as the data are consolidated.

The next update of this report will take place on Tuesday, June 28, 2022.

Given what has been observed in Europe about the disease, targeted communication was quickly implemented towards MSM people. The messages remind you of the symptoms and what to do in case of symptoms. They are currently broadcast digitally and via an affinity display network in bars and restaurants. At the same time, posters, flyers and advisory sheets were handed out thanks to associations, ARS and Sexosafe teams present in the field.

Finally, the website, dedicated to the sexuality of MSM people, offers a summary of knowledge on the subject and preventive measures.

Prevention actions are continuously adapted to the development of the situation and the state of knowledge.

In the usual absence of monkey cups in Europe and of a compound reported by the cases identified with a risk zone, the current European context constitutes a warning and indicates contamination in Europe. That is why, in France, the long-term monitoring of monkey pox through the mandatory notification system is intensified and information and alarm messages are sent to healthcare professionals. Exchanges also continue with other European countries, the WHO and the ECDC.

What are monkey cups (Monkeypox)?

Monkey pox is an infectious disease caused by an Orthopox virus. This zoonotic disease is usually transmitted to humans in forest areas in Central and West Africa by wild rodents or primates, but human-to-human transmission is also possible, especially in the family home or in the care environment.

How is it transmitted?

The monkey pox virus can be transmitted by direct contact with lesions on the skin or mucous membranes of a sick person, as well as by drops (saliva, sneezing, sputum, etc.). Sexual intercourse, with or without penetration, meets these conditions for contamination, and having multiple partners increases the risk of being exposed to the virus.

Contamination can also occur by contact with the patient’s surroundings (bedding, clothing, tableware, towels, etc.). It is therefore important that patients observe isolation throughout the duration of the disease (until the last scabs disappear, usually 3 weeks).

In Central or West Africa, humans can also be infected by contact with animals, wild or in captivity, dead or alive, such as rodents or monkeys.

Monkeypox virus infection is not known as an STI, but direct contact with damaged skin during intercourse facilitates transmission.

What are the symptoms?

Infection with monkeypox virus can cause a blister rash consisting of fluid-filled blisters that develop into dehydration, crusting and then scarring. Itching may occur. The vesicles are more concentrated in the face, in the anogenital area, palms and soles of the feet, may be present, but also on the trunk and limbs. The mucous membranes are also affected, in the mouth and genital area. This rash may be accompanied by fever, headache, body aches and asthenia. Lymph nodes can be swollen and painful, under the jaw, in the neck or in the groin fold. Sore throat is also reported.

The incubation of the disease can vary from 5 to 21 days. The fever phase lasts about 1 to 3 days. The disease usually heals spontaneously, after 2 to 3 weeks, but sometimes 4 weeks.

Are smallpox signs 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.

At this stage, the cases reported in Europe are mostly mild and there are no reported deaths.

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