Cases of monkeypox (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 early May 2022. Since that date, the epidemic affected an increasing number of countries, and the disease is subject to increased surveillance in France and in Europe.
The Director-General of the WHO announced on Saturday 23 July that he was declaring a public health emergency of international concern regarding this epidemic. This is the organization’s highest alert level to trigger a series of actions from member states.
In France, orthopoxvirus infections are subject to long-term surveillance through the mandatory notification system. In light of the current epidemic, the surveillance of these infections has been strengthened by Public Health France, and information and alert messages have been sent to health professionals and the most vulnerable population groups.
Update in France
From 2 August 2022 at As of 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 cases) %).
The distribution of cases by region of residence (when known) is shown in Figure 1 for cases with residence in France. That by reporting region is shown in figure 2.
The region of residence is not stated for 543 cases and 7 cases live abroad.
Figure 1. Confirmed monkeypox (n=1,689 cases) by region of residence, France, May-August 2022 (data as of 08/02/2022 – 12:00)
Figure 2. Confirmed monkeypox (n=2,234 cases) by reporting region, France, May-August 2022 (data as of 08/02/2022 – 12:00)
The distribution of cases by symptom onset date (when known) is shown in Figure 3. 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 onset of symptoms; as a result, and given the reporting deadlines, 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 the patient’s diagnosis. As an alternative to this information, the distribution of cases by their reporting date is shown in Figure 4.
Figure 3. Confirmed cases of monkeypox (n=1,578 cases) by week after symptom onset, France, May-August 2022 (data as of 02/08/2022 – 12:00). Data for the last few weeks (in gray) is 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).
All cases identified to date are adult males, except for 15 adult females and 2 children (under 15 years of age). Adult cases have a median age of 36; 25% of adult cases are under 30 years of age and 25% are between 43 and 84 years of age.
Among the cases studied, 75% showed a genito-anal rash, 71% a rash on another part of the body, 76% fever and 72% lymphadenopathy.
45 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 so far.
The median time to use the test after the date of onset of symptoms has decreased since the start of the epidemic: it decreased from 13 days in S18-2022 (May 2 to 8) to 5 days in S27-2022 (July 4 to 10) .
Of the cases studied, 67 are immunocompromised (5.0% of cases respond); 358 are HIV positive (ie 26% of cases know their HIV status). Among non-HIV carriers, 662 are on pre-exposure prophylaxis or “PrEP”* (ie, 66% of non-HIV carriers who answered the question).
To date, in France, 96% of cases where 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 symptom onset.
Most of the surveyed cases state that they cannot identify the person who allegedly infected them; 24% are secondary cases, i.e. they report having been in contact with a case of monkeypox in the three weeks before the onset of symptoms.
The next update of this report will be on Friday, August 5, 2022.
*PrEP is an HIV prevention treatment for people who do not have HIV and are particularly at risk.
Information and prevention measures
Given what has been observed in Europe about the disease, targeted communication was quickly implemented towards MSM people. The website sexosafe.fr, dedicated to the sexuality of MSM, is regularly updated with a summary of knowledge on the subject and preventive measures. The messages about the symptoms and what to do in case of symptoms were passed on via a digital campaign. Since June 17, the digital campaign has generated almost 507,085 clicks on the banners and more than 429,991 visits to the Sexosafe site.
This unit was supplemented by a poster campaign in cozy places with almost 1,350 poster spaces. And for the past few weeks by airing spots on local 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 area will also be made available in the coming days, following the publication of the opinion of the High Authority for Health on July 7.
Preventive measures are continuously adapted to the development of the situation and the state of knowledge.
In France, long-term monitoring of monkeypox is being reinforced through the mandatory notification system, and information and alert messages are sent to health professionals.. Exchanges also continue with other European countries, WHO and ECDC.
Monkeypox info service: a listening unit 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 the SIS Association, the telephone line “Monkeypox info service” is available every day from 8 am to 11 pm on the free number 0 801 90 80 69 (free, anonymous and confidential calls and services ). The unit is responsible for accompanying prevention messages and protective measures, to provide information on symptoms, treatments and vaccination, to advise and direct the care devices.
- Since the line opened, 3,679 interviews have been conducted on the Monkeypox info service (median age: 39).
- 1647 interviews were conducted 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 (against 141 the week before).
- In order of importance, the interviews mainly deal with the means of prevention (and especially access to vaccination), then the symptoms and the psychological and relational issues.
- More women contact the line (190 against 130 the week before). Their concerns are linked to a sense of vulnerability because they are in contact with people in danger.
Preventive vaccination against monkeypox
Faced with the spread of the Monkeypox virus (monkeypox), the High Authority for Health, seized by the Directorate General for Health, recommended in its opinion of 7 July 2022 that preventive vaccination be offered to the groups most exposed to the virus. .
In terms of vaccination coverage, 37,005 doses of 3rd generation vaccine were delivered by the agency to the territories on 02/08/2022.
Since July 11, 2022, people who fall within the indications preserved by HAS, in addition to people who have had risky contact with a sick person, can book an appointment to be vaccinated throughout France:
- Men who have sex with men report multiple sex partners.
- Trans people report more sexual partners.
- sex workers.
- Professionals who work in places of sexual consumption.
Vaccination may also be considered on a case-by-case basis for health professionals who have to care for sick people.
For more information on vaccination and access to vaccination sites:
What is Monkeypox?
Monkeypox is an infectious disease caused by an Orthopoxvirus. This zoonotic disease is usually transmitted to humans in forested areas of 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 setting.
How is it transferred?
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, sputtering, etc.). Sexual intercourse, with or without penetration, fulfills these conditions for contamination, and having multiple partners increases the risk of exposure to the virus. In particular, direct contact with damaged skin during intercourse facilitates transmission.
Contamination can also occur through contact with the patient’s surroundings (bedding, clothing, crockery, towels, etc.). It is therefore important that patients observe isolation for the entire 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 captive, dead or alive, such as rodents or monkeys.
What are the symptoms?
Infection with the monkeypox virus can cause a blistering rash consisting 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, palms and soles, 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 may be swollen and painful, under the jaw, in the neck or in the inguinal fold. Sore throats are also reported.
The incubation period 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.
Is monkeypox serious?
The disease is more serious 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.