Update on July 5, 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, and suspected cases are being investigated. In many countries, the assessment and therefore the situation is changing very rapidly. In France, cases of this virus are subject to long-term surveillance through mandatory reporting. In view of the current warnings, the control of these infections is being strengthened by the French Public Health and information and warning messages are being sent to health workers.

The monkeypox case: an update in France

As of 14:00 on 05 July 2022, 577 cases have been confirmed: 387 in Ile-de-France, 52 in Auvergne-Rhône-Alpes, 37 in Occitania, 30 in New-Aquitaine, 23 in Hauts-de-France, 21 in Provence -8 in Alpes-Côte d’Azur, Normandy, 6 in Grand Est, 5 in Brittany, 4 in Pays-de-la-Loire, 3 in Bourgogne-Franche-Comte and 1 in Centre-Val de Loire.

As of 14:00 on July 4, 2022, the distribution of the investigated 552 confirmed cases by locality is presented in Figure 1.

Figure 1. Confirmed monkeypox cases (n=552) by residential area, France, May-July 2022 (data as of 04/07/2022 – 14:00)

Among these cases, 3 women and 1 child have been infected with the monkeypox virus since May 7, 2022, when the first case of infection was detected in France.

Confirmed adult cases ranged in age from 19 to 71 years (median age: 35 years).

Symptom onset dates vary between May 7, 2022 and July 01, 2022 (Figure 2). These cases were diagnosed a median of 6 days (0 to 22 days) after the onset of symptoms; therefore, last week’s data is not consolidated.

Figure 2. Confirmed monkeypox cases by date of symptom onset (n=552), France, May-July 2022 (data as of 04/07/2022 – 14:00)

Figure 2. Confirmed monkeypox cases by date of symptom onset (n=552), France, May-July 2022 (data as of 04/07/2022 – 14:00)

Among the investigated cases, 78% presented a genito-anal rash, 73% an eruption elsewhere on the body, 75% fever, and 72% lymphadenopathy.

Among the investigated cases, 29 were immune deficiency; 149 were infected with HIV (27%) and there were no deaths.
To date, 97% of cases of sexual orientation provided in France have occurred among men who have sex with men (MSM). Among cases with available data, 75% reported having at least 2 sexual partners in the 3 weeks prior to symptom onset.

Most of the investigated cases state that they cannot identify the person who allegedly infected them; 100 are secondary cases, meaning exposure to monkeypox in the three weeks prior to the onset of symptoms.

Information and preventive measures

Targeted outreach to MSM people was rapidly implemented, given what was observed about the disease in Europe. sexosafe.fr, dedicated to the sexuality of MSM people, has been updated with a summary of knowledge on the topic and preventive measures. Messages reminding of symptoms and what to do in case of symptoms were communicated through a digital campaign, posters and flyers and later through field events. Since June 17, the digital campaign has generated approximately 192,000 banner clicks and more than 173,000 visits to the sexosafe website. This device was completed with a poster campaign in entertainment venues with approximately 1,350 poster locations. At the same time, posters, flyers and leaflets were distributed in the field, thanks to participating associations, ARS and Sexosafe groups, as part of pride marches and in MSM meeting places. To date, 1,514 posters and 57,500 flyers have been ordered.

Prevention measures are continuously adapted to the evolution of the situation and the state of knowledge.

While monkeypox is not common in Europe and there is no association reported by risk zone-defined cases, the current European context constitutes a warning and suggests contamination in Europe. Therefore, long-term monitoring of monkey disease is being strengthened in France through a mandatory notification system, and information and warning messages are sent to health officials.. Exchanges continue with other European countries, WHO and ECDC.

What is monkey pox (monkey pox)?

Monkeypox is an infectious disease caused by Orthopoxvirus. This zoonotic disease is usually transmitted to humans by wild rodents or primates in the forest areas of Central and West Africa, but human-to-human transmission is also possible, particularly in the family home or care setting.

How is it transmitted?

The monkeypox virus can be transmitted by droplets (saliva, sneeze, spray, etc.), as well as by direct contact with a patient’s skin or mucous membrane damage. Sexual intercourse with or without penetration meets these conditions for contamination, and having multiple partners increases the risk of exposure to the virus.

Contamination can also occur through contact with the patient’s environment (bedding, clothing, dishes, bathrobes, etc.). Therefore, it is important for patients to observe isolation during the entire duration of the disease (until the last itching disappears, at most 3 weeks).

In Central or West Africa, humans can also become infected through contact with wild or captive animals, dead or alive, such as rodents or monkeys.

Infection with the monkeypox virus is not recognized as an STI, but direct contact with damaged skin during intercourse facilitates transmission.

What are the symptoms?

Infection with the monkeypox virus can cause a blistering rash consisting of fluid-filled blisters that dry, peel, and then progress to scarring. Itching may occur. Vesicles are mostly concentrated on the face, anogenital area, palms and soles of the feet, and can also be found on the trunk and limbs. Mucous membranes in the oral cavity and genital area are also affected. This rash may be accompanied by fever, headache, body aches and asthenia. Lymph nodes may be swollen and painful under the chin, in the neck, or in the groin. Sore throats are also reported.

Incubation of the disease can vary from 5 to 21 days. The fever phase lasts about 1 to 3 days. The disease often heals on its own, after 2-3 weeks, and sometimes after 4 weeks.

Is monkey flower serious?

The disease is more severe in children and people with weak immunity. It can be complicated by superinfection of skin lesions or respiratory, digestive, ophthalmological or neurological disorders.

No deaths were reported in Europe, particularly in France.

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