Cases of monkeypox (monkeypox) not directly related to travel to Central or West Africa or from travel returnees have been reported in Europe and around the world, suspected cases are being investigated in many countries and the situation is therefore changing very quickly. In France, infections with this virus are subject to long-term surveillance by means of reporting requirements. Given the current alerts, Public Health France is stepping up surveillance of these infections and sending information and alerts to healthcare professionals.
Case of monkeypox: update in France
As of June 28, 2022 at 14:00, 440 cases have been confirmed: 312 in Ile-de-France, 30 in Occitania, 29 in Auvergne-Rhône-Alpes, 21 in New Aquitaine, 16 in Provence-Alpes-Côte d’ Aur, 16 in Hauts-de-France, 7 in Normandy, 3 in Brittany, 3 in Grand-Est, 1 in Centre-Val-de-Loire, 1 in Bourgogne-Franche-Comté and 1 in Pays-de- la Loire.
Of the 399 confirmed cases as of 27 June 2022 at 14:00, 358 were the subject of an investigation, 5 are unavailable or have refused to answer the questionnaire and 36 are under investigation.
Among these cases, a first case concerns a child attending a primary school in Ile-de-France. He has been treated medically and shows no signs of seriousness. A probable case was identified in the same siblings.
The adult cases confirmed at 2:00 p.m. on June 22, 2022 range in age from 19 to 71 years (mean age: 35 years).
The dates of symptom onset are between May 7, 2022 and June 21, 2022 (Figure 1). Cases were diagnosed a median of 6 days (range 0-22 days) after symptom onset; therefore, data for the last week is not consolidated.
Figure 1. Confirmed cases of monkeypox (n=399), by date of symptom onset, France, May-June 2022 (as of 06/27/2022 – 02:00 p.m.)
Of the cases examined, 74% presented with a genito-anal rash, 72% with a rash on another part of the body, 70% with fever, and 72% with lymphadenopathy.
Among the cases studied, 13 are immunocompromised; no cases died.
So far, as in other European countries, these cases have mainly, but not exclusively, occurred in men who have sex with men (MSM), with no direct association with returnees from endemic areas. Most cases report multiple sexual partners.
Most of the cases examined state that they cannot identify the person who allegedly infected them.
After all, 60 of the cases examined are secondary cases.
Among the cases studied, 81 traveled, stayed or worked abroad before the onset of their symptoms, some in several different countries: thus 43 trips are reported in Spain, 9 in Belgium, 6 in Germany, 5 in the United Kingdom, 4 in Switzerland , 4 in Portugal, 2 in the Netherlands, 2 in Denmark, 2 in Mali, 2 in Greece, 1 in Luxembourg, 1 in India, 1 in the United States, 1 in Colombia, 1 in Morocco, 1 in Cyprus, 1 in Serbia and 1 in Canada. These voyages do not systematically represent the origin of the contamination and the list of countries mentioned may change as the data is consolidated.
The next update of this report will be on Tuesday 05 July 2022.
Targeted communication towards MSM individuals was quickly put in place given what was observed in Europe about the disease. The messages remind you of the symptoms and what to do if symptoms occur. They are currently being broadcast digitally. At the same time, posters, flyers and advice sheets were distributed thanks to associations, ARS and Sexosafe teams present on the ground at Pride marches and at places where MSM meet.
Finally, a summary of knowledge on the subject and preventive measures is offered on the sexosafe.fr website dedicated to the sexuality of MSM people.
Preventive measures are continuously adapted to the development of the situation and the level of knowledge.
Since monkeypox is not normally present in Europe and there is no link between the identified cases and a risk area, the current European context is a warning and suggests contamination in Europe. For this reason, in France, long-term surveillance of monkeypox is reinforced through the mandatory reporting system, and information and alerts are sent to health professionals. The exchange with other European countries, the WHO and the ECDC will also be continued.
What is monkeypox (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, particularly within families or in foster care settings.
How is it transmitted?
The monkeypox virus can be transmitted through direct contact with lesions on the skin or mucous membranes of a sick person, as well as through droplet infection (saliva, sneezing, syringes, etc.). Sexual intercourse, with or without penetration, fulfills these conditions for contagion, and having multiple partners increases the risk of exposure to the virus.
Contamination can also occur through contact with the patient’s environment (bed linen, clothing, dishes, bath linen, etc.). It is therefore important that patients remain isolated for the entire duration of the disease (until the last scabs disappear, usually 3 weeks).
In central or western Africa, humans can also become infected through contact with animals, whether wild or captive, dead or alive, such as rodents or monkeys.
Monkeypox virus infection is not known as an STI, but direct contact with broken skin during sexual intercourse facilitates transmission.
What are the symptoms ?
Infection with the monkeypox virus can cause a blistering rash, consisting of fluid-filled blisters that dry up, become crusted, and then scar. Itching may occur. The vesicles are more concentrated on the face, anogenital area, palms and soles, but may also be present 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 groin crease. Sore throats are also reported.
The incubation of the disease can last 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 after 4 weeks.
Is smallpox of the sign serious?
The disease is more severe in children and immunocompromised people. It can be complicated by superinfection of skin lesions or by respiratory, digestive, ophthalmologic, or neurologic disorders.
At this stage, cases reported in Europe are mostly mild and no deaths have been reported.
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