Monkeypox Cases: Current Situation in Europe and Surveillance in France

Health authorities in the United Kingdom have reported 9 confirmed cases of Monkeypox in individuals who have not traveled to a high-risk area (Central or West Africa) and who report no connection to people who have traveled to these areas. These cases therefore contracted the infection within the United Kingdom. Virological analyses of these 9 cases indicate a Monkeypox virus belonging to the West African viral clade. The first three cases were diagnosed on May 13, 2022, in an infant and his parents. The other 6 cases, diagnosed subsequently, have no epidemiological link to the first two cases.

Additionally, on May 13, 2022, Portugal reported 5 confirmed cases of Monkeypox virus infection, and 15 additional suspected cases are currently under investigation. These 20 cases involve men, most of whom are young.

To date, these cases have occurred primarily, though not exclusively, among men who have sex with men (MSM), with no direct links to individuals returning from endemic areas.

Given the usual absence of Monkeypox in Europe and the lack of reported links between the identified cases and a risk area, the current European situation constitutes a warning and suggests local transmission within Europe. For this reason, in France, ongoing surveillance of Monkeypox through the mandatory reporting system has been strengthened, and information and alert messages are being sent to healthcare professionals. Discussions are also ongoing with other European countries, the WHO, and the ECDC.

What is Monkeypox?

Monkeypox is an infectious disease caused by an orthopoxvirus. This zoonotic disease is usually transmitted to humans in the forested areas of Central and West Africa by wild rodents or primates, but human-to-human transmission is also possible, particularly within households or in healthcare settings.

How is it transmitted?

The monkeypox virus can be transmitted through direct contact with the skin lesions or mucous membranes of an infected person, as well as through droplets (saliva, sneezing, coughing, etc.). Infection can also occur through contact with the patient’s environment (bedding, clothing, dishes, bath linens, etc.). It is therefore important for patients to remain in isolation for the entire duration of the illness (until the last scabs have fallen off, usually 3 weeks).

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

Infection with the MKP virus is not classified as an STI, but direct contact with broken skin during sexual intercourse facilitates transmission.

What are the symptoms?

Monkeypox infection begins with a fever, often high, accompanied by headaches, body aches, and fatigue. After about two days, a vesicular rash appears, consisting of fluid-filled blisters that dry out, form scabs, and eventually heal. Itching is common. The blisters tend to concentrate on the face, the palms of the hands, and the soles of the feet. The mucous membranes are also affected, particularly in the mouth and genital area. The lymph nodes are swollen and painful, under the jaw and in the neck.

The incubation period for the disease can range from 5 to 21 days. The fever phase lasts about 1 to 3 days. The disease usually resolves on its own after two to three weeks.

Is monkeypox serious?

The disease is more severe in children and in immunocompromised individuals. It can lead to complications such as secondary infections of the skin lesions or respiratory, digestive, ophthalmological, or neurological complications.

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