Monkeypox Cases: Update as of July 21, 2022

Update as of July 21, 2022, following reports of monkeypox cases in France and around the world.

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Cases of monkeypox with no direct link to travel to Central or West Africa or to travelers returning from those regions have been reported in Europe and around the world since early May 2022. Since then, the outbreak has spread to a growing number of countries, and the disease is now subject to enhanced surveillance in both France and Europe.

In France, orthopoxvirus infections are subject to ongoing surveillance through the mandatory reporting system. Given the ongoing outbreak, surveillance of these infections has been strengthened by Santé publique France, and information and alert messages have been sent to healthcare professionals and the populations most at risk.

Update on the Situation in France

As of July 21, 2022, at 12:00 p.m., 1,567 confirmed cases had been recorded in France: 726 cases in Île-de-France, 123 in Auvergne-Rhône-Alpes, 97 in Occitanie, 72 in Nouvelle-Aquitaine, 55 in Provence-Alpes-Côte d’Azur, 41 in Hauts-de-France, 29 in Grand Est, 18 in Normandy, 16 in Burgundy-Franche-Comté, 15 in Pays-de-la-Loire, 11 in Centre-Val de Loire, 10 in Brittany, 1 in Corsica, and 1 in Martinique. The region of residence is unknown for 347 cases, and 5 cases reside abroad.

The distribution of cases by region of residence (when known) is shown in Figure 1 for cases residing in France. The distribution by region of reporting is shown in Figure 2.

Figure 1. Confirmed cases of monkeypox (n=1,215 cases) by region of residence, France, May–July 2022 (data as of 07/21/2022 – 12:00 PM)

Figure 1. Cas confirmés de variole du singe (n=1 215 cas) par région de résidence, France, mai-juillet 2022 (données au 21/07/2022 – 12h00)

Figure 2. Confirmed cases of monkeypox (n=1,473 cases) by region of reporting, France, May–July 2022 (data as of July 21, 2022 – 12:00 p.m.)

Figure 2. Cas confirmés de variole du singe (n=1 473 cas) par région de signalement, France, mai-juillet 2022 (données au 21/07/2022 – 12h00)

The distribution of cases by date of symptom onset (when known) is shown in Figure 3. The date of symptom onset for these cases ranges from May 7, 2022, to July 17, 2022. They were diagnosed a median of 6 days (ranging from 0 to 23 days) after symptom onset; consequently, and given reporting delays, data from the past few weeks are not consolidated.

The reports received do not always mention the date of symptom onset or the date of diagnosis. As an alternative to this information, the distribution of cases by date of reporting is shown in Figure 4.

Figure 3. Confirmed cases of monkeypox (n=1,179 cases) by week of symptom onset, France, May–July 2022 (data as of 07/21/2022 – 12:00 PM). Data from the last few weeks (in gray) are not fully consolidated.

Figure 3. Cas confirmés de variole du singe (n=1 179 cas) par semaine de début des symptômes, France, mai-juillet 2022 (données au 21/07/2022 – 12h00)

Figure 4. Confirmed cases of monkeypox (n=1,410 cases) by week of reporting, France, May–July 2022 (data as of July 21, 2022 – 12:00 PM)

Figure 4. Cas confirmés de variole du singe (n= 1 410 cas) par semaine de signalement, France, mai-juillet 2022 (données au 21/07/2022 – 12h00)

All cases recorded to date, except for 7 adult females and 2 children, are adult males. Adult cases have a median age of 36 years; 25% of adult cases are under 30 years of age, and 25% are between 43 and 84 years of age.

Among the cases investigated, 78% presented with a genital-anal rash, 72% with a rash on another part of the body, 76% with a fever, and 74% with lymphadenopathy.

Forty cases (3.4%) were hospitalized due to their Monkeypox virus infection, including 33 (3.0%) for complications related to this diagnosis. No cases have died.

The median time to testing per surveillance week has been decreasing since the start of the outbreak: it fell from 13 days in Week 18 of 2022 (May 2–8) to 5 days in Week 26 of 2022 (July 4–10).

Among the investigated cases, 51 are immunocompromised (4.8% of responding cases); 290 are HIV-positive (26% of cases aware of their HIV status). Among cases not living with HIV, 554 are on PrEP (69% of respondents to the question).

To date, in France, 96% of cases for which sexual orientation is reported occurred among men who have sex with men (MSM). Among cases for which information is available, 74% reported having had at least two sexual partners in the three weeks prior to symptom onset.

Most of the cases surveyed report being unable to identify the person who may have infected them; 227 are secondary cases, meaning they reported having been in contact with a monkeypox case within the three weeks prior to the onset of symptoms.

The next update to this report will be released on Wednesday, July 27, 2022.

Information and Prevention Initiatives

Given what has been observed in Europe regarding the disease, targeted communication was quickly implemented for MSM. The website sexosafe.fr, dedicated to the sexual health of MSM, is regularly updated with a summary of current knowledge on the subject and prevention measures. Messages reminding people of the symptoms and what to do if symptoms appear were shared through a digital campaign. Since June 17, the digital campaign has generated nearly 379,018 clicks on banners and over 308,551 visits to the Sexosafe website. This initiative was supplemented by a poster campaign in social gathering places, with nearly 1,350 display locations. In recent days, radio spots have also been broadcast on community radio stations. At the same time, posters, flyers, and fact sheets have been distributed through community organizations, Regional Health Agencies (ARS), and Sexosafe teams on the ground, during Pride parades, and in MSM social spaces. To date, 2,749 posters and 84,500 flyers have been ordered.

In the coming days, a digital campaign on preventive vaccination and field tools will also be made available, following the publication of the Haute Autorité de Santé’s advisory on July 7.

Prevention efforts are continuously adapted to the evolving situation and the current state of knowledge.

  • Access the documents:

    • Monkeypox Information | Poster

    • Monkeypox Information | Flyer

Given the usual absence of monkeypox in Europe and the lack of reported links between identified cases and a high-risk area, the current European context constitutes an alert and suggests local transmission in Europe. This is why, 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.

Monkeypox Info Service: a hotline to answer questions about monkeypox

Since Wednesday, July 13, a hotline has been available to answer questions about monkeypox. Funded by Santé publique France and operated by SIS Association (Sexualités info service Association), the “Monkeypox info service” hotline is available daily from 8 a.m. to 11 p.m. at the toll-free number 0 801 90 80 69 (free calls and services; anonymous and confidential). This service is responsible for promoting prevention messages and protective measures, providing information on symptoms, treatments, and vaccination, and offering advice and referrals to care services.

  • Since the line opened, 1,685 calls have been handled by the Monkeypox Info Service, 91% of which were from men with an average age of 39.

Learn more

Preventive vaccination against monkeypox

In response to the spread of the Monkeypox virus, the High Authority for Health, consulted by the Directorate General of Health, recommended in its opinion of July 7, 2022, that preventive vaccination be offered to groups most at risk of exposure to the virus.

Regarding the rollout of the vaccination, 20,048 doses of third-generation vaccine had been delivered by the Agency to the regions as of July 21, 2022.

Since July 11, 2022, in addition to individuals who have had high-risk contact with an infected person, individuals meeting the criteria established by the HAS may schedule an appointment to be vaccinated throughout the country:

  • Men who have sex with men and report having multiple sexual partners.

  • Transgender individuals reporting multiple sexual partners.

  • Sex workers.

  • Professionals working in venues where sexual services are provided.

Vaccination may also be considered on a case-by-case basis for healthcare professionals who care for infected individuals.

To learn more about 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 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 skin lesions or mucous membranes of an infected person, as well as through droplets (saliva, sneezing, spittle, etc.). Sexual intercourse, with or without penetration, meets these conditions for transmission, and having multiple partners increases the risk of exposure to the virus. In particular, direct contact with broken skin during sexual intercourse facilitates transmission.

Transmission can also occur through contact with the infected person’s environment (bedding, clothing, dishes, bath towels, etc.). It is therefore important for infected individuals 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.

What are the symptoms?

Infection with the monkeypox virus can cause a vesicular rash, consisting of fluid-filled blisters that dry out, form scabs, and eventually heal. Itching may occur. The blisters tend to concentrate on the face, the anogenital area, the palms of the hands, and the soles of the feet, but may also appear on the trunk and limbs. The mucous membranes are also affected, particularly in the mouth and genital region. This rash may be accompanied by fever, headache, body aches, and fatigue. Lymph nodes may be swollen and tender under the jaw, in the neck, or in the groin. Sore throat has also been reported.

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 spontaneously after 2 to 3 weeks, though sometimes it takes 4 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 involvement.

In Europe, 2 deaths (in Spain) have been reported to date.

See previous updates

See also

Smallpox B (Mpox)

thematic dossier

Smallpox B (Mpox), formerly known as monkeypox, is a rare viral infectious disease caused by the monkeypox virus and transmitted primarily from rodents to humans, and then from person to person,...

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