MONKEYPOX. More than 2,400 cases of monkeypox have been confirmed in France, including 862 in Ile-de-France. What are the symptoms ? Treatments ? How do you get monkeypox? What cause? Is it dangerous? Photos of the buttons, transmission, test, info... We take stock.

[Updated August 9, 2022 at 10:32 a.m.] The monkeypox virus or virus ' monkeypox' is the origin of a infectious disease which is transmitted to humans by animals, mainly rodents (squirrels, Gambian rats) and originally located in Africa. Since early May 2022 , of the emerging cases outside of Africa , not directly related to a trip . In its balance sheet of August 4, 2022, Public Health France confirm 2,423 homes in France (862 in Ile-de-France) whose 20 cases in women (adults) and 2 children . Two deaths have been reported in Europe, Spain . On August 4, the UNITED STATES decided a public health emergency for the monkeypox epidemic. As of July 27, more than 18,000 cases in 78 countries have been reported to the World Health Organization. The Director General of the WHO announced on July 23 that he said public health emergency of international concern regarding the Monkeypox outbreak. 98% of cases for which the sexual orientation is indicated are occurred in men who have sex with men. A listening device called ' Monkeypox info service ' is open in France to answer questions from the public. It is accessible every day from 8 a.m. to 11 p.m., on the toll-free number 0 801 90 80 69 (free call and services, anonymous and confidential). VS ' is what monkey pox ? How is the transmission monkeypox? How to avoid the contamination ? What tests in case of doubt? What cause ? Is it dangerous ? What are the typical symptoms (photo of pimples) ?

Definition: what is monkeypox?

Monkeypox is caused by orthopoxvirus ape , which belongs to the genus Orthopoxvirus of the Poxviridae family. ' L' orthopoxvirose simienne , or 'monkey pox', is a rare viral zoonoses (virus transmitted to humans by animals) which is mainly observed in isolated areas of central and western Africa , close to tropical rainforests ' indicates the WHO . We speak of 'monkey' pox because the virus was discovered in 1958 in laboratory monkeys in Copenhagen most 'it is a mistake to say this because it is rather a smallpox virus hosted by rodents like squirrels and large African rats like the Gambian rat' explains Professor Jeanne Brugère-Pi Junecoux. ' What a virus clinically resembles smallpox but monkeypox is due to a poxvirus different from smallpox virus ' explains the WHO. The first human case was detected in 1970, in the Democratic Republic of the Congo at a child living in an area where smallpox had been eliminated since 1968. Two strains of monkeypox are known:

• the Congo strain or central African strain (most virulent)
• the West African strain (less virulent which seems to be the one found in the current cases)

Regarding the 2022 cases, 'the preliminary data of tests PCR indicate that the souches of viruses monkeypox detected in Europe and other non-endemic areas belong to the West African clade ' where the virus first appeared, the WHO said on June 4.

What are the differences with smallpox?

The monkeypox virus clinically resembles smallpox but it is a different poxviruses. The so-called 'monkey' pox is more benign, associated with lymph nodes (there are no nodes in smallpox), the scars are less severe. Monkey pox is also very similar to chicken pox which is more contagious.

How many cases of monkey pox are there in France?

Monkeypox infection is a notifiable disease in France. As of August 4, 2,423 confirmed cases have been identified in France. The cases most frequently resided in Ile-de-France (862 cases or 49% of cases whose region of residence is known), in Occitania (210 cases, or 12%) and in Auvergne-Rhône-Alpes (181 cases, or 10%).

► The majority of cases investigated are men, adult cases have a median age of 36 ; 25% of adult cases are under 30 years old and 25% are 43 to 84 years old. 96% of cases where sexual orientation is reported occurred among men who have sex with men (MSM). 72% report having had at least 2 sexual partners in the 3 weeks before the onset of symptoms

► 20 cases are women

► 2 cases of children

►69 cases are immunocompromised

► Among the cases investigated, 47 were hospitalized because of their Monkeypox virus infection, including 39 for complications related to this diagnosis. No cases died.

How many cases and what treatment in Île-de-France?

Ile-de-France is the region with the most monkeypox cases at the moment ( 862 to August 4). Post-exposure vaccination with a 3rd generation smallpox vaccine may be offered to individuals identified as risk contacts monkeypox virus as well as health professionals exposed to risk without personal protective measures. July 26, a new center dedicated to vaccination against monkeypox opened in Paris, in the 13th district within the grounds of the Edinson Municipal Health Center. Of the vaccination centers were already open in Paris since mid-July (AP-HP Bichat, AP-HP Pitié Salpêtrière for example). The list of vaccination centers is published by the Regional Health Agency of each region on their website ( ARS Ile-de-France ). ' They are communicated to people with contact cases at risk, potentially eligible for vaccination. They can also be contacted directly by people who know they are at-risk contacts of a confirmed case to assess the indication for vaccination. “says the Agency. The vaccine made available is currently Imvanex® .

What are the symptoms of monkey pox?

Monkeypox is a disease 'with cutaneous tropism' explains Professor Brugère-Picoux. The symptoms go away on their own, but can be serious in some cases.

► Among the French cases investigated : 75% presented a genito-anal rash, 70% a rash on another part of the body, 76% fever and 72% lymphadenopathy.

Typically, within the first 5 days, Monkeypox infection causes:

• fever
• headache
• adenopathy (swollen lymph nodes)
• back pain
• myalgia (muscle aches)
• asthenia (exhaustion)
• Of the sore throat

Within 1-3 days (sometimes longer) of onset of fever , the patient develops rash symptoms (rash) which often begins on the face then spreads to other parts of the body, including the palms of the hands, soles of the feet and the mucous membranes (mouth and genital area (sex, anus)). Skin involvement occurs in one push . Of the itching are frequent. Buttons go through different successive stages:

• macules
• papules
• vesicles
• pustules
• scabs

When the scabs fall off, people are no longer contagious. The other mucous membranes (ENT, conjunctiva) may also be affected. Recently detected cases in men who have sex with men have reported a preponderance of lesions in the genital area . ' L'incubation illness can range from 5 to 21 days . The fever phase lasts about 1 to 3 days. The disease, generally benign, most often heals spontaneously, after 2 to 3 weeks' emphasizes Public Health France.

► If symptoms appear ( fever and rash with blisters ), contact the SAMU Center 15 . It is recommended that you isolate pending medical advice and avoid contact with other people.

► Other symptoms were reported during the summer of 2022 on social networks. For example hives pimples that extend over the body (not necessarily painful , and without much scratching) observed by a young man and described on his twitter account . 'I have lesions all over my mouth. My lips, neck, cheeks and tongue are doubling in size. I can't open my mouth and I can't speak because my throat is so swollen' he says. In contrast, 'at no time did I have anal and genital lesions' .

Photo: What do monkeypox pimples look like?

Monkeypox causes pimples that can make you think of chickenpox: first vesicles (pimples with liquid inside) then pustules and finally scabs . When the scabs fall off, people are no longer contagious.

What is the incubation period for monkeypox?

'The incubation of the disease can range 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' specifies Public Health France.

How do you get infected with monkeypox?

According to researchers from the Pastor Institute , transmission of monkeypox virus outside of Africa' is probably due to the global decline in immunity to viruses of the orthopoxvirus genus (responsible for human smallpox), following the cessation of smallpox vaccination in the 1980s. Monkeypox could therefore become the most important infection in orthopoxvirus in humans.
► Transmission between men: The transmission  mainly occurs through respiratory droplet particles (sputter, sneeze) and speak direct skin contact or some mucous membranes (mouth, sex, anus ) with pimples or scabs. Sexual intercourse, with or without penetration, meets these conditions for contamination, and having multiple partners increases the risk to be exposed to the virus. Transmission can also be done via the laundry sharing (clothes, sheets, towels, etc.), toiletries (toothbrushes, razors, etc.), crockery, sex toy, syringe…

► Sexual intercourse : Monkeypox is not known as a sexually transmitted disease per se. But sexual contact with a person carrying the virus promotes the transmission of the virus. It is important to abstain from sexual contact, and more generally from prolonged skin contact, when you have signs of monkeypox and/or if you test positive.

►Transmission from animals to humans: 'The virus is mainly transmitted to humans from various wild animals , rodents or primates for example 'explains the WHO. The infection is caused by a direct contact with blood, body fluids, or broken skin or mucous membranes of infected animals . ' In Africa, human infections have been documented as a result of handling infected monkeys, Gambian giant rats and squirrels, with rodents thought to be the main reservoir of the virus. The consumption of meat from infected animals undercooked is a possible risk factor ' develops WHO.

What faire if on est cas contact?

The High Authority for Health ( HAS ) recommends vaccinate contact cases of a confirmed case monkeypox with the smallpox vaccine. No need to isolate yourself though. For children (-18 years old), the HAS recommends that vaccination be considered on a case-by-case basis. If your child has a contact case, the Regional Health Agency ( ARS ) recommends:

• Monitor the appearance of symptoms (fever, rash) and call 15 if necessary;
• Be offered a consultation in order to have the child benefit from a vaccination if it is deemed necessary by the doctor
• In the absence of symptoms, and in the state of knowledge, there is no known risk of contagion. No measure is therefore necessary for the child (neither isolation nor adaptation of activities) nor for the other members of the family.

What are the rules for isolation with monkeypox?

A person with a positive monkeypox virus diagnostic test (PCR) result is a confirmed case of monkeypox and should self-isolate for 3 weeks from their date of onset of signs if their clinical condition does not require hospitalization, remind Public Health France . It is contagious from the first signs until the complete healing of the skin. During home isolation if possible in a separate room from other residents:

• No outings or visits, except essential (medical for example)
• No physical contact (no kissing, skin-to-skin contact, etc.)
• Wear a surgical mask in the presence of other people
• Cover rashes or pimples as well as possible (clothing, bandages)
• Do not share personal effects (objects, dishes, clothes, linens)
• No contact with pets (possibility of transmission)
• Respect the treatment given by the doctor, because certain drugs are to be avoided (do not take anti-inflammatories)
• Clean hands, short fingernails, no scratching, no touching pimples.
• Wash your hands before any contact and regularly using soap and water or a hydro-alcoholic solution.
• Avoid taking baths, prefer showers and dab dry (without rubbing).
• Wash personal belongings separately (dishes, laundry at 60° if possible).
• Regularly clean/disinfect affected surfaces, especially sanitary ones (once a day), with the usual products.
• It is recommended abstain from sexual intercourse until 21 days after the onset of symptoms.

If scabs fall off, they can be contagious, as can soiled dressings and bandages: put them in a specific bin bag to close, then put in another bin bag to close before throwing it away with household waste. Relatives should wash their hands regularly, avoid direct contact (skin to skin) with the infected person or their personal effects (dishes, laundry, etc.) and wear a surgical mask near them.

How long are you contagious?

'Monkey pox is a contagious disease, confirms Professor Brugère-Picoux most not as much as chickenpox .' The person is contagious from the first signs of the disease until the complete healing of the skin, recalls the Mission nationale Coreb . ' People living with an infected person should avoid close contact WHO Director-General Tedros Adhanom Ghebreyesus recalled at a press conference in June.

Diagnosis: what test to do for monkey pox?

If you think you have symptoms of monkeypox, you should see a doctor or call 15 if you don't know who to turn to. Confirmation of the diagnosis of monkeypox requires a analysis of the virus in the laboratory, in particular by PCR test. The reference levy is the skin sample (biopsy or swab by rubbing several vesicles) and/ or nasopharyngeal if the person has a rash in the mouth or throat. 'Under a microscope (skin sample, editor's note), we immediately recognize the virus because it is a big virus' says Professor Brugère-Picoux. While waiting to carry out the test and know the results, the people tested must isolate themselves. On July 25, the High Authority for Health ( HAS ) is pronounced in favor of registration for reimbursement by health insurance tests nucleic acid amplification (NAAT) to detect Monkeypox virus infection. The HAS recommends ' depending on the clinical context and the type of lesions observed, to perform in order of priority: mucosal samples, skin samples or samples from the oropharyngeal sphere '. Before Calling Back' that the diagnosis of Monkeypox virus infection is primarily clinical, detection by NAAT test should therefore only be carried out only in case of persistent doubt after examination clinical '. The use of this type of test is thus limited to 'cas suspects ' and ' possible cases' .

► The cas suspects are patients with clinical signs suggestive of infection with Monkeypox virus without exposure to an identified risk of infection. Case definitions are evolving to include a category' cas possible 'corresponding to patients with clinical signs suggestive of Monkeypox virus infection and at least one exposure to risk of infection (return from a trip to an African country where the virus usually circulates, or multiple sexual partners regardless of either sexual orientation, or man who has sex with men).As with suspected cases, possible cases should make the subject of a biological confirmation test (with the exception of possible cases, if the clinical symptoms are sufficiently suggestive and the differential diagnoses have been ruled out, the test may not be performed);
► The probable cases are patients with clinical signs suggestive of Monkeypox virus infection and an epidemiological link with a confirmed case. The action to be taken for probable cases is adapted, with the a suppression of the systematic test due to the strong clinical suspicion and the link to a confirmed case.
► The confirmed case : it is no longer necessary to have a positive qPCR or RT-PCR result specific for MKP virus to confirm a case; a positive result in generic qPCR of the genus Orthopoxvirus , associated or not with a partial sequencing result specific for Monkeypox virus, confirms the case.

What is the treatment for monkeypox?

Monkeypox is a disease whose patient usually heals spontaneously in two to three weeks. ' In the situation where a treatment of Monkeypox infection is to be considered during a severe form of the disease in particular and after collegial discussion, the tecovirimat would be the treatment first proposed ' indicates the High Council of Public Health ( HCSP ). Tecovirimat (SIGA Technologies) is an antiviral medicine in the form of capsules that will prevent the virus from spreading in the body. The recommended dosage for adults and children varies according to weight, specifies the National Agency for the Safety of Medicines and Health Products ( ANSM ) :
► For patients 13 kg to less than 25 kg: 1 capsule administered every 12 hours
► For patients weighing 25 kg to less than 40 kg: 2 capsules administered every 12 hours
► For patients 40 kg and over: 3 capsules administered every 12 hours

The recommended treatment duration is 14 days . Tecovirimat capsules should be taken in the 30 minutes after a meal.

What vaccine is given against monkeypox?

Abolished since 1984, smallpox vaccination is back in France in the face of the emergence of cases of the Monkeypox virus responsible for monkeypox. Vaccination against monkeypox is offered for prevention to people most exposed to the virus (list below) or post-exposure to contact cases of an infected person. It's the smallpox vaccine Imvanex , produced by the Danish Bavarian Nordic Laboratory which is currently indicated in the fight against monkey pox.

Is monkeypox dangerous?

WHO is particularly concerned about the risks posed by this virus to vulnerable people, especially the children, immunocompromised and the pregnant women . 'There is a total uncertainty today. The warning from the authorities is serious. We can worry but perhaps wrongly, we have to wait to see how it evolves' answers Professor Brugère-Picoux. Before recalling that the monkeypox virus 'is a stable virus, it is a DNA virus, it does not mutate easily like an RNA virus (type le Sars-Cov-2 du Covid-19, editor's note)'. The disease can be complicated by superinfection of skin lesions or respiratory disorders , digestive, ophthalmological or neurological. In Europe, 2 deaths have been reported in Spain.

Is monkeypox fatal?

'The rate of mortality during outbreaks of monkeypox has become established between 1% and 10% (3.6% for West African strain; 10.6% for Central African strain) , most of death occurring in young people “says the WHO.” The illness usually lasts 2 to 4 weeks. In Europe, 2 deaths (Spain) have been reported to date.

How to protect yourself from monkeypox?

Since the disease is transmissible by contact with the lesions, it is necessary to avoid contact with the affected person and with what she may have touched (sheets, towels, clothes...). The infected person must isolate themselves. When a person is infected with the monkeypox virus, they must ' avoid contact with your pet as much as possible , ideally by having it guarded by another person during the time of isolation ' and ' before each contact with your animal, wash your hands, then wear gloves and a single-use mask ' recommended the National Health Security Agency ( Considered ) on June 16 who questioned the transmission of the virus from humans to animals. 'Compared to human smallpox, eradication measures may not be as effective with monkeypox due to viral reservoir in several wildlife populations in Africa ' says Professor Brugère-Picoux. Finally, vaccination against smallpox provided cross-protection against monkeypox virus estimated at 85%.

What is the origin of monkeypox?

Monkeypox is a disease that emerged in Africa . The first human cases were identified in 1970 in the Democratic Republic of the Congo. We recognize a zoonotic origin (transmission from animals (squirrel, Gambian rat in Africa...)) in most African cases. The emerging cases outside Africa since early May 2022 (first case reported in England by the UKHSA the 7th) are linked to human-to-human contamination: “Investigations are ongoing, but the sudden appearance of monkeypox in many countries at the same time suggests that there may have been an undetected transmission for a certain time' explained the WHO on June 1. While animal-to-human transmission is accepted in Africa, these emerging cases are linked to human-to-human contamination, often observed in gay men or bisexual with genital and facial skin lesions . 'A sexual transmission can be suspected. Human-to-human transmission is possible through contact with bodily fluids, skin lesions (including scabs), the environment or objects contaminated by the patient. he can also be a contamination of nosocomial origin ' explained Professor Jeanne Brugère-Picoux, veterinarian and member of the National Academy of Medicine in a summary document of May 22, 2022. Contacted by telephone, she confirms that for the moment ' we are in total uncertainty, we have reason to worry but We have to wait and see if it continues or not. '. According to her 'only one complete epidemiological investigation will assess the risk linked to this virus emerging outside its usual geographical region (Africa, editor's note)' .

Thanks to Professor Jeanne Brugère-Picoux, veterinarian and member of the National Academy of Medicine.

Sources :

- Monkeyox - Evolution of the course of action, expansion of vaccination and provision of Tecovirmiat. DGS, July 8, 2022

- Monkeypox virus (monkey pox) Patient Information Sheet, after diagnosis. Coreb mission. June 3, 2022.

- Monkey pox: risk of human-to-human spread since the description of nearly one hundred sporadic indigenous cases described simultaneously since May 6, 2022 in Europe, North America and Australia. Jeanne Brugère-Picoux. MAY 22, 2022.

- Epidemiological update: monkeypox outbreak, 20 May 2022, ECDC

- Monkeypox, Centers for Disease Control and Prevention

- Orthopoxvirose simienne, WHO, 6 June 2018

- Pastor Institute

- Monkeypox, Public Health France