Monkey pox: symptoms, isolation, where is the epidemic?

MONKEYPOX. The monkeypox epidemic continues in France with more than 2,600 confirmed cases in mid-August. Symptoms, transmission, contagion, photos of pimples, incubation, testing, isolation: the latest news.

[Updated August 17, 2022 at 11:19 a.m.] The monkeypox epidemic continues in France. According to the latest update published by Public Health France , 2,673 people were infected in France by this virus called ' Monkeypox ' in English including 895 in Ile-de-France. But ' It's a virus that we can control' reassured the immunologist Brigitte Autran, President of the new 'Committee for monitoring and anticipating health risks' (ex-Covid Scientific Council), at the Parisian August 16. According to her, 'a zero Monkeypox strategy is possible, unlike that of zero-Covid' provided ' vaccinate target populations' . 95% of cases for whom sexual orientation is given in France are occurred in men who have sex with men. Monkey pox is a infectious disease which is initially transmitted to humans by animals, mainly rodents (squirrels, Gambian rats) and originally located in Africa. His symptoms are pain (fever, headache, etc.) . Since early May 2022 , of the emerging cases outside of Africa , not directly related to a trip . L' ' public health emergency of international concern' was decreed by the WHO Director General in July. To avoid offending any cultural, social, national, regional, professional or ethnic groups and to minimize any negative impact on trade, travel, tourism or animal welfare, WHO experts are currently exchanging for give a new name to this disease and its virus . Since August 12, the names of the two strains of Monkeypox virus have been changed by the WHO . We are now talking about 'Clade I' to designate the strain called 'Congo' or Central Africa (the most virulent) and 'Clade II' for the so-called 'West African' strain (less virulent). Clade II consists of two subclades: 'Clade IIa' and 'Clade IIb' (found in the 2022 epidemic). VS ' is what monkey pox ? How is the virus transmitted? 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 (the most virulent) renamed 'Clade I' by the WHO in August 2022.
  • the West African strain (less virulent which seems to be the one found in current cases) renamed 'Clade II'.

How long is the isolation?

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 ( disappearance of scabs ). This isolation, after medical advice, can be lifted after 14 days in case of recovery (healing of all the vesicles with fall of the crusts). A work stopping or an authorization for full-time telework may be issued to you by your attending physician, specifies the ARS of Ile-de-France .

During home isolation (ideally) 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 for the duration of solitary confinement.
  • Regular airing of the room where the infected person is staying.

If scabs fall off, they can be contagious, as well as soiled dressings and bandages: put them in a specific garbage bag to be closed, then put in another garbage bag to be closed 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.

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.

Where is the epidemic in France?

Monkeypox infection is a notifiable disease in France. In the point of situation of the August 11, Public Health France reports 2,673 cases of monkey pox in France : 895 homes in Ile-de-France , 236 in Occitanie, 205 in Auvergne-Rhône-Alpes, 162 in Provence-Alpes-Côte d'Azur, 117 in Hauts-de-France, 104 in New Aquitaine, 68 in Grand Est, 43 in Pays-de-la- Loire, 30 in Normandy, 27 in Bourgogne-Franche-Comté, 26 in Brittany, 24 in Centre-Val de Loire, 2 in Corsica, 2 in Martinique, 1 in Guadeloupe and 1 in Saint-Martin. For 720 cases, the region of residence was not provided, and 10 cases reside abroad. The adult cases have a median age of 36 years ; 25% of adult cases are under 30 years old and 25% are 43 to 77 years old. Of the total cases, 28 are adult females and 2 are children.

What are the symptoms of monkey pox?

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

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 presents with Rashes (rash) that often start on the face then spread 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, conjunctivae) may also be affected.

► 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' .

How long do monkeypox symptoms last?

' The fever phase lasts about 1 to 3 days. The disease, generally benign, most often heals spontaneously, after 2 to 3 weeks' informs Public Health France.

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.

  monkeypox pimples
Typical pimples in monkeypox infection

What is the incubation period for monkeypox?

'The incubation of the disease can range from 5 to 21 days, on average 6 to 13 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 is monkeypox transmitted?

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 with orthopoxvirus in humans.
► Transmission between men: The transmission  mainly occurs through particles from respiratory droplets (sputter, sneeze within 2 meters for at least 3 hours) 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…

►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 following the handling of 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.

Can you catch monkeypox during sex?

Sexual contact with a person carrying the virus favors the transmission of the virus. The virus has been isolated from the semen of patients. “It is not known how long the virus persists in semen and genital secretions, or whether these biological fluids can transmit the disease” report the ARS of Ile-de-France . As a result and as a precaution, the French health authorities recommend:

  • abstain from sexual intercourse for the entire period of isolation (approximately 3 weeks);
  • do not share sex toys;
  • to use a condom during sexual intercourse of any type until 8 weeks after the end of the infectious period (the period of contagiousness begins as soon as the first symptoms appear and lasts until the lesions have healed) .

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.

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 . That's about 3 weeks.

  Image of the different clinical phases of monkeypox
Image of the different clinical phases of monkeypox

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. The ' possible cases ' correspond to patients with clinical signs suggestive of Monkeypox 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 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).

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.

Monkey pox vaccine

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 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 monkeypox. A thirty places offer vaccination in Ile-de-France.

Is monkeypox dangerous?

The disease may be complicated by superinfection of skin lesions or respiratory disorders , digestive, ophthalmological or neurological. In Europe, 2 deaths have been reported in Spain. 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)'.

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 disposable 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 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. Interviewed in May 2022.

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