France - Monkeypox outbreak 2022-2024

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Mpox: update on the epidemic

Published 08/21/2024 | Modified 08/21/2024

During a briefing on the Mpox epidemic, Prime Minister Gabriel Attal detailed the measures taken by France to strengthen health vigilance, inform travelers, and intensify the fight against the virus.

Prime Minister Gabriel Attal announced on Tuesday, August 20, 2024, during an update on the Mpox epidemic , that the French health system is on maximum alert to deal with all possible scenarios
...
The Prime Minister's announcements on Mpox

Travelers going to or returning from areas where the virus is circulating are now systematically informed of the precautionary measures to adopt.

Health professionals have been alerted and the diagnostic capacities of laboratories and hospitals will be strengthened.

In addition, 232 vaccination sites are already operational across the territory, with more to come.

In addition, France will donate 100,000 doses of vaccine , which will be distributed via the European Union to the most affected regions, demonstrating European solidarity against the epidemic .

"Monkeypox info service"

This telephone service provides information on the symptoms of Mpox, treatments, preventive measures and vaccination, and provides guidance on support systems.
The number 0 801 90 80 69 is open every day from 8 a.m. to 11 p.m. (calls and services are free, anonymous and confidential).
Monkeypox info service

To go further

Mpox: the latest on the virus

All information on the Ministry of Health website.
sante.gouv.fr

https://www.info.gouv.fr/actualite/variole-du-singe-point-de-situation-sur-lepidemie-de-mpox

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Mpox: the latest on the virus

updated 23.08.24

Diseases Health

The mpox virus (monkeypox, formerly “monkey pox”) is an infectious disease caused by an orthopoxvirus that is characterized in particular by a skin rash that can be isolated or preceded or accompanied by fever or swollen lymph nodes. The virus is transmitted between people, especially family and close friends. Human-to-human transmission occurs through direct contact with an infected person , through bodily fluids, skin lesions of the disease or internal mucous membranes such as the mouth, as well as indirectly through objects that the patient has contaminated , such as clothing or bed linen or to a lesser extent during prolonged face-to-face contact through droplets (spitting, sneezing).


Situation in France and internationally

There are two main clades of mpox : clade 1, originally present in the Congo Basin in Central Africa, and clade 2 present in West Africa.

Clade 1 mpox outbreaks have been increasing in frequency in Africa since early 2023, and the total number of cases in 2024 is already higher than in 2023. This clade is different from the one responsible for the 2022 mpox outbreak in Europe, particularly in France (clade 2). The main focus of transmission identified is in the Democratic Republic of Congo (DRC), accounting for more than 95% of cases, with only strains belonging to clade 1. Confirmed cases of mpox have also been reported in countries neighbouring the DRC, such as Rwanda, Uganda, Burundi, Kenya, Central African Republic and Congo.

On Wednesday, August 14, 2024, the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC) due to the active circulation of clade 1 mpox in Central Africa. The overall risk of infection with clade 1 mpox for the general population of the EU/EEA is currently considered by the European Centre for Disease Prevention and Control (ECDC) to be low. This risk is considered moderate for people with multiple sexual partners (who were not infected with mpox or who were not vaccinated during the 2022 epidemic) and is considered high in the event of close contact with imported cases of mpox. Today in France, no contamination by Clade 1 has been recorded, however sporadic cases could occur. A first case of Clade 1 mpox was detected in Sweden on August 15, 2024.

Since the 2022 epidemic, it is the clade 2 virus that has been circulating quietly in Europe and France, with a monthly number of reported cases varying between 12 and 26 in France between January and June 2024.

From January 1 to June 30, 2024, a total of 107 cases of Monkeypox virus (MPOX) infection were reported to Public Health France via the mandatory reporting (MR) of orthopoxviruses: 14 in January, 13 in February, 12 in March, 21 in April, 26 in May and 21 in June.

Of these 107 reported cases, five were not biologically confirmed. All cases involved adults aged between 18 and 65 (median age of 36), and only one involved a woman. More than a third of the cases (n=42, 39%) resided in the Ile-de-France region (including 28 in Paris), 30 in Auvergne-Rhône-Alpes (including 28 in the Rhône), 8 in Nouvelle Aquitaine, 7 in Provence-Alpes-Côte d'Azur and 6 in Occitanie. The other 14 cases were domiciled in Hauts-de-France (3), Bourgogne-Franche-Comté (3), La Réunion (3), Normandy (2), Brittany (2) and Grand Est (1). An increase in the number of cases was noted in April/May in Auvergne-Rhône-Alpes and in May/June in Ile-de-France. To date, the cases are mostly benign and no deaths have been reported.

For more information, see the press release of 08/18/2024: MPOX epidemics: update on the health situation and preparation of the French health system

Consult:
Epidemiological situation update in France. January to June 2024. on the Sante Publique France website

Symptoms and incubation period

Infection with the mpox virus can cause a rash, made up of fluid-filled vesicles that develop into dryness, crusting and then healing. Itching may occur. The vesicles are concentrated on the face, in the anogenital area, the palms of the hands and soles of the feet, may be present but also 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. The 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 period of 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 but sometimes 4 weeks.

Mode of transmission of the disease

Transmission of the mpox virus occurs when a person comes into contact with an animal, a human being or materials contaminated by the virus. The virus enters the body through a break in the skin (even if not visible), the respiratory tract or the mucous membranes. Transmission from animals to humans can occur through bites or scratches, through the preparation of bushmeat, through direct or indirect contact with body fluids or material from the lesion. There are usually no animal reservoirs present in Europe.
The virus is transmitted between people, especially family and close friends. Human-to-human transmission occurs through direct contact with an infected person , through bodily fluids, skin lesions of the disease or internal mucous membranes such as the mouth, as well as indirectly through objects that the sick person has contaminated , such as clothing or bed linen or to a lesser extent through prolonged face-to-face contact through droplets (spitting, sneezing).

It is therefore important that patients remain isolated for the entire duration of the illness (until the last scabs have disappeared, usually 3 weeks).

What to do if you have symptoms?

If symptoms appear (fever and rash with blisters), contact your doctor or a free information, screening and diagnosis center (CeGIDD) for HIV infections, viral hepatitis and STIs.

Find the contact details of the CEGIDD nearest to you on monkeypox-info-service.fr

IMPORTANT: A diagnosis of monkeypox can be carried out there under certain conditions. Contact the center's secretariat by telephone before any physical travel!

It is recommended to self-isolate while awaiting medical advice and to avoid contact with other people.
For more information, see the information sheet "I have MPOX. What precautions should I take for my loved ones and me?"

Monkeypox info service : a listening device to answer questions about the mpox virus

Since July 2022, a listening service has been open to answer questions raised by the mpox virus.
Subsidized by Public Health France and supported by SIS Association (Sexualities info service Association), the "Monkeypox info service" telephone line 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) .

Resources and online chat are also available at monkeypox-info-service.fr .

This system is responsible for supporting prevention messages and protective measures, providing information on symptoms, treatments and vaccination, and providing advice and guidance on care systems.

Preventive vaccination against the mpox virus

Adult contacts at high risk of contracting the MPOX virus as defined by Public Health France can be vaccinated, including exposed healthcare professionals without individual protective measures.
This is a post-exposure vaccination, in a reactive strategy around a confirmed case of MPOX. Ideally, the vaccine should be administered within 4 days after the risky contact and no more than 14 days.

In 2022, faced with the spread of the mpox virus, the High Authority for Health, contacted by the General Directorate of Health, recommended in its opinion of July 7, 2022 that preventive vaccination be offered to groups most exposed to the virus.

Since July 11, 2022, in addition to people who have had risky contact with a sick person, people who meet the indications selected by the HAS can make an appointment to be vaccinated throughout the territory:

– Men who have sex with men reporting multiple sexual partners;
– Trans people reporting multiple sexual partners;
– Sex workers;
– Professionals working in places of sexual consumption.

Vaccination can also be considered on a case-by-case basis for healthcare professionals who are required to care for sick people.

The contact details of all the vaccination centres against the mpox virus are available on: sante.fr/monkeypox

Following the Public Health Emergency of International Concern (PHEIC) declared by the WHO on 14 August 2024, the health authorities will, if necessary, develop the epidemic response strategy in close collaboration with health professionals and representatives of the health system. In this sense, an opinion from the High Authority for Health will be issued on 30 August 2024 to reassess the vaccination strategy, if necessary.

Review of vaccination in France

Number of vaccinations against the mpox virus

Total number of doses administered as of July 31, 2024

154,247 vaccinations* * data currently being consolidated

...

https://sante.gouv.fr/soins-et-maladies/maladies/infections-sexuellement-transmissibles/cas-groupes-d-infection-par-le-virus-monkeypox

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Mpox (MPXV): HAS updates its vaccination recommendations to better combat the circulation of the virus


PRESS RELEASE - Posted on Sep 02 2024

September 2, 2024 While the mpox epidemic has intensified on the African continent, with the circulation of several clades including clade Ib, clade II is still present in France. In this context, the Ministry of Health has urgently contacted the High Authority for Health (HAS) so that it can update its vaccination recommendations issued during the last epidemic in 2022. In response, the HAS is today publishing an opinion in which it recommends the two complementary strategies used in 2022: one preventive for unvaccinated or incompletely vaccinated people at high risk of exposure to the virus; and the other reactive for people in contact with identified cases. Finally, the HAS recommends the administration of a booster dose for people vaccinated two years ago.

On August 14, the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC) in response to the emergence in Africa of a new clade of mpox (clade Ib), which has demonstrated the capacity for sexual transmission, and its rapid spread to the Democratic Republic of Congo and other countries on the continent. At the same time, since the 2022 epidemic, France has been one of 13 countries in the European zone where clade IIb continues to circulate quietly [1] : the latest data published by Santé publique France report 126 cases since the beginning of the year. It is in this context, and while the immunity of the world population against orthopoxviruses has almost disappeared since the cessation of smallpox vaccination in the early 1980s, that the Ministry of Health urgently contacted the HAS to reassess the vaccination strategy against the Monkeypox virus (MPXV).

The HAS is publishing its opinion today, which aims to meet three objectives: prevent the emergence of MPXV clade Ib in France, reduce or even eliminate the circulation of clade II in France, and strengthen long-term immunity to prepare for possible epidemic outbreaks.

Protect those most at risk of exposure and vaccinate case-contact persons in response

The HAS relied in particular on the available knowledge concerning MPXV, on national and international epidemiological data, as well as on the efficacy data of the third-generation smallpox vaccine MVA-BN used in 2022 (marketed under the name Imvanex in Europe and Jynneos in the United States), the latter showing in particular a vaccine efficacy in pre-exposure more than 14 days after two doses [2] at 82%. Following its assessment and while the mode of transmission by intimate/sexual contact is mainly observed regardless of the clade, it considers that the targets of this vaccination remain unchanged since its previous recommendations. It therefore recommends implementing the following two complementary strategies:

• A preventive vaccination campaign for people at high risk of exposure to the virus

The HAS recommends that people at high risk of exposure to the virus be eligible for vaccination with the MVA-BN vaccine (Imvanex or Jynneos), namely:
- Men who have sex with men (MSM) and trans people reporting multiple sexual partners;
- People in prostitution;
- Professionals in sexual encounter places, regardless of the status of these places;
- Partners or people sharing the same living space as the people mentioned above.

• A reactive vaccination strategy around identified cases

The HAS recommends that people who have had a risky contact, as defined by Public Health France [3] , as well as immunocompromised people who have had close contact with a risky contact person, should also be eligible for vaccination with the MVA-BN vaccine (Imvanex or Jynneos). As a reminder, this reactive vaccination should ideally be administered within 4 days of the first risky contact to have optimal efficacy, and at the latest within 14 days.


Concerning minors, in the absence of marketing authorization (MA) for the vaccine for this population, the HAS reminds that post-exposure vaccination must be considered on a case-by-case basis and as part of a shared medical decision.

What are the vaccination procedures?

As a reminder, primary vaccination with the MVA-BN vaccine (Imvanex or Jynneos) is based on the administration of two doses spaced at least 28 days apart, or a single dose for people who received a smallpox vaccination with a first-generation vaccine before 1980. For immunocompromised people, the schedule is two doses supplemented by a third at least 28 days after the administration of the second, regardless of the history of smallpox vaccination. The HAS also emphasizes that, given the natural immunity conferred by past infection, it is not recommended to vaccinate people who contracted MPOX in 2022 or in subsequent years.

The HAS also supports the administration of a booster dose to people who received a primary vaccination in 2022. Indeed, in the absence of an established protection threshold, uncertainties remain about the duration of protection induced by the vaccine. Available studies show a significant decrease in neutralizing antibodies in the two years following a two-dose primary vaccination. They also suggest that a booster dose is associated with a longer persistence of antibodies than after a simple primary vaccination. The HAS therefore recommends a single booster dose to people who received their first vaccination in 2022 with a complete schedule.

Vaccination schedules for eligible individuals vary depending on whether or not they are immunocompromised and on their history of infection and vaccination. These situations are summarized in the table below.

Summary table of the different vaccination schedules to be carried out in persons eligible for vaccination depending on their history of infection and vaccination


a Smallpox vaccine received before 1980
* The booster dose should be given at a distance from the primary vaccination and ideally two years or more after the last dose. Persons eligible for a booster dose who were primary vaccinated in 2022 can therefore be revaccinated.

The HAS reminds that compliance with preventive measures (barrier gestures, isolation, etc.) has proven its effectiveness in reducing transmission, in addition to vaccination. Compliance with these measures remains absolutely necessary, even for vaccinated people.

Finally, the HAS stresses the importance of having data quickly, particularly concerning the monitoring of the epidemic, the duration of protection conferred by vaccines and the effectiveness of post-exposure vaccination and against the different clades . It is continuing its scientific monitoring work and reserves the right to adjust its recommendations in light of this new data.


[1] Continued circulation of mpox- an epidemiological and phylogenetic assessment, European Region, 2023 to 2024 Eurosurveillance August 24
[2] Policy brief: WHO position on smallpox and mpox (orthopoxvirus) vaccines August 24 based on a systematic review of 12 studies : Pischel L, Martini BA, Yu N, Cacesse D, Tracy M, Kharbanda K, et al. Vaccine effectiveness of 3rd generation mpox vaccines against mpox and disease severity: a systematic review and meta-analysis. Vaccine 2024:126053. http://dx.doi.org/10.1016/j.vaccine.2024.06.021
[3] Case and contact definition and contact tracing guidelines (April 2023)

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https://www.has-sante.fr/jcms/p_3538112/en/mpox-mpxv-la-has-actualise-ses-recommandations-vaccinales-pour-mieux-lutter-contre-la-circulation-du-virus

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Mpox cases in France. January 1 - September 3, 2024.

Published on September 4, 2024
Updated on September 4, 2024

Key points

• A total of 143 cases of MPOX have been reported to Public Health France since January 1, 2024, including 14 in the last 7 days.
• Only clade II Monkeypox viruses were detected by the Orthopoxvirus CNR.
• The reported cases all concern adults, 140 men and 3 women.

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https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/mpox/documents/bulletin-national/cas-de-mpox-en-france.-1er-janvier-3-septembre-2024

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Mpox cases in France. January 1 - September 10, 2024.

Published on September 11, 2024
Updated on September 11, 2024

Key points

• A total of 151 cases of MPOX have been reported to Public Health France since January 1, 2024, including 8 in the last 7 days.
• Only clade II Monkeypox viruses were detected by the Orthopoxvirus CNR.
• The reported cases all concern adults, 147 men and 4 women.

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PDF 0.21 MB

https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/mpox/documents/bulletin-national/cas-de-mpox-en-france.-1er-janvier-10-septembre-2024

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Mpox cases in France. January 1 - September 17, 2024.

Published on September 18, 2024
Updated on September 18, 2024

Key points

• A total of 160 cases of MPOX have been reported to Public Health France since January 1, 2024, including 9 in the last 7 days.
• Only clade II Monkeypox viruses were detected by the Orthopoxvirus CNR.
• The reported cases all concern adults, 154 men and 6 women.

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PDF 0.21 MB

https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/mpox/documents/bulletin-national/cas-de-mpox-en-france.-1er-janvier-17-septembre-2024

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Mpox cases in France. January 1 - September 24, 2024.


Published on September 25, 2024
Updated on September 25, 2024

Key points

• A total of 167 cases of MPOX have been reported to Public Health France since January 1, 2024, including 7 in the last 7 days.
• Only clade II Monkeypox viruses were detected by the Orthopoxvirus CNR.
• The reported cases all concern adults, 161 men and 6 women.

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https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/mpox/documents/bulletin-national/cas-de-mpox-en-france.-1er-janvier-24-septembre-2024

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Mpox cases in France. January 1 - October 1, 2024.

Published on October 2, 2024
Updated on October 2, 2024

Key points

• A total of 170 cases of MPOX have been reported to Public Health France since January 1, ²⁰²⁴ , including 3 in the last 7 days.
• Only clade II Monkeypoxviruses were detected by the Orthopoxvirus CNR.
• The reported cases all concern adults, 164 men and 6 women.

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PDF 0.28 MB

https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/mpox/documents/bulletin-national/cas-de-mpox-en-france.-1er-janvier-1er-octobre-2024

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Mpox cases in France. January 1 - October 15, 2024.


Published on October 16, 2024
Updated on October 16, 2024

Key points

• A total of 186 cases of MPOX have been reported to Public Health France since January 1, 2024, including 11 in the last 7 days.
• Only clade II Monkeypox viruses were detected by the Orthopoxvirus CNR.
• The reported cases all concern adults, 180 men and 6 women.

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PDF 0.23 MB

https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/mpox/documents/bulletin-national/cas-de-mpox-en-france.-1er-janvier-15-octobre-2024

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Mpox cases in France. January 1 - October 22, 2024.


Published on October 23, 2024
Updated on October 23, 2024


Key points

• A total of 190 cases of MPOX have been reported to Public Health France since January 1, ²⁰²⁴ , including 4 in the last 7 days.
• Only clade II Monkeypox viruses were detected by the Orthopoxvirus CNR.
• The reported cases all concern adults, 183 men and 7 women.

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PDF 0.23 MB

https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/mpox/documents/bulletin-national/cas-de-mpox-en-france.-1er-janvier-22-octobre-2024

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Mpox cases in France. January 1 - October 29, 2024.


Published on October 30, 2024
Updated on October 30, 2024

Key points

• In total, 195 cases of MPOX have been reported to Public Health France since January 1, 2024, including 5 in the last 7 days.
• Only clade II Monkeypox viruses were detected by the Orthopoxvirus CNR.
• The reported cases all concern adults, 188 men and 7 women.

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PDF 0.24 MB

https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/mpox/documents/bulletin-national/cas-de-mpox-en-france.-1er-janvier-29-octobre-2024

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Mpox cases in France. January 1 - November 12, 2024


Published on November 13, 2024
Updated on November 13, 2024


Key points

• In total, 203 cases of MPOX have been reported to Public Health France since January 1, 2024, including 8 in the last 14 days.
• Only clade II Monkeypox viruses were detected by the Orthopoxvirus CNR.
• The reported cases all concern adults, 195 men and 8 women.

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PDF 0.27 MB

https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/mpox/documents/bulletin-national/cas-de-mpox-en-france.-1er-janvier-12-novembre-2024

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Mpox cases in France. January 1 - November 26, 2024.


Published on November 27, 2024
Updated on November 27, 2024
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Key points

• In total, 209 cases of MPOX have been reported to Public Health France since January 1, 2024, including 6 in the last 14 days.
• Only clade II Monkeypox viruses were detected by the Orthopoxvirus CNR.
• The reported cases all concern adults, 201 men and 8 women.

Download

PDF 0.23 MB

https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/mpox/documents/bulletin-national/cas-de-mpox-en-france.-1er-janvier-26-novembre-2024

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