sharon sanders
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Epidemiological update: Monkeypox multi-country outbreak
Epidemiological update
31 May 2022
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This report presents an update of monkeypox confirmed cases in the European Union/European Economic Area (EU/EEA) and worldwide.
Summary of Epidemiological update as of 31 May [1]:
Since the last update on 25 May 2022:
Monkeypox (MPX) is a zoonotic disease and is currently the most prevalent orthopoxviral infection in humans after the eradication of smallpox and the cessation of universal smallpox vaccination. In endemic areas, monkeypox virus (MPXV) probably circulates among a number of mammals, although there is no known reservoir. Occasional spill-over events to humans generate outbreaks. MPXV is transmitted to humans through bite or direct contact with an infected animal’s blood, meat, bodily fluids, or cutaneous/mucosal lesions.
This report presents an update of MPX confirmed cases in the European Union/European Economic Area (EU/EEA) and worldwide. Cases detected in the EU/EEA have been reported according to the ECDC case definition (Figure 3, page 6) and are obtained through screening of official websites. Cases reported from outside the EU/EEA are collected through screening of official websites and media sources.
EU/EEA update
As of 31 May, a total of 321 cases have been confirmed from 17 EU/EEA Member States (Table 1, Figure 2). Most cases are in young men, self-identifying as MSM. There have been no deaths. The clinical presentation is generally described to be mild, with most cases presenting with lesions on the genitalia or peri-genital area, indicating that transmission likely occurred by close physical contact during sexual activities. Multiple countries have reported cases which appear to be linked to events taking place in Spain (Madrid and the Canary Islands) and Belgium (Antwerp). However, many countries also report cases with no known epidemiological link to travel abroad, contact with other cases, animals or attendance to specific events.
Table 1. Number of confirmed cases by country, EU/EEA, as of 31 May 2022 [2]
Figure 2. Geographical distribution of confirmed cases of MPX in EU/EEA countries, as of 31 May 2022
Worldwide update
As of 31 May 2022, a total of 236 cases have been confirmed in non-endemic European countries outside the EU/EEA as well as in the Americas, Australia, and Asia. Cases were reported in Argentina (2), Australia (2), Canada (26), Israel (2), Mexico (1), Switzerland (4), Thailand (1)*, United Arab Emirates (4), the United Kingdom (179), and the United States (15). Most of the cases outside the UK, Canada and US are reported to be linked to travel. However, cases with no known travel history, contact with other cases, animals or specific events are also reported.
Figure 1. Geographical distribution of confirmed cases confirmed cases of MPX worldwide, as of 31 May 2022
ECDC actions
ECDC is monitoring this event through epidemic intelligence activities and reports relevant news on an ad-hoc basis. A news item was published on 19 May and the latest epidemiological update was posted on 25 May. Multi-lateral meetings between affected countries, WHO EURO and ECDC have taken place to share information and coordinate response. A process in EpiPulse has been created to allow countries to share information with one another, WHO, and ECDC. A rapid risk assessment "Monkeypox Multi-country outbreak" was published on 23 May. Reporting in the European Surveillance System (TESSy) is being implemented in collaboration with WHO-Euro from 2 June.
In addition, ECDC is offering laboratory support to Member States and collaborating with stakeholders on risk communication activities such as targeted messaging for the general public and for MSM communities and providing guidance to countries hosting events in the summer. ECDC is also providing guidance on clinical sample storage and transport, case and contact management and contact tracing, IPC guidance, cleaning and disinfection in healthcare settings and households and vaccination approaches.
Case definition
Confirmed case
A person with a laboratory-confirmed monkeypox infection (1) monkeypox virus specific PCR assay positive result or (2) orthopoxvirus-specific PCR assay positive result which is then confirmed by nucleotide sequence determination of the detected virus as MPXV) with symptom onset since 1st March 2022.
Probable case
(1) A person with an unexplained rash* on any part of their body
AND one or more other symptom(s) of monkeypox infection** with symptom onset since 1st March 2022
AND one of the following:
(2) A person with an unexplained generalised or localised maculopapular or vesiculopustular rash with centrifugal spread, with lesions showing umbilication or scabbing, lymphadenopathy and one or more other MPX-compatible symptoms***
[1] Cut off for data collection: 31 May 09:30. Data presented in this update are compiled from official sources or, if not available, from public sources quoting national authorities. An asterisk (*) indicates that latest data were collected through media.
[2] Data presented in this update are compiled from official sources or, if not available, from public sources quoting national authorities. An asterisk (*) indicates that latest data were collected through media.
*Since EU/EEA countries are just starting to identify cases and if testing capacity is sufficient, the above more sensitive case definition can be used. In countries with limited testing capacity for orthopoxviruses, the following description can be added to characterise the rash: ‘unexplained localised or generalised maculopapular or vesiculopustular rash potentially with umbilication or scabbing’.
**Fever (usually higher >38.5°C), headache, back ache, fatigue, lymphadenopathy (localised or generalised).
zhttps://www.ecdc.europa.eu/en/news-events/epidemiological-update-monkeypox-multi-country-outbreak-0
Epidemiological update
31 May 2022
TwitterFacebookLinked InMail
This report presents an update of monkeypox confirmed cases in the European Union/European Economic Area (EU/EEA) and worldwide.
Summary of Epidemiological update as of 31 May [1]:
Since the last update on 25 May 2022:
- 202 confirmed cases of monkeypox have been reported in EU/EEA Member States. Cases have been reported from Spain (69)*Portugal (59), Netherlands (20), Germany (16), France (12), Italy (9), Belgium (6), Czech Republic (4), Ireland (2)*, Sweden (2), Finland (1), Malta (1), Slovenia (1).
- 136 confirmed cases have been reported outside of the EU/EEA. Cases have been reported from the United Kingdom (108)*, Canada (11), the United States of America (7), United Arab Emirates (3), Argentina (2), Switzerland (2), Israel (1) and Thailand (1)*.
- A total of 321 cases have been confirmed in the EU/EEA.
- A total of 557 cases have been confirmed worldwide (including EU/EEA).
Monkeypox (MPX) is a zoonotic disease and is currently the most prevalent orthopoxviral infection in humans after the eradication of smallpox and the cessation of universal smallpox vaccination. In endemic areas, monkeypox virus (MPXV) probably circulates among a number of mammals, although there is no known reservoir. Occasional spill-over events to humans generate outbreaks. MPXV is transmitted to humans through bite or direct contact with an infected animal’s blood, meat, bodily fluids, or cutaneous/mucosal lesions.
This report presents an update of MPX confirmed cases in the European Union/European Economic Area (EU/EEA) and worldwide. Cases detected in the EU/EEA have been reported according to the ECDC case definition (Figure 3, page 6) and are obtained through screening of official websites. Cases reported from outside the EU/EEA are collected through screening of official websites and media sources.
EU/EEA update
As of 31 May, a total of 321 cases have been confirmed from 17 EU/EEA Member States (Table 1, Figure 2). Most cases are in young men, self-identifying as MSM. There have been no deaths. The clinical presentation is generally described to be mild, with most cases presenting with lesions on the genitalia or peri-genital area, indicating that transmission likely occurred by close physical contact during sexual activities. Multiple countries have reported cases which appear to be linked to events taking place in Spain (Madrid and the Canary Islands) and Belgium (Antwerp). However, many countries also report cases with no known epidemiological link to travel abroad, contact with other cases, animals or attendance to specific events.
Table 1. Number of confirmed cases by country, EU/EEA, as of 31 May 2022 [2]
| Austria | 1 |
| Belgium | 10 |
| Czech Republic | 5 |
| Denmark | 2 |
| Finland | 1 |
| France | 17 |
| Germany | 21 |
| Ireland* | 2 |
| Italy | 14 |
| Malta | 1 |
| the Netherlands | 26 |
| Portugal | 96 |
| Slovenia | 2 |
| Spain* | 120 |
| Sweden | 3 |
| Total | 321 |
As of 31 May 2022, a total of 236 cases have been confirmed in non-endemic European countries outside the EU/EEA as well as in the Americas, Australia, and Asia. Cases were reported in Argentina (2), Australia (2), Canada (26), Israel (2), Mexico (1), Switzerland (4), Thailand (1)*, United Arab Emirates (4), the United Kingdom (179), and the United States (15). Most of the cases outside the UK, Canada and US are reported to be linked to travel. However, cases with no known travel history, contact with other cases, animals or specific events are also reported.
Figure 1. Geographical distribution of confirmed cases confirmed cases of MPX worldwide, as of 31 May 2022
ECDC is monitoring this event through epidemic intelligence activities and reports relevant news on an ad-hoc basis. A news item was published on 19 May and the latest epidemiological update was posted on 25 May. Multi-lateral meetings between affected countries, WHO EURO and ECDC have taken place to share information and coordinate response. A process in EpiPulse has been created to allow countries to share information with one another, WHO, and ECDC. A rapid risk assessment "Monkeypox Multi-country outbreak" was published on 23 May. Reporting in the European Surveillance System (TESSy) is being implemented in collaboration with WHO-Euro from 2 June.
In addition, ECDC is offering laboratory support to Member States and collaborating with stakeholders on risk communication activities such as targeted messaging for the general public and for MSM communities and providing guidance to countries hosting events in the summer. ECDC is also providing guidance on clinical sample storage and transport, case and contact management and contact tracing, IPC guidance, cleaning and disinfection in healthcare settings and households and vaccination approaches.
Case definition
Confirmed case
A person with a laboratory-confirmed monkeypox infection (1) monkeypox virus specific PCR assay positive result or (2) orthopoxvirus-specific PCR assay positive result which is then confirmed by nucleotide sequence determination of the detected virus as MPXV) with symptom onset since 1st March 2022.
Probable case
(1) A person with an unexplained rash* on any part of their body
AND one or more other symptom(s) of monkeypox infection** with symptom onset since 1st March 2022
AND one of the following:
- has a positive laboratory test result on orthopoxviral infection (e.g., orthopoxvirus-specific positive PCR without sequencing, electron microscopy, serology);
- has an epidemiological link to a confirmed or probable case of monkeypox in the 21 days before symptom onset;
- reports travel to MPX endemic countries in the 21 days before symptom onset;
- is a person (of any sexual orientation) who had multiple or anonymous sexual partners in the 21 days before symptom onset;
- is a man who has sex with men.
(2) A person with an unexplained generalised or localised maculopapular or vesiculopustular rash with centrifugal spread, with lesions showing umbilication or scabbing, lymphadenopathy and one or more other MPX-compatible symptoms***
[1] Cut off for data collection: 31 May 09:30. Data presented in this update are compiled from official sources or, if not available, from public sources quoting national authorities. An asterisk (*) indicates that latest data were collected through media.
[2] Data presented in this update are compiled from official sources or, if not available, from public sources quoting national authorities. An asterisk (*) indicates that latest data were collected through media.
*Since EU/EEA countries are just starting to identify cases and if testing capacity is sufficient, the above more sensitive case definition can be used. In countries with limited testing capacity for orthopoxviruses, the following description can be added to characterise the rash: ‘unexplained localised or generalised maculopapular or vesiculopustular rash potentially with umbilication or scabbing’.
**Fever (usually higher >38.5°C), headache, back ache, fatigue, lymphadenopathy (localised or generalised).
zhttps://www.ecdc.europa.eu/en/news-events/epidemiological-update-monkeypox-multi-country-outbreak-0