Monkeypox

Monkeypox is an infectious disease caused by a virus that is transmitted from animals to humans, but which can also be transmitted from human to human. 

Since the 1970s, monkeypox has caused several outbreaks in West and Central Africa (endemic regions). Up until May 2022, reported cases in other continents were always limited and have always been associated with travel to affected areas. 
 

Transmission
Transmission occurs mainly through direct contact - with skin sores (red patches or pimples) or body fluids of a sick person - and through indirect contact (sheets, cloths, etc.). A person infected with the virus who has no symptoms can also be contagious.

See also: How is the virus transmitted?
 

Risky practices
Anyone can get monkeypox. However, close and prolonged contact is usually required to transmit the virus. It has been observed that the majority of infected people have had sexual activity with a large number of different, new and/or anonymous partners. 

See also : Risky practices
 

Symptoms
Infected people usually have flu-like symptoms (fever, swollen glands) and skin sores (red patches or spots). 

See also: What are the symptoms?
 

People at risk of complications
Pregnant women, young children, elderly people, people with a weakened immune system.

See also: People at risk of complications
 

Instructions in case of symptoms
Contact a doctor or health centre as soon as possible and follow their instructions. You may be ill and contagious: avoid spreading the disease to others. 

See also : What should I do if I have symptoms?

Instructions in case of a positive test
You must avoid spreading the disease to others. The Cantonal Doctor's Office will contact you: according to your symptoms and the position of your lesions and after assessing the risks, specific and adapted recommendations will be given to you, to be followed during the entire period of contagiousness

See also: What happens if I am tested positive for monkeypox?
 

Prevention
Avoid engaging in risky practices (multiple new and/or anonymous sexual partners).

See also: Prevention and treatment
 

Treatment
Most infections heal spontaneously, so there is usually no need for specific treatment and medication to treat fever and pain is sufficient if necessary. 

See also: Prevention and treatment
 

Vaccination
On 24^th August 2022, the Federal Council announced that it had ordered 40'000 doses of vaccine against monkeypox. While waiting to know the number of doses intended for the canton of Geneva, the Directorate General of Health is in the process of organising the vaccination campaign with its field partners, including the HUG and Checkpoint. 

See also: Vaccination

Situation (November 2022)

In Switzerland, the first case of monkeypox was detected in Bern on 21^st May 2022. On 4^th November, 546 cases were laboratory-confirmed in Switzerland (502 on 19^th September). At the same date, about 80'000 cases had been diagnosed in the non-endemic zones (about 62'000 on 19^th September).

Consult the FOPH data.

Monkeypox is usually a mild disease, but it is not without consequences. The disease is called mild because, in this outbreak, most people recover within a few weeks, without specific treatment and without hospitalisation. It is not benign, however, because more vulnerable people can develop a severe form of the disease, and because infected people can experience severe pain in their sores.

On 23 July 2022, Tedros Adhanom Ghebreyesus, Director-General of WHO, declared the global monkeypox epidemic a "public health emergency of international concern".

See also :

• Federal office of public health - FOPH
• European Centre for Disease Prevention and Control - ECDC
• Office fédéral de la sécurité alimentaire et des affaires vétérinaires - OSAV | for information about animals, including pets (website in French, German and Italian)

Transmission

The virus is transmitted by close and direct contact with an infected person via skin sores (vesicles, patches, wounds), body fluids (saliva, blood) or the mucous membranes of natural orifices.

To a lesser extent, transmission can take place :

• by indirect contact with contaminated objects, cloths, sheets
• and/or prolonged contact through respiratory secretions (spittles and micro droplets, for example by talking for a long time and in close proximity to a sick person).

The virus is present in the body's biological fluids such as saliva, blood and also in lesions. It can enter another person's body through small wounds in the skin (even if they are not visible), and mucous membranes (mouth, nose, eyes, anus, vagina, etc.). Research is underway to find out if monkeypox virus is also present in other body fluids such as breast milk, vaginal secretions or semen.

The more one has close contacts with different people, the greater the risk of being infected with the virus. Monkeypox is not considered a sexually transmitted disease. However, the act of sexual intercourse facilitates the transmission of the virus. For example, the majority of infected people have had a high level of sexual activity with a large number of new and/or anonymous partners.
 

Period of contagiousness

A person is contagious from the time of flu-like symptoms and before the appearance of skin sores (which usually appear 1 to 3 days after flu symptoms). He/she remains contagious until these sores disappear (see diagram below in French). In the current outbreak, one finds also 'asymptomatic' transmission: that is, a person who is ill may not show any symptoms and still be contagious.

As a precautionary measure, the UK health authorities recommend condom use for at least 8 weeks after infection. The World Health Organisation (WHO) even recommends condom use for 12 weeks after recovery. Scientific studies are underway to clarify this recommendation.  

Transmission

The risk for the population that does not engage in risky practices remains low. Nevertheless, health authorities must remain watchful and vigilant in the face of a new and extraordinary situation, where the number of cases is increasing and contaminations are occurring outside endemic areas and without any link to a return from travel.

People most at risk of being contaminated are those who engage in practices at risk, and therefore have close contact with a contagious person, for example :

• Extensive sexual activity with new and/or different and/or anonymous partners
• Skin-to-skin or skin-to-body fluid contact, or contact with the clothes, sheets or linens of a contagious person
• Health personnel in close contact with an infected person and without appropriate protective equipment 
• To a lesser extent, living together (in the same household) with an infected person.
   

Monkeypox is usually a mild disease, but it is not harmless. The disease is said to be mild because, in this outbreak, most patients recover within a few weeks, without specific treatment and without hospitalisation. However, monkeypox is not benign because infected people can experience severe pain in the lesions and because more vulnerable people can develop a severe form of the disease.

According to the knowledge available from previous outbreaks, the people at risk of developing a severe form of the disease are:

• pregnant women
• young children
• elderly persons*
• people with a weakened immune system.

* Elderly people, however, have a low risk of contracting monkeypox. In Switzerland, adults over 50 years of age were vaccinated against (human) smallpox in their childhood and up until 1972. This vaccine was also very effective against monkeypox.

There are several scenarios regarding symptoms and the timing of their onset and cessation. We describe the most common ones.

Symptoms of monkeypox usually appear between 5 and 21 days after exposure to the virus. A person is contagious as soon as symptoms appear. It has been observed in the current outbreak that some people do not develop symptoms. They can nonetheless also transmit the virus.

Flu-like symptoms

The following symptoms are described:

• Sudden outbreak of fever (over 38.5°C)
• Headaches
• A runny nose
• Coughing
• Sore throat
• Reduced sense of smell
• Aching and stiff muscles
• Swollen lymph nodes (mainly in the neck, but also under the armpits and in the groin)
• Muscle pain
• Back pain
• Extreme fatigue

This phase does not always occur. 

Skin sores

Flu-like symptoms are followed, after one to three days but sometimes longer, by skin sores or lesions:

• These may consist of red patches or pimples, usually with fluid inside and which are itchy.
• The sores usually appear first on the face and then on the rest of the body including the palms of the hands, soles of the feet and genitals; however, other cases have been described with solitary pimples (about one third of cases consist only of sores in the genital area).
• Some people may have only a few sores, others may have hundreds.
• These lesions can take between 2 and 4 weeks to disappear.
• The lesions contain the virus. You should therefore avoid touching them. You should wait until the lesions have dried, all the scabs have fallen off and new skin has formed to make sure you do not pass the disease on to others.

Monkeypox symptoms can sometimes be confused with those of other diseases, such as syphilis, herpes, shingles, or chickenpox. Only a health professional can make a proper diagnosis. If you notice any symptoms, contact a doctor.

If you have symptoms consistent with monkeypox :

• Contact a doctor (GP, hospital...) without delay who will establish the need to carry out or not a test. Report to the doctor any contact or exposure at risk so that he/she can determine whether any protective measures should be taken.
   
• While waiting for your doctor's counsel, avoid transmitting the disease to other people - that is to say avoid :
  • Leaving your home,
  • Meeting other people,
  • Going to places where there are many people and where you cannot keep your distance.
     
• In all cases:
  • Avoid sharing objects (sheets, linen, dishes)
  • If you have to go out or meet other people: put on a mask and cover the pimples.

Where to get tested?

All doctors and health centres in the canton of Geneva are authorised to carry out tests. If your doctor has recommended that you go to the HUG for a screening, it is best to call 022 372 33 11 to make an appointment.

Please do not wait to contact a health professional!
The symptoms of monkeypox can resemble those of other infections, namely syphilis and herpes. While the greatest risk with monkeypox is passing it on to someone else (as the majority of cases in the current epidemic have mild symptoms), other diseases can be more problematic and should be treated as soon as possible.

If your test is positive, a member of the cantonal doctor's office will contact you.

Individualised recommendations

Depending on your symptoms and the location of your sores and pimples, and after doing a risk assessment, specific and adapted recommendations will be given to you, to be applied during the whole period of contagion. The aim of these recommendations is to prevent you from passing on monkeypox to other people. For example, it may be necessary to:  

• Stay at home
• Stay in your room, depending on the configuration of your home
• Avoid meeting other people
• Avoid going to places where there are many people and where you cannot keep your distance
• Prefer working from home.

These measures will be discussed with you. They will be adapted to your situation. 

In any event, it is imperative to:

• Limit close contacts, including sexual relations; 
• Avoid sharing objects (sheets, clothes, kitchenware, etc.) 
• Wear a mask and cover your pimples if you go out or meet other people
• Avoid people at risk of complications (pregnant women, young children, elderly people, people with a weakened immune system).

End of period of contagion

The individualised recommendations given to you by the SMC must be followed during your period of contagiousness. You are no longer considered contagious when all sores have scabbed over, the scab has fallen off and a new layer of skin has formed over it (wound healing). This lasts, depending on the person, between 2 to 4 weeks.

At the end of the contagion period, a thorough cleaning of the home including surfaces, bedding, clothes and dishes must be carried out.
 

After the period of contagion

Research is underway to find out if the monkeypox virus is also present in other body fluids such as vaginal secretions or semen. As a precaution, the UK health authorities recommend condom use for at least 8 weeks after infection. The World Health Organisation (WHO) even recommends condom use for 12 weeks after recovery.

Contact tracing 

It is also important to identify the people to whom you could have transmitted the virus. 

People living in the same household as you, people with whom you had intimate relations in the days before the onset of symptoms and health professionals who may have had unprotected contact with you will receive a recommendation to watch for symptoms and avoid meeting people at risk of complications. If they develop symptoms, testing is required.

To ask questions or talk privately with trained staff about monkeypox: 

Most infections heal spontaneously. Therefore, there is usually no need for specific treatment, and, if needed, medication for fever, pain or itching is sufficient.

In rare cases and depending on the situation, antiviral or immunoglobulin treatment is prescribed by health professionals.

To date, the best method of prevention is the earliest possible detection of infected persons. The aim is to keep them from infecting other people, thereby breaking the chains of transmission. 

If you have been in contact with a person who has been confirmed as having monkeypox

• Ask the person who has tested positive for monkeypox to pass on your contact to the cantonal doctor's office (SMC), the health authority with which he/she is already in contact. The SMC will contact you with advice and you can ask any questions you may have about your individual situation. All the information collected is treated as strictly confidential.
• Or call the cantonal doctor's office (SMC) yourself at 022 546 55 27 to receive guidance and recommendations. 
• Watch out for any symptoms of monkeypox (flu-like symptoms and/or skin sores) and take your body temperature at least twice a day until the 21^st day after the last contact with the person who tested positive for monkeypox. If symptoms appear, contact a doctor and report this exposure to monkeypox.
• Avoid all contacts. You should adapt your behaviour to avoid transmitting the disease to others. For example, as a precautionary measure, you can be careful by: 
  • limiting your contacts to avoid infecting anyone, 
  • abstaining from sexual contact
  • avoiding physical contact with people at risk (children, elderly people, immunosuppressed people, pregnant women)
  • abstaining from sleeping in the same bed as another person
  • washing your hands regularly
  • avoiding to share objects (linen, sheets, kitchenware, etc.) or using the same bathroom as other people.

On 24^th August 2022, the Federal Council announced that it had ordered 40'000 doses of vaccine against monkeypox. On 14^th October 2022, the FOPH announced the imminent arrival of the vaccines in Switzerland; they will subsequently be delivered directly to the cantons by the Army's Pharmacy. While waiting to know the number of doses intended for the canton of Geneva, the Directorate General of Health is organising the vaccination campaign with its field partners, including the HUG and Checkpoint. 

Registration for vaccination started in Geneva on Thursday, September 15. Registration is still open (see steps below). As soon as the vaccine is available, registered persons will receive an SMS indicating the time and date of the first appointment.

Vaccination against monkeypox is one measure among others: it protects partially, but not 100%, and it is necessary to continue to be cautious. If you have any symptoms:

• get tested,
• cover the sores,
• avoid all intimate contact.
   

Purpose of monkeypox vaccination

• To reduce the risk of infection
• To reduce the severity of symptoms in the event of illness
• To protect vulnerable people (children, pregnant women and people who are at risk of serious complications if they are infected)

 
Usual vaccination scheme

Two doses of MVA-BN vaccine with a minimum of 28 days between the two doses.
 

Persons eligible for vaccination

According to the FOPH criteria, vaccination against monkeypox is recommended for people who have the highest probability of being infected with the monkeypox virus. These are:

• Multipartner men (men who have sex with men - MSM) and multipartner trans* people,
• People who may be at risk of exposure to the monkeypox virus for professional reasons and despite protective equipment (medical personnel, specialized laboratory personnel, etc.),
• people who have had risky contacts with people who are ill according to the FOPH criteria, but who have not yet developed the disease.

If you meet these criteria and would like to be vaccinated against monkeypox, we invite you to contact Checkpoint, Groupe Santé Genève or the dermatology department of the HUG. These facilities handle part of the registration process, and anyone who is interested and meets the above criteria may write directly either one of these addresses to request registration:

• vaccination.mkp@dialogai.org (Checkpoint) - (also a contact point for people from other cantons who would like to be vaccinated in Geneva)
• vaccination.monkeypox@groupesante.ch (Groupe Santé Genève)
• Dermatologie.Isp@hcuge.ch (HUG)

If you are not sure if you want to be vaccinated, if you are not sure if you are at risk or if you have any other questions, you can anonymously contact the SMC monkeypox hotline at 022 546 55 27.

Vaccination process

As soon as the vaccine is available, applicants will receive a text message with the appointment time and date for the first dose, as well as a number to call to change the appointment date if necessary. The text message does not mention the term "monkeypox."

Early registrants - the date of registration being the deciding factor - will be the first to be vaccinated.

Individuals will be greeted by trained staff to ensure a warm, non-judgmental welcome.

Patients must present themselves at the reception desk with a document confirming their identity (identity card, passport, driver's license, etc.). A residence permit and legal address are not required and will not be requested.

No screening will be performed at the vaccination center except for the usual contraindications to any vaccination procedure.

You will find further information related to monkeypox vaccination here: 

Factsheet - Monkeypox