Monkeypox

1. Overview

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.

To date, monkeypox has caused several outbreaks in West and Central Africa (endemic regions). Previously reported cases in other continents have always been associated with travel to the affected areas. 

In Switzerland, the first case of monkeypox was detected in Bern on 21 May 2022. By 2 July 2022, 115 cases had been laboratory confirmed in Switzerland. By 4 July, approximately 6,200 cases had been diagnosed in about 50 countries that are not usually endemic for this disease, the majority of which are in Europe.

In Geneva, 31 cases have been reported to date.

Although the situation is not alarming, it needs to be closely monitored to limit spread of disease among the population.

The virus was named "Monkeypox" in 1958 in Denmark. At that time the virus was still unknown and had only been diagnosed in monkeys. Current knowledge shows that the virus infects various animal species and not mainly monkeys (for example, rodents play an important role in transmission). The disease was first diagnosed in humans in 1970 in the Democratic Republic of Congo.

 

Since its discovery in humans, outbreaks have been rare, with very few patients. For this reason, scientists currently do not have all the answers regarding this virus.

See also 
Pages updated regularly according to the latest findings of scientific research.

2. Transmission of monkeypox virus

The virus is transmitted by large respiratory droplets or by contact with infected body fluids.

For example, you can become ill  by: 

  • Talking to a sick person for a long time and in close proximity
  • Direct contact with skin sores or injuries
  • Contact with material that has been contaminated by skin sores (e.g. sheets).

As with all viruses, the closer the contact with different people, the greater the risk of being infected by the virus.

The virus is present in the body's biological fluids such as saliva, blood and also in skin sores or lesions. It can enter another person's body through small skin injuries (even if not visible), and mucous membranes (mouth, nose, eyes, anus, vagina, etc.).

Research is underway to find out whether the monkeypox virus is also present in other body fluids such as breast milk, vaginal secretions or semen.

Monkeypox is not considered a sexually transmitted disease. However, the act of sexual intercourse facilitates the transmission of the virus: as the disease is transmitted through prolonged contact with a contagious person, the higher the number of sexual partners, the greater the risk of catching the disease.

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). 

As a precautionary measure, the UK health authorities and the World Health Organisation (WHO) recommend the use of condoms for several weeks after infection and until the possibility of sexual transmission is definitively ruled out by scientific studies.

To date, the vast majority of recently reported cases have had a favourable course with remission of symptoms.

 

Many cases of monkeypox have been reported in communities of men who have sex with men. What is the situation?

During this outbreak, several cases of monkeypox were detected in people who have sex with men (MSM) who were involved in events that put them at risk of contracting the disease (multiple sexual partners). It is important to understand that the risk of monkeypox is not limited to MSM. Anyone who is in close contact with a contagious person is at risk. The assumption is that people who have multiple sexual partners multiply the risk situations and thus the likelihood of contracting the disease. In addition, as the World Health Organisation (WHO) points out, the overrepresentation of people who have sex with men among those diagnosed with monkeypox may also be explained by the positive health-seeking behaviour in this community (i.e. they are aware of health issues, know how to recognise symptoms and have the reflex to seek medical advice if in doubt). Monkeypox rashes can resemble some sexually transmitted diseases, such as herpes or syphilis, which may explain why these cases are detected in sexual health clinics. Currently, there are several signals that there may be under-detection of cases and a silent circulation of the virus. It is likely that the more we learn about monkeypox, the more we will be able to identify cases in the wider community. Stigmatising people because of a disease is never acceptable. Anyone can contract or transmit monkeypox, regardless of their sexuality.

3. People at risk

The risk to the general population is considered to be low. Nevertheless, the health authorities need to be attentive 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 being related to returning from a trip abroad.

People most at risk of infection

The people most at risk of infection are those who have close contact with an infectious person, for example :

  • Health workers in close contact with a symptomatic person if they are not wearing appropriate protective equipment
  • People living in the same household as a person with symptoms
  • Sexual partners of a person with symptoms
  • People who have skin-to-skin or skin-to-body fluid contact or contact with the clothes, sheets, towels of an infected person.

People at risk of complications

The disease is usually mild. Most patients recover within a few weeks.

Based on knowledge from previous outbreaks, 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.

4. Monkeypox symptoms

Monkeypox symptoms usually appear between 5 and 21 days, after exposure to the virus.

Flu-like symptoms

The following symptoms are described:

  • Sudden outbreak of fever (over 38.5°C)
  • Headaches
  • 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.

Complications rarely occur.

 

5. What to do in case of symptoms

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 screening of the virus. 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, isolate yourself from other people, i.e. stay in your home, stay in your room if the home is shared, avoid meeting other people and avoid sharing objects. If you have to go out to the doctor or meet other people: put on a mask and cover the pimples.

6. Positive test for monkeypox

  1. If your smear test confirms the presence of monkeypox, you should remain in isolation until you are no longer contagious. 

    A person is no longer contagious once the skin sores have scabbed over, the scab has fallen off and a new layer of skin has formed underneath. This takes 2 to 4 weeks. The isolation period is therefore of 2 to 4 weeks. If your condition allows it, your isolation should take place at home.
     
  2. The cantonal doctor's office will contact you to draw a list of people with whom you have been in contact. 

    All the information gathered will remain confidential. People living in the same household as you, people with whom you have had close contact in the days before the onset of symptoms and health professionals who may have been in unprotected contact with you will be given a recommendation for self-monitoring. They will not be quarantined. If they develop symptoms, testing will be necessary.

7. Prevention and treatment

To date, the only method of prevention is early detection of infected persons 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.
     
  • 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 21st day after the last contact with the person who tested positive for monkeypox.
     
  • Avoid all contacts. You are not formally quarantined, but for 21 days and as a precautionary measure, you should 
    • limit your contacts to avoid infecting anyone, 
    • abstain from sexual contact
    • avoid physical contact with people at risk (children, elderly people, immunosuppressed people, pregnant women)
    • abstain from sleeping in the same bed as another person
    • and wash your hands regularly.

The human smallpox vaccine that has been used in Switzerland in the past provides 85% protection against monkeypox. Since human smallpox has been eradicated, its vaccine is currently not available in Switzerland. It is also not yet clear to what extent current vaccines available in other countries could be useful against monkeypox. Research is ongoing

Most infections heal by themselves, so there is usually no need for specific treatment. Medication for fever and pain should be sufficient if necessary.