Outbreak Monkeypox in Europe

A number of patients have been diagnosed with monkeypox in the Netherlands so far. We are investigating other possible cases. An update on any further confirmed cases will follow on Wednesday.

 

Monkeypox is a viral infection that occurs mostly in West Africa and Central Africa. This zoonosis (a disease that can be transmitted to humans from animals) is largely found in rodents in Africa. The disease is usually mild in humans.

Monkeypox is different to impetigo (a skin infection caused by a bacterium that is common in the Netherlands). The name monkeypox is frequently used for impetigo on the islands of Aruba, Bonaire and Curaçao and in Suriname.

Outbreak in Europe

It was announced in May 2022 that a number of people in Europe had contracted the disease. What is striking is that a majority of these people had no obvious link to areas in Africa. This could mean that the virus has managed to spread to Europe. Furthermore, in most of the currently known cases the rash started around the anus and pubic region before spreading to the rest of the body.

Various people may have caught the disease through MSM contact (men who have sex with men). Health authorities are currently investigating how the virus is being spread and what risk groups will need to be alerted. The variant currently found in Europe is usually not particularly infectious, but there is still a significant lack of clarity on the way in which it has spread in the people who are now unwell with it.

Symptoms

The symptoms of monkeypox infection resemble those of smallpox infection, but the course of the disease is generally much milder. Initial symptoms often include:

  • fever
  • headache
  • muscle ache
  • swollen lymph nodes
  • chills
  • fatigue

One to three days later, you will get a rash that usually starts on the face and then appears on the rest of the body. This rash starts as spots that develop blisters. The blisters form scabs which eventually fall off the skin after two to three weeks.

Transmission

Most people become infected after contact with a person or animal infected with the virus. The virus can enter through your mucous membranes (e.g. in the mouth, nose, eyes) and open wounds (not necessarily visible wounds). The virus can also be spread through droplets from blisters or from the mouth and pharynx, though not through droplets floating around in the air.

Source and contact tracing

If someone tests positive for monkeypox, the Municipal Public Health Service (GGD) will start source and contact tracing. In the contact study, the GGD tries to determine where someone possibly became infected and with whom the patient has been in contact.

Isolation

If you test positive for monkeypox, you have to stay in isolation. You are not allowed to have contact with others until all symptoms have disappeared. In the case of monkeypox, this is when all the scabs have fallen off your skin.

Quarantine

High-risk contacts of infected people should go into quarantine. These include people you have had sex with, your family members, or others who have been in contact with your skin blisters. The GGD will determine for each situation when this is necessary, and will consult RIVM if necessary.

Vaccination

‘Smallpox’, caused by a very similar virus to the monkeypox virus, was eradicated by a successful vaccination campaign. The smallpox vaccine was one of those offered under the National Immunisation Programme, but was discontinued in the 1970s once smallpox had been eradicated.
The smallpox vaccine can be used during the first few days of a possible infection (post-exposure prophylaxis). The vaccine can also be used preventively in people who are at greater risk of infection.