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Monkeypox

In recent months, several outbreaks of the monkeypox virus have been reported in Belgium and other countries around the world. These are rare cases. But what exactly is monkeypox?

What is it?

Monkeypox is a disease that was discovered in monkeys in 1958. The first human case was recorded in 1970. 

It is a disease caused by infection with the monkeypox virus.

Despite being named monkeypox, the source of the disease remains unknown. However, (mostly) rodents and primates might carry the virus and infect people.

What are the symptoms?

Monkeypox can be spread from the time symptoms start.

The main symptoms are:

  • Pimples or blisters that turn into scabs
  • Fever
  • Swollen lymph nodes
  • Fatigue
  • Muscle aches
  • Headache
  • Rectal pain (if that area is affected) 
  • Other, more rare symptoms

Symptoms may appear after an incubation period of five to twenty-one days (usually six to thirteen days). A sick person is contagious from about 2 days before symptoms appear until the lesions are healed.

What health risks are involved?

Persons infected with the monkeypox virus will usually heal spontaneously. Symptoms last two to four weeks. Some cases can be more serious, especially for more vulnerable people (pregnant women, people who are immunosuppressed, the elderly, children, etc.).

How do you get infected with the monkeypox virus?

The virus can be spread from one person to another by:

  • prolonged contact with respiratory secretions (saliva droplets and aerosols)
  • close and direct contact with skin lesions (wounds, scabs), bodily fluids (blood, saliva, semen), or mucous membranes (mouth, anus, cavities that naturally produce mucous)
  • contact with contaminated items or bed linens

Sexual encounters are currently the most commonly reported mode of transmission.

How to reduce contamination risks?

  1. Avoid any contact with infected persons and items they touch.
  2. Wash and disinfect your hands regularly.

Note: Having multiple sexual partners increases your risk of infection.

What to do if you have symptoms?

First, contact your general practitioner. They will determine whether testing is necessary.

If you don't have a GP call 1710.

While waiting for your test result, stay at home and avoid any form of physical contact. This is necessary to protect others.

What to do if you have a confirmed infection?

If you have a confirmed infection, you must stay home until your skin lesions have completely healed and your scabs have fallen off. This phase usually lasts three weeks, sometimes four.

If you have a rash or other symptoms, stay in a separate room or area if possible, away from the people or animals you live with.

  • Avoid any contact with other persons, especially pregnant women, the elderly, children and immunosuppressed persons.
  • As scientists are not yet sure how long the virus remains in the body, it is recommended that condoms be used for a period of 12 weeks after the skin lesions have disappeared completely.
  • Wash your hands regularly, especially after touching skin lesions or any items, clothing, bed linens or surfaces that may have touched the lesions.
  • Dry your hands with disposable wipes or a clean towel.
  • Contact your general practitioner to get a medical certificate. If you don't have a GP, call 1710.

Which contacts pose a risk?

We distinguish between high-risk contacts and very high-risk contacts.

The following constitute very high-risk contacts:

  • Sexual partners
  • Persons with whom there was prolonged skin-to-skin contact while the patient had a rash
  • Healthcare workers who have been in contact with a patient in a particularly dangerous situation (e.g. When bodily fluids come into contact with the eyes, nose or mouth or in case of needle-stick injuries) without appropriate personal protective equipment Physicians and regional health authorities carry out the risk assessment jointly, on an individual basis.

The following constitute high-risk contacts:

  • Persons living in the same household as you or in a similar environment
  • Persons who have shared clothing, bed linens, kitchen utensils, etc. with the patient while they had a rash
  • Persons who care for the patient while they are experiencing symptoms
  • Caregivers who were in contact with a patient while not using appropriate personal protective equipment
  • Laboratory workers who have accidentally been exposed to a virus sample at work while not using personal protective equipment 
  • Fellow passengers who were one or two seats away from a symptomatic individual in an aeroplane, bus or train for a duration of three hours or more.

What must you do after a (very) high-risk contact?

For all high-risk and very high-risk contacts: 

  •  Check yourself regularly for symptoms (fever, headache, rash or other skin lesions, etc.) for a period of 21 days after your last contact with the infected person. If further contact with the infected person cannot be avoided, this period starts from the time of diagnosis and ends 21 days after the full recovery of the infected person. Do you have symptoms? In this case, contact your doctor, get tested and stay home until your test result is known.
  • Avoid any close contact for 21 days, but especially with young children, pregnant women and persons who are immunosuppressed. You must avoid all sexual contact.
  • Avoid contact with animals (especially rodents, such as squirrels, mice, rats, hamsters, guinea pigs, etc.).
  •  You must not donate blood, organs or bone marrow for at least 21 days after the last day of exposure.
  • In certain cases, you can still be vaccinated after exposure (see below). 

Additional measures for very high-risk contacts:

  • In addition to the above measures, very high-risk contacts are advised to wear a surgical mask during any contact with other persons. Very high-risk contacts who come into contact with young children (e.g. in a day nursery), pregnant women or immunosuppressed persons, must self-quarantine for 21 days.

What to do with pets?

If you are infected with the monkeypox virus, you must take the following precautions for pets:

  • Avoid contact between the pet and the infected person insofar as possible. If possible, have someone else look after your pet during your self-isolation.
  • Wash your hands before any contact with your pet and wear gloves and a disposable face mask.

What treatments are available?

For the time being, no specific treatments against monkeypox are available in Belgium. The available treatments are mainly aimed towards keeping the symptoms under control (pain, fever). As mentioned earlier, you must definitely stay at home until your skin lesions have healed completely and your scabs are gone. Contact your doctor in case of severe pain or discomfort.

Where can you get tested?

Most Brussels hospitals can currently test you for the monkeypox virus. Contact the hospital to find out which steps to take. General practitioners can also carry out tests if they have the necessary equipment. Get in touch with your physician for more information. If you don't have a GP, call 1710.

What about vaccination?

Currently, there is no specific vaccine for monkeypox in the EU/EEA. However, the smallpox vaccine provides cross-protection against monkeypox. 

You can get vaccinated in two cases. In both cases, you must fulfil certain conditions to be able to receive the vaccine.

  • First case: vaccination after exposure to the virus:
  1. All very high-risk contacts, within four days of exposure to the virus, to avoid infection
  2. Very high-risk contacts who are also at serious risk of infection (immunosuppressed persons, pregnant women), up to fourteen days after exposure, in order to limit the severity of a possible infection
  3. High-risk contacts with an increased risk of infection (immunosuppressed persons, pregnant women), preferably within four days of exposure and up to a maximum of fourteen days
  • Second case: preventive vaccination (before exposure to the virus):
  1. all men who have sex with multiple men;
  2. women on PrEP with frequently alternating sexual contact;
  3. male and transgender sex workers;
  4. people with severe immune disorders and a high risk of serious infection;
  5. laboratory personnel handling virus cultures;

The vaccinating physician decides whether or not vaccination is needed following an individual risk based on the above criteria.

The following persons are not eligible for vaccination with Imvanex/Jynneos:

  • Persons under 18 years of age. However, unauthorised vaccination of persons under 18 years of age is possible under strict conditions, after a benefit-risk assessment, after exposure to the virus, under the responsibility of the administering physician and of the regional health officer and with the consent of the parents and/or the child. Such vaccination has to comply with the Health Security Committee's recommendation 9720.
  • Persons who were vaccinated against smallpox as a child (born before 1976), unless they are immunocompromised.
  • Persons with symptoms of monkeypox or another serious illness which involves fever or acute infection.
  • Persons who have already had monkeypox.
  • Persons who are allergic to the vaccine or any of its components (especially benzonase, ciprofloxacin and gentamicin).
  • Persons with a history of severe chicken protein allergy.
  • Persons who were vaccinated with a non-compatible vaccine during the past two weeks (live (attenuated) vaccine, mRNA vaccine).

Vaccination guidelines will be regularly updated. Follow our website or social media to stay informed.

Where to get vaccinated?

In Brussels, you can currently get vaccinated at CHU Saint-Pierre, UZ Brussel, Cliniques universitaires Saint-Luc and Erasme. As a reminder, vaccination is only possible in certain specific cases (see above). A vaccination centre should open soon at Pachéco.

How to recognise skin lesions?

Evolution of skin lesions: 

variole_du_singe_-_exemples_de_lesions_cutanees.png

Source: UK Health Security Agency

Useful links

Sciensano - Monkeypox (Information for health care professionals and patients, recommendations for sample collection, request forms for lab analyses, etc.)