In the beginning of May 2022, one case of monkeypox was detected in England, which had occurred after travel to Nigeria. In the course of this, 6 further cases of monkeypox were diagnosed in England in people with no previous travel and no contact with known travel-associated cases. These are two cases in one family and four cases in men who have sex with men (MSM). The latter apparently got infected in London. Apart from the family and two of the MSM cases, there are no known links between the cases. Further 2 cases have been reported in the meantime. Investigations into the sources of infection and other suspected cases are in progress.
Additional cases are reported by GeoSentinel and various media reports from the following countries:
Description: Monkeypox is a zoonosis caused by an orthopoxvirus, a DNA virus genetically related to the variola and vaccinia viruses. Monkeypox is endemic in West and Central Africa. Increased cases have been recorded in Nigeria since September 2017, and imports by returning travellers to England and the USA have also been recorded more frequently in recent years. There are two types of monkeypox virus: the West African type and the Central African type (Congo Basin).
Transmission: Monkeypox is transmitted from infected animals by a bite or by direct contact with blood, body fluids or lesions of the infected animal. It can be transmitted via abrasions in the mouth to people who eat infected animals. It can also be transmitted from person to person via the respiratory tract, through direct contact with body fluids of an infected person or with virus-contaminated objects. The incubation period is 5-21 days, usually about 7 to 17 days.
Symptoms: Symptoms of monkeypox include fever, headache, muscle aches, swollen lymph nodes and chills. 1- 3 days after the onset of symptoms, a rash develops that may look like chickenpox or syphilis and spreads from the face to other parts of the body, including the genitals. The disease is usually mild. In immunocompromised individuals, the disease can be severe. The mortality rate is about 1% for the West African type and up to 10% for the Central African type.
For further details, see WHO factsheet, ECDC and CDC.
Further cases must be expected. Persons showing symptoms as described above should contact a doctor, ideally in advance by telephone. Persons who have several sexual partners or practice casual sex should be particularly vigilant!
Prevention: Good personal hygiene, avoid contact with infected persons and animals at all costs. During stays in West and Central Africa: No consumption of bushmeat. The individual risk of contact with a patient with monkeypox depends on the type and duration of contact. In the case of very close contact with a case (e.g. family members, aeroplane neighbours, medical personnel), the risk of infection has so far been classified as moderate; in the case of sexual / intimate contact, it is probably high.
In case of corresponding clinic, persons without travel history should also be isolated, tested and reported for monkeypox.
MANDATORY REPORTING: In Switzerland, every suspected case must be reported within 2 hours to the respective cantonal doctor and to the FOPH (Tel. +41 58 463 87 06) ! Special laboratories, such as the Spiez Laboratory or the Reference Laboratory for Imported Viral Diseases (HUG) or the ZBS1 at the Robert Koch Institute (RKI; consiliary laboratory for smallpox), offer molecular diagnostics for identifying monkeypox infections (material: crust or vesicular fluid).
A vaccine against smallpox, including monkeypox, is licensed in Europe (Imvanex®). This is available in Zurich at the Centre for Travel Medicine of the University of Zurich. It is a "3rd generation smallpox vaccine" with a live-attenuated vaccine virus (modified vaccinia virus Ankara; MVA-BN), but which has become replication-incompetent after many passages. Two vaccine doses s.c. at an interval of 28d are indicated for laboratory personnel on a pre-exposure basis. Indication for post-exposure vaccination must be discussed with a specialist.
Geosentinel asks to report confirmed and suspected cases at: geosennel@geosentinel.org
Source image: NCDC
WHO 18.5.2022, RKI 19.5.2022, UK GOV, 16.5.2022, Outbreak News Today, 18.5.2022, CDC, Labor Spiez
Protect yourself against ticks during outdoor activities (see factsheet mosquito and tick bite protection). Vaccination against TBE is recommended for (planned) stays in endemic areas (CH: throughout Switzerland except cantons of Geneva and Ticino).
After recreational activities: Always examine your body for ticks or tick bites. If redness appears at least 3 days (7-10 days on average) after tick bite: consult a physician to rule out erythema migrans (Lyme disease), which would require antibiotic treatment.
Over 120 cases of salmonella have been reported since 2019 in Germany (68 cases), Sweden (37 cases), Norway (5 cases), Denmark (9 cases), and the Netherlands (2 cases). Cases have also been reported in the United States and Canada. The salmonella outbreak is linked to sesame products (tahini and halva) imported from Syria. Fourteen batches have tested positive for one or more of the Salmonella-outbreak strains. Tahini is a paste made from raw sesame seeds. Halva is a confectionery product that contains a high percentage of sesame seeds.
The recurrent occurrence of cases and the repeated discovery of positive samples since 2019 indicate that contaminated sesame-based products have been circulating in the EU market for more than two years.
Consequences for travelers
Considering the limited information on the production and distribution of the sesame products from Syria, there is still a risk of new salmonella infections in the EU/European Economic Area. Caution should be shown when consuming these products (tahini, halva).
References
All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.
All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.
Travellers should be immune to chickenpox. Persons between 11 and 40 years of age who have not had chickenpox should be vaccinated (2 doses with minimum interval of 4-6 weeks).
EKRM_Factsheet_Layperson_DE_TBE.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
There is a risk of arthropod-borne diseases other than malaria, dengue, chikungunya or zika in sub-/tropical regions, and some areas of Southern Europe. These include the following diseases [and their vectors]:
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
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