Monkeypox

Several European countries are currently reporting monkeypox infections. Cases have also been confirmed in Switzerland. The disease is transmitted through close contact and is usually mild. If you have symptoms, please consult a physician immediately.

Current situation and assessment

28 June 2022, 5pm	New	Total since 21 May 2022
Laboratory-confirmed cases in Switzerland	4	72

(Updates take place on working days)

We do not currently see a threat to the population. Presently the national and international epidemiological data suggest that outbreaks are limited. It has to be assumed that new cases will occur in Switzerland. For this reason we are calling on all healthcare actors for support in the early detection of cases and the isolation of infected people.

We are continuing to monitor the situation closely in coordination with the cantons, the European Centre for Disease Prevention and Control (ECDC) and the WHO, and will provide information on further developments here.

Global data: Monkeypox Data Explorer - Our World in Data

Top of page

Incidence of monkeypox

So far there have been isolated cases or relatively small outbreaks of monkeypox infection among humans in West and Central Africa. Up to spring 2022, outside West and Central Africa only isolated cases of monkeypox – primarily imported from Nigeria – were detected, for example in Israel (2018), Singapore (2019), the United States (2021) and the UK (2018 and latterly in 2022).

Top of page

Spread and course of the disease (epidemiology)

Since the beginning of May 2022, extraordinary clustering of monkeypox has for the first time been observed in various countries in Europe and North America and in Australia. Further cases have occurred in South America, Israel and the United Arab Emirates, and suspected cases have occurred in North Africa. Not all these cases are directly epidemiologically related; in other words, there are also cases where no infectious contact could be determined in retrospect. The virus spread from person to person, also via sexual contact. Only very few of those affected had previously been in a former risk area (West or Central Africa).

Since 21 May 2022 a number of cases have occurred in Switzerland.

Top of page

Pathogen and transmission

The monkeypox virus (a subspecies of orthopoxvirus) is seen as being moderately transmissible.

It is a zoonotic disease, meaning that the infection is normally transmitted from animals (in most cases rodents) to humans. This can happen via bites or close contact with infected animals and their secretions, and in rare cases also through the consumption of the insufficiently cooked flesh of infected animals.

The current outbreak mainly involves human-to-human transmission. Transmission can occur through close contact with an infected person via:

• skin and mucous membranes (for example eyes, nose, mouth or genitals),
• skin wounds (infected secretions or blood) or
• recently contaminated objects (such as bedclothes, towels, clothing, hygiene articles and door handles),
• respiratory secretions or large respiratory droplets.

At the moment it is not known for certain whether monkeypox can also spread via sperm or vaginal secretion. What is certain, however, is that the virus can be transmitted through direct contact with skin and mucous membranes, also during sexual activity.

The transmission routes in the current outbreak are currently being investigated scientifically.

Sexual contact with an infected person may increase the likelihood of human-to-human transmission. Men who have sex with men (MSM, but not exclusively MSM) currently seem to be at a higher risk of infection.

Additional information (in German and French): Affenpocken : Aids-Hilfe Schweiz.

Note: the disease can, in principle, be transmitted by all people in close contact.

People are contagious from the onset of symptoms until the end of the rash, in other words until the last skin crusts have fallen off (see Symptoms below). This can take about three weeks.

Top of page

Symptoms and clinical course of the disease

The symptoms of the disease are usually:

• severely swollen lymph nodes,
• fever ≥38.5°C,
• headache, muscle and back pain,
• shivering,
• exhaustion,
• after several days a rash with vesicles,
• then pustules and finally crusts (similar to smallpox).

The rash often begins on the face and then spreads to other parts of the body, including the palms of the hands, the soles of the feet and the genitals. In the current outbreak, in some cases the rash is limited to the genital region only. In 20 percent of cases, the rash is completely absent.

Photos: CDC - Clinical Recognition

As a rule the incubation period (the period between infection and the onset of the illness) is 5 to 21 days, sometimes more (source: WHO).

The course of the disease is generally mild. Most of those affected recover within a few weeks. People with immune deficiency, pregnant women, children and older adults seem to be at a higher risk of a severe course.

The (rare) complications of monkeypox can include secondary bacterial infection such as pneumonia, septicaemia, encephalitis or corneal inflammation of the eyes..

A distinction is made between two variants of the monkeypox virus: the Central African variant and the less severe West African variant. During the current outbreak, so far only the West African variant has been detected. With this variant the mortality rate without intensive care runs at around one per cent of cases. Note that This figure could be an overestimate. This is because surveillance in countries where this disease is consistently prevalent (endemic countries) is limited. This means that mild cases could be overlooked.

The extent to which asymptomatic infections (infections without any symptoms of illness at all) can occur is not currently known.

Photo: Skin rash in the early stage of monkeypox disease. Source: CDC's Public Health Image Library Media #2329

Difference compared with similar disease patterns

In monkeypox, all skin lesions are always at the same stage at the same time (vesicles, then pustules and finally crusts).
By contrast, in chickenpox (= varicella) the skin changes are always simultaneous at different stages (vesicles alongside pustules and crusts).

People with shingles (= herpes zoster), syphilis (= lues) and allergic reactions can sometimes present similar symptoms to monkeypox.

Prevention

While there is no specific vaccine against monkeypox at present, first- and second-generation smallpox vaccines provide effective protection. These were administered as part of the programme to eradicate smallpox – in Switzerland up until 1972.

For the immunisation of adults against smallpox a third-generation smallpox (MVA-BN/Imvanex®) has been authorised in Europe and the United States. This also provides good (around 85 per cent) protection against monkeypox. This vaccine is not currently authorised in Switzerland. In special situations there is the option of off-label use. In this case the doctor can also administer the therapy without authorisation.

Detailed information (German, French and Italian only): Richtlinien und Empfehlungen zu Impfungen und Prophylaxe page under “Allgemeine Empfehlungen”, Impfempfehlungen des BAG, welche einen Off-label Use beinhalten (PDF, 1 MB, 23.03.2015) (Bull BAG 2015; Nr. 13: 217-19)

Preventing further spread: most important measure and responsibilities

• Cantonal health authorities: responsible for contact tracing
• Doctors: must report a suspected case of monkeypox to the competent cantonal medical office within two hours.
• Each and every person: follow the recommendations if there are signs of the typical symptoms of the disease (see Recommendations section).

The person who has contracted the disease must go into isolation as quickly as possible. The competent authorities will identify, contact and inform everyone who had contact with the infected person during the course of the disease. Currently there is no compulsory quarantine for contacts. However, they must monitor their state of health closely and consult a doctor immediately in the event of typical symptoms.

See also:
You have tested positive for monkeypox
You have had contact with an infected person

Treatment

Treatment mainly addresses the symptoms (symptomatic treatment). In severe cases an antiviral therapy, tecovirimat, can be administered. Preparations containing this active ingredient are not currently authorised in Switzerland. In special situations there is the option of off-label use. In this case the doctor can also administer the therapy without authorisation.

Detailed information (German, French and Italian only): Richtlinien und Empfehlungen zu Impfungen und Prophylaxe page under “Allgemeine Empfehlungen”, Impfempfehlungen des BAG, welche einen Off-label Use beinhalten (PDF, 1 MB, 23.03.2015) (Bull BAG 2015; Nr. 13: 217-19)

Top of page

Recommendations if you have symptoms or are at a greater risk of infection

Do you have one or more of the symptoms mentioned above (see Symptoms and clinical course of the disease)?

• Contact a doctor immediately.
• Before going to the doctor: Please phone the health centre to tell them that you suspect you have a monkeypox infection.
• Avoid all close contact with other people (including sexual contact) until a monkeypox infection can be ruled out.
  You can find out what to do and look out for in the event of a confirmed monkeypox infection under You have tested positive for monkeypox.

Are you in a group that is at a higher risk of infection or have you returned from travelling in West or Central Africa? (See Pathogen and transmission)

• Monitor your state of health.
• Consult a doctor immediately if you experience symptoms.
• Proceed as described above.
  

Top of page

You have tested positive for monkeypox

• Isolate at home or – if you live with other people – in one room. Avoid contact with other people if possible. If this is not possible, wear a mask. Stay in isolation until the crusts over the skin wounds fall off and a new layer of skin forms.
• Ensure good hand hygiene; wash your hands regularly.
• Do not share bedclothes or towels with other people. Wash this laundry at at least 60 degrees Celsius. Do not share dishes, and wash them thoroughly with detergent (in the dishwasher if possible).
• After use, thoroughly clean or disinfect surfaces and other objects also used by other people.
• Skin wounds contain viruses, so if you have to leave home cover your skin wounds as well as possible with clothes and if possible do not touch them.
• Regularly disinfect your hands as well as the surfaces in your immediate environment.
• The disease can be transmitted between animals and people, so avoid contact with animals (including pets). The most frequently asked questions and answers on animal health in connection with monkeypox can be found on the Monitoring of zoonoses page (in German, French and Italian) (Federal Food Safety and Veterinary Office FSVO).
  
• If you absolutely have to leave home (for example to see a doctor), do not under any circumstances use public transport.
  

You have had contact with an infected person

• Measure your body temperature daily and check your state of health.
• If you have a temperature higher than 38.5 degrees Celsius, a skin rash or flu-like symptoms, phone a doctor. Tell the health centre that you have been in close contact with someone who has monkeypox.
• You should not have bodily or sexual contact with anyone for 21 days (or until monkeypox infection can be ruled out).
• For 21 days (or until monkeypox has been ruled out) avoid any contact with mammals, especially rodents.
  

Top of page

Frequently asked questions (FAQ)

What are monkeypox?

Monkeypox is caused by the monkeypox virus. It is a subspecies of the orthopox virus and is closely related to the cowpox virus as well as the smallpox virus (variola / smallpox), which has been eradicated by vaccination.

See also “Pathogen and transmission”

Why is the disease called monkeypox?

The monkeypox virus occurs primarily among various rodents in West and Central Africa. Various other animal species (including monkeys) and also humans are so-called “false hosts” for the virus. Since the disease was first detected in monkeys in 1958, it was given the name "monkeypox".

Where did monkeypox occur before the May 2022 outbreaks?

The monkeypox virus occasionally caused isolated cases in West and Central Africa, as well as smaller outbreaks in humans. Up to spring 2022, outside West and Central Africa only isolated cases of monkeypox – primarily imported from Nigeria – were detected, for example in Israel (2018), Singapore (2019), the United States (2021) and the UK (2018 and latterly in 2022).

Further information can be found under “Epidemiology”

What has changed in May 2022?

Since the beginning of May 2022, extraordinary clustering of monkeypox, with several hundred cases, has for the first time been observed in several European countries as well as in North America and other continents outside Africa. Not all cases are directly epidemiologically related; in other words, there have also been cases where no infectious contact could be determined in retrospect. The virus spread from person to person, also via sexual contact. Very few of those affected had been in a former risk area (West or Central Africa) prior to contracting the disease.

Since 21 May 2022 a number of cases have occurred in Switzerland.

Further information can be found under “Current situation and assessment”

How is monkeypox transmitted?

Answers to this question can be found under “Pathogen and transmission”

Who is currently at a greater risk of infection? And what do you have to be aware of in this case?

It seems that currently especially (but not exclusively) men who have sex with men (MSM) have an increased risk of infection. Or people who have travelled back from West and Central Africa. Do you belong to one of these groups?

Then monitor your state of health daily. If you have the typical symptoms of the disease, please contact a medical professional and follow the behavioural recommendations.

Before visiting your doctor: Please inform the health facility by phone about your suspected monkeypox infection

Can animals and pets also be infected with monkeypox?

Yes. In close contact, including skin lesions or mucous membrane secretions, monkeypox viruses can be transmitted from humans to animals and vice versa.

People infected with monkeypox should stay away from their cats, rodents and/or other (domestic and wild) mammals during their illness (i.e. until the last skin crusts have fallen off).

The most frequently asked questions and answers on animal health in connection with monkeypox can be found on the Monitoring of zoonoses page (in German, French and Italian) (Federal Food Safety and Veterinary Office FSVO).

How long are affected persons contagious?

You are contagious from the appearance of the first symptoms until the end of the rash, i.e. until the last skin crusts have fallen off. This can be up to three weeks.

See also “Pathogen and transmission” and “Symptoms”

What are the symptoms?

Answers to this question can be found under “Symptoms and clinical course of disease”

What should people do if they notice signs/symptoms of illness?

Answers to this question can be found under "Recommendations" and "You have tested positive for monkeypox".

What is the clinical course of the disease?

Answers to this question can be found under “Symptoms and clinical course of disease”

Is there a vaccine?

Answers to this question can be found under “Prevention”

How can we prevent the spread of monkeypox?

Answers to this question can be found under “Prevention”

What are the treatment options?

Answers to this question can be found under “Prevention”

What is the current picture and how do we estimate the situation?

Answers to this question can be found under “Current situation and assessment”

Top of page

Last modification 28.06.2022