Mpox (Monkeypox)

Currently, an accumulation of mpox infections is observed in Europe and North America. Mpox is a viral infectious disease caused by an orthopox virus. In humans, the clinical picture bears some resemblance to smallpox (variola), although mpox is generally milder.
You will find further information on the situation and current assessment on the the website of the federal office of public health (FOPH):

*as of 21.07.2022

Mpox is a notifiable disease. As of 20.07.2022, confirmed cases must be reported to the cantonal medical service within 24 hours using the "Form for clinical findings of mpox". Suspected cases no longer have to be reported.

The notification to the cantonal medical service is made via the following contact:

• via email to epi-bs@hin.ch
• for further queries call 061 267 07 96; Mo-Fri from 8a.m to 5p.m.

Procedure in case of suspected mpox:

• The attending physician recommends that the patient isolates himself or herself at home and avoid close contact to other people until the laboratory results are known.
• Laboratory diagnosis by PCR from smear or biopsy of skin efflorescences- samples must be sent to the National Reference Center for Emerging Viral Infections (see CRIVE for forms).
  • Important: Before sending the samples, the laboratory should be informed by telephone
  • Contact number 079 55 30 922 (24 hours a day)
  • Suspected case: shipment in category B UN 3373 (triple packed)
  • Confirmed case: shipment in category A UN 2814
• Reporting to the cantonal medical service within 24h after confirmation of infection (form Notification of clinical findings monkeypox).
• Postive results from foreign persons are transmitted by the cantonal medical servie to the FOPH for onward transmission to the relevant countries.

After receiving the positive laboratory result the cantonal medical service contacts the patient, identifies risk contacts and provides information on further hygiene and isolation recommendations.

Laboratory Reporting

• This is done by the analyzing laboratory.
• Positive findings should be reported by the analyzing laboratory to the cantonal medical service and the FOPH within 24 hours.

Detailed information on the procedure and reporting can be found here:

*As of 06.07.2022

For the current outbreak the FOPH has created the following case definitions (adjustments may still follow):

Suspected case:

A suspected case is a person of any age and sexual orientation who has or had one or more of the following common symptoms that cannot be explained by differential diagnosis:

• Acute rash or single lesion (vesicles, then pustules and finally crusts, similar to smallpox)
• Headache
• Acute onset of fever (>38.5 C)
• Lymphadenopathy (swollen lymph nodes)
• Myalgia (muscle and body pain)
• Back pain
• Asthenia (pronounced weakness)
• Proctitis (inflammation of the mucous membrane of the rectum)
• Balanitis (inflammation of the glans penis)

=> It is not necessary to obtain negative laboratory results for the listed common causes* of rashes to classify a case as a suspected case.

=> Mpox infection may also occur concurrently with a differential diagnosis:

*Varicella zoster, herpes zoster, measles, Zika, dengue, chikungunya, herpes simplex, bacterial skin infections, disseminated gonococcal infection, primary or secondary syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, molluscum contagiosum, allergic reaction (e.g., to plants), and any other locally relevant common causes of papular or vesicular rash.

A case is all the more likely if one or more of the following conditions are met:

• An epidemiologic link to a suspected or confirmed case of mpox in the 21 days preceding the onset of symptoms.
• Close and prolonged physical contact in the last 21 days before symptom onset, especially with different and/or anonymous sexual partners.
• Direct close physical contact in the last 21 days before symptom onset with a man who has sex with men.
• Participation in events with direct close physical contact (especially skin and mucous membrane contact).

Confirmed case:

• A case in which laboratory detection of mpox virus has been confirmed by PCR testing.

Case definitions are dynamic and may be adjusted:

Therefore, for up-to-date information, please refer to the WHO website

Mpox occasionally causes outbreaks on the African continent. The infectious disease is transmitted from animals (probably rodents) to humans (zoonosis). Since the beginning of May 2022, a cluster of mpox-cases among humans has been detected for the first time in several countries in Europe and also in North America. Transmission probably occurred from human to human and not all affected persons have a travel history in a risk area (West and Central Africa).

The mpox virus infects various rodent species as hosts, and also monkeys and humans as false hosts. Animal-to-human transmission can occur, for example, through a bite by an infected animal, through eating undercooked meat, or through close contact with such animals.
In the current outbreak, human-to-human transmission is the primary concern. In this case, transmission can occur through close contact of an infected person via:

• Skin and mucous membranes (for example, eye, nose, mouth, genitals).
• Skin injuries (infected secretion or blood)
• Recently contaminated items (for example, bedding, towels, clothing, hygiene items, door handles)
• Respiratory secretions or large respiratory droplets

Sexual contact with an infected person can increase the likelihood of person-to-person transmission. It appears that currently, men who have sex with men (MSM) in particular (but not exclusively) are at increased risk of infection.It is currently not certain whether mpox can also be spread by semen or vaginal secretions. However, it is certain that the virus can be transmitted through direct skin and mucosal contact, including during sexual activity. The transmission routes in the current outbreak are being scientifically investigated.
 

Symptoms include fever, headache, muscle and back pain, swollen lymph nodes, chills and fatigue. Typically, a rash develops with vesicles or pustules (similar to smallpox). The time from infection to onset of illness is usually between 5 and 21 days.

The course of the disease is usually mild. Most affected individuals recover within a few weeks. Immunocompromised individuals, as well as infants, children, young adults, pregnant women, and people of advanced age, appear to be at higher risk for a severe course.

It is important to be aware that cases of mpox look similar to some sexually transmitted infections, such as herpes, and can be confused with other diagnoses. 

Treatment is mainly symptomatic. In severe cases, antiviral therapy (Tecovirimat) may be administered after expert advice.

There is no specific vaccine against mpox. The first- and second-generation smallpox vaccines administered as part of the smallpox eradication program - in Switzerland until 1972 - confer effective protection. A third-generation smallpox vaccine (MVA-BN/Imvanex) has been licensed in Europe for immunization against smallpox in adults. This also provides good protection against mpox. The mpox vaccine from Bavarian Nordic is now available in Switzerland. For more information, see the Webpage Mpox Vaccination.