Monkeypox virus on the rise

If someone tests positive for monkeypox, they must remain in isolation

In the Netherlands, more and more people are diagnosed with monkeypox. Anyone can get monkeypox and the virus affects all age groups. Most infections have been found in MSM men who have sex with men (men who have sex with men). Monkeypox is transmitted through intimate contact such as kissing, making out and sex. The virus can enter through the mucous membranes and small wounds or tears in the skin. It is possible that the virus can also spread via droplets from blisters or from the oral cavity, although this chance is currently estimated as low.

As soon as there are visible symptoms (vesicles, scabs) you are infectious to others anyway. However, blisters can also be in less visible places, such as in your mouth or in the rectum, and then they look more like canker sores. Some people have flu-like symptoms before the blisters appear. We currently consider people with these symptoms to be contagious.

Source and contact research
If someone tests positive for monkeypox, the GGDMunicipal Health Service starts the source and contact investigation. In this investigation, the GGD tries to find out where the infection may have taken place and with whom else there was contact. It is important to participate in the source and contact investigation. The sooner the GGD can inform the persons with whom it has been in contact, the sooner a possible new infection can be prevented. Especially because the incubation period now seems to be an average of 8.5 days. However, it can take up to 3 weeks until you get symptoms.

Insulation
If someone tests positive for monkeypox, they must remain in isolation. You may not have contact with others until all complaints are over. Monkeypox is when all the scabs – which are caused by the blisters – have fallen off the skin. The scabs can still transmit the virus. Often the rash lasts the longest. If there is (also) proctitis, all complaints associated with proctitis (such as anal pain) must be over.

Vaccination
On July 7, 2022, the Ministry of Health, Welfare and Sport decided to preventively vaccinate people who have an increased risk of infection with monkeypox. It’s about:

• participants in the nationwide HIV human immunodeficiency virus PreP scheme. These are men who have sex with men and transgenders who are not infected with HIV but who have an increased risk of it.
• people on the waiting list for the nationwide HIV-PrEP pre-exposure prophylaxis scheme. Men with an increased risk of HIV receive an invitation (via their therapist).
• men who have sex with men and who regularly visit the STI sexually transmitted disease clinic.

Vaccination is only possible if you have received an invitation. The series consists of two injections with a four-week interval. In combination with an old smallpox vaccination, 1 vaccination is sufficient. It is currently being worked out when vaccination will start, who exactly will be invited for vaccination and how.

About the vaccine
The vaccine used is the smallpox vaccine Imvanex® and is registered in Europe for adults to protect against smallpox. Because the smallpox virus and the monkeypox virus are very similar, it is expected that it also protects against infection with the monkeypox virus.

Efficacy against monkeypox has only been investigated in animal studies. In laboratory animals, the vaccine protects against serious infection if they are exposed to the monkeypox virus after vaccination. But there are no large studies in humans that have looked at how well the vaccine protects against symptomatic infection or against serious monkeypox disease. Therefore, a study on the efficacy against monkey pox will also be started at the same time as vaccination.

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