The European Centre of Disease Prevention and Control has today released the Rapid Risk Assessment Monkeypox multi-country outbreak – first update. Since early May 2022 and as of 7 July, cases of monkeypox have been reported in twenty-six European Union/European Economic Area (EU/EEA) countries. So far 4 908 cases have been reported in the EU/EEA, representing 65% of all cases reported worldwide in 2022 in this outbreak in non-endemic countries.
Human-to-human transmission of monkeypox occurs through the close contact of skin lesions of an infected person, through respiratory droplets in prolonged face-to-face contact, and through fomites. In the current outbreak, monkeypox cases are relatively mild and are still identified primarily among groups of men who have sex with men (MSM). Despite this, the potential exists for transmission to other population groups, and the severity may be higher among children, pregnant women, and those with compromised immune systems. The risk to people having multiple sexual partners (including some groups of MSM) remains moderate and low for the broader population.
The updated rapid risk assessment includes new information on the different clinical picture of monkeypox cases in the ongoing outbreak, and insights from modelling work developed collaboratively between ECDC and the European Health Emergency preparedness and Response Authority (HERA). This modelling work assesses vaccination strategies as outbreak response measures as a complement to the isolation of cases and effective contact tracing for controlling the outbreak.
Early diagnosis, isolation, effective contact tracing and vaccination strategies are key for the effective control of this outbreak. At this point, mass vaccination for monkeypox is not required nor recommended. When there is less effective tracing, mathematical modelling results indicate that targeted pre-exposure vaccination as prophylaxis for individuals at high risk would be the most effective strategy to use vaccines to control the outbreak. Therefore, prioritising groups of MSM at higher risk of exposure, as well as front-line staff with a risk for occupational exposure should be considered in developing vaccination strategies. In settings where higher vaccine uptake is expected, post-exposure prophylaxis vaccination of close contacts of cases or even ring vaccination should also be considered.
Activities to increase awareness of health professionals across specialities should continue. Risk communication and community engagement (RCCE) are core elements in aiming to control this outbreak. The most affected groups, such as MSM, healthcare workers, sex workers, and those at risk of severe disease should be prioritised for RCCE strategies. A toolkit to support RCCE strategies, including key messages, has been jointly developed by ECDC and the WHO Regional Office for Europe and is available for adaptation and use by public health authorities.