HPSC has now been notified of 177 confirmed cases of Monkeypox in Ireland. Today they have published the latest report on confirmed cases.
Weekly report on the epidemiology of Human Monkeypox in Ireland, Week 37 2022
Key Points
- Cases of monkeypox infection with no link to an endemic area have been reported since 16-05-2022. Outside of endemic areas cases are primarily occurring among men and where information is known, among gay, bisexual or other men who have sex with men (gbMSM).
- On 23 July 2022, the World Health Organization (WHO) declared the multi-country outbreak (including both endemic and non-endemic countries) a Public Health Emergency of International Concern (PHEIC). A PHEIC is the highest level of alert that the United Nations health body can confer.
- Information on the global epidemiological situation is available here, WHO Dashboard here and information on the European situation is available here.
- To enable the monitoring of cases in Ireland and the Public Heath response, Monkeypox infection was made a notifiable infection on the 27-05-2022.
- This report includes confirmed cases of Monkeypox infection notified on the Computerised Infectious Disease Reporting system for Ireland (CIDR) up to the end of the preceding epidemiological week.
- As of week 37 2022 (up to midnight on the 17-09-2022), 177 confirmed cases of Monkeypox infection have been notified on CIDR.
- In week 37 2022, 4 confirmed cases were notified.
- Among all 177 cases notified to date, gender for 175 cases is male and 2 cases is female. Median age is 35 years.
- Sexual orientation is known for 160, 159 of whom self-identify gbMSM.
- 18 cases have been hospitalised; 10 cases were admitted for clinical care related to Monkeypox infection, 2 admitted for isolation purposes only, and information on the reason for admission for the other 6 is still awaited.
- The epidemiological picture to date in Ireland is similar to that seen in other countries where cases are primarily among gbMSM.
- Further information on Monkeypox infection including the symptoms, and how to reduce the risk are available here.
Figure 1: Number of confirmed cases of Monkeypox infection by week of notification reported on CIDR in Ireland up to midnight 17-09-2022.
Table 1: Summary characteristics of confirmed cases of Monkeypox infection, based on cases reported up to midnight 17-09-2022
Number of events | % of events | ||
Gender* | Male | 175 | 98.9 |
Female | 2 | 1.1 | |
Unknown/missing | 0 | 0.0 | |
Age(years) | Mean age (years) | 37 | |
Median age (years) | 35 | ||
Age groups(years) | 0-18 | 1 | 0.6 |
19-24 | 7 | 4.0 | |
25-34 | 73 | 41.2 | |
35-44 | 64 | 36.2 | |
45-54 | 23 | 13.0 | |
55-64 | 8 | 4.5 | |
65 and older | 1 | 0.6 | |
Area | CHO1 | 4 | 2.3 |
CHO2 | 0 | 0.0 | |
CHO3 | 6 | 3.4 | |
CHO4 | 6 | 3.4 | |
CHO5 | 6 | 3.4 | |
CHO6 | 20 | 11.3 | |
CHO7 | 56 | 31.6 | |
CHO8 | 10 | 5.6 | |
CHO9 | 69 | 39.0 | |
Sexual orientation | gbMSM | 159 | 89.8 |
Other | 1 | 0.6 | |
Not known | 17 | 9.6 | |
Male includes cis and trans males; Female includes cis and trans females.
Technical Notes
1. Data Source: Data for this report are based on cases notified on the Computerised Infectious Disease Reporting (CIDR) up to midnight 17-09-2022. Data were extracted from CIDR system on 20-09-2022. Some data have been supplemented by information provided by Departments of Public Health. Data are provisional and subject to ongoing review, validation and update. As a result, figures in this report may differ from previously published figures.
2. Case definitions: The current case definition for Monkeypox infection is available here.
3. Epidemiological week: For the purposes of epidemiology the 365 days of the year are split into 52 or 53 epidemiological weeks (epi weeks). This is to standardize time for epidemiological surveillance. This is important to allow for comparison of events that occurred in a given year, or a period of a year, with previous years. As these are internationally agreed they also facilitate comparison between countries. Epi weeks (epidemiological weeks) start on a Sunday and end on a Saturday. The first epidemiological week of the year ends on the first Saturday of January, as long as it falls at least four days into the month, even if it means that this first week starts in December. A breakdown of epidemiological weeks is available here.
4. Epidemiological date (Epi date): Epidemiological date is based on the earliest of dates available on the case and taken from date of onset of symptoms, date of diagnosis, laboratory specimen collection date, laboratory received date, laboratory reported date or event creation date/notification date on CIDR. By using this date rather than event creation/ notification date, adjusts for any delays in testing/notification.
5. Gender: Gender is based on gender identity where it is provided, otherwise sex at birth is used. Gender identity refers to a person’s internal sense of themselves (how they feel inside) as being male, female, transgender, non-binary or something else. This may be different or the same as a person’s assigned sex at birth. Further information and resources can be found at the website of Transgender Equality Network Ireland www.teni.ie.
6. CHO Areas: The counties covered by each CHO area are as follows:
- CHO 1: Donegal, Sligo/Leitrim/West Cavan, and Cavan/Monaghan;
- CHO 2: Galway, Roscommon, and Mayo;
- CHO 3: Clare, Limerick, and North Tipperary/East Limerick;
- CHO 4: Kerry, North Cork, North Lee, South Lee, and West Cork;
- CHO 5: South Tipperary, Carlow/Kilkenny, Waterford, and Wexford;
- CHO 6: Wicklow, Dun Laoghaire, and Dublin South East;
- CHO 7: Kildare/West Wicklow, Dublin West, Dublin South City, and Dublin South West;
- CHO 8: Laois/Offaly, Longford/Westmeath, Louth, and Meath;
CHO 9: Dublin North, Dublin North Central, and Dublin North West
For each case notified, Public Health follows up all those who had close contact with the case while they were infectious. Public health risk assessments are undertaken, and those who were in contact with the cases are advised on what to do in the event that they become ill, and are offered vaccination if appropriate.
The cases in Ireland are part of an ongoing multi-country outbreak of monkeypox in Europe, the Americas and many other regions worldwide (https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html, https://monkeypoxreport.ecdc.europa.eu/). The vast majority of these cases do not have a travel link to a country where monkeypox is endemic. Many countries have reported that the cases are predominantly, but not exclusively, in men who self-identify as gay, bisexual or other men who have sex with men (gbMSM). The WHO has determined that this multi-country outbreak of monkeypox constitutes a Public Health Emergency of International Concern. This declaration comes with recommendations for countries with cases of monkeypox, like Ireland, to strengthen their public health and clinical responses to stop transmission and emphasises the importance of engagement with affected communities (https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi–country-outbreak-of-monkeypox–23-july-2022, https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox).
In addition to the multi-country outbreak that is affecting Ireland, there are ongoing monkeypox outbreaks in endemic areas (https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396).
The HSE has established a Monkeypox Crisis Management Team (CMT) to coordinate the multiagency, multidisciplinary response to the outbreak in Ireland. The HSE continues to actively monitor the evolving international situation. To assist in Ireland’s response, monkeypox has been made a notifiable disease. This means that medical practitioners (and laboratories) are required to notify the local Medical Officer of Health/Director of Public Health of monkeypox cases in Ireland.
About monkeypox
Monkeypox is an uncommon disease that is caused by infection with monkeypox virus. The virus is found in some animal populations in remote parts of Central and West Africa, and in the past has caused occasional limited outbreaks in local communities and travellers. The cases being reported across multiple countries now are unusual because most of the cases do not have a link to travel to these parts of Africa.
There are two main clades (variants) of monkeypox: Clade one (I) (formerly Congo Basin clade) and Clade two (II) (formerly West African clade). Clade II consists of two subclades (IIa and IIb). Clade IIb is the primary group of variants circulating in the 2022 global outbreak.
Monkeypox spreads through close contact, including contact with the skin rash of someone with monkeypox. People who closely interact with someone who is infectious are at greater risk for infection: this includes sexual partners, household members, and healthcare workers. The risk of spread within the community in general, is very low.
Symptoms of monkeypox
Symptoms of monkeypox virus infection include:
- itchy rash (see below),
- fever (>38.50C),
- headache,
- muscle aches,
- backache,
- swollen lymph nodes,
- chills,
- exhaustion.
The rash starts as raised red spots that quickly change into little blisters. It usually develops within 1 to 3 days of the start of the fever or other symptoms, but some people may only have a rash. Sometimes the rash first appears on the face and spreads to the mouth, palms of the hands and soles of the feet. However, following sexual contact, the rash may be found initially in the anogenital areas. Not everyone will experience all the symptoms of monkeypox. Rash in the anogenital area, or complications of the rash such as rectal pain, may be the main symptom. Some people may have only a small number of lesions.
The rash goes through different stages before finally forming scabs which later fall off.
Images of the different stages of the rash can be found on the HPSC website at the following link: www.hpsc.ie/a-z/zoonotic/monkeypox/factsheets
Treating Monkeypox:
Monkeypox infection is usually a self-limiting illness and most people recover within weeks, although it can occasionally cause severe complications including death. In endemic Monkeypox infection, severe illness has been seen in people with very weak immune systems, pregnant women and in very small babies.
There is no medicine that can cure monkeypox. Treatment of monkeypox is mainly supportive. This involves treating any uncomfortable symptoms, such as pain or itch, that occur, keeping the patient warm, comfortable and relaxed, and making sure they get plenty of fluids. This allows the person’s own body defences to fight the infection.
Vaccination:
Please see the latest HSE statement on monkeypox vaccination.
Gay, bisexual and men who have sex with men (gbMSM):
Anyone, regardless of their sexuality, can get monkeypox if in close physical contact with a case. However, many of the cases in this multi-country outbreak are in men who self-identify as gay, bisexual or other men who have sex with men (gbMSM).
A community engagement response is underway to create awareness within the gbMSM community about monkeypox and its symptoms, including the development of key messaging that is informative but does not stigmatise. This has been designed by representatives from man2man.ie and MPOWER in collaboration with the HSE and has been recognised as best practice in Europe.
As the virus spreads through close contact, the HSE is advising those who self-identify as gbMSM to be alert to any unusual rashes or vesicular lesions on any part of their (or their partner’s) body, including their genitalia. If they do notice any such changes, they should contact their local STI Clinic or their General Practitioner (GP) for advice.
A list of public STI services is available on the HSE’s Sexual Wellbeing website: https://www.sexualwellbeing.ie/sexual-health/hse-sti-services-in-ireland.html.
Further information on monkeypox infection can be found on the HPSC website: https://www.hpsc.ie/a-z/zoonotic/monkeypox/
HPSC continues to closely monitor this situation and provides relevant updates to the public as appropriate.
For the latest information on confirmed cases of monkeypox in Ireland see Epidemiology of Monkeypox in Ireland Report.
For each case notified, Public Health follows up all those who had close contact with the case while they were infectious. Public health risk assessments are undertaken, and those who were in contact with the cases are advised on what to do in the event that they become ill, and are offered vaccination if appropriate.
The cases in Ireland are part of an ongoing multi-country outbreak of monkeypox in Europe, the Americas and many other regions worldwide (https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html, https://monkeypoxreport.ecdc.europa.eu/). The vast majority of these cases do not have a travel link to a country where monkeypox is endemic. Many countries have reported that the cases are predominantly, but not exclusively, in men who self-identify as gay, bisexual or other men who have sex with men (gbMSM). The WHO has determined that this multi-country outbreak of monkeypox constitutes a Public Health Emergency of International Concern. This declaration comes with recommendations for countries with cases of monkeypox, like Ireland, to strengthen their public health and clinical responses to stop transmission and emphasises the importance of engagement with affected communities (https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi–country-outbreak-of-monkeypox–23-july-2022, https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox).
In addition to the multi-country outbreak that is affecting Ireland, there are ongoing monkeypox outbreaks in endemic areas (https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396).
The HSE has established a Monkeypox Crisis Management Team (CMT) to coordinate the multiagency, multidisciplinary response to the outbreak in Ireland. The HSE continues to actively monitor the evolving international situation. To assist in Ireland’s response, monkeypox has been made a notifiable disease. This means that medical practitioners (and laboratories) are required to notify the local Medical Officer of Health/Director of Public Health of monkeypox cases in Ireland.
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