2022–2023 mpox outbreak in Belgium

The 2022–2023 mpox outbreak in Belgium is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. Belgium was the fifth country, outside of the African countries with endemic mpox, to experience an outbreak in 2022. The first case was documented in Antwerp, Belgium, on 19 May 2022.[1] As of 10 August, Belgium has 546 cases and 1 suspected case.[2]

2022–2023 mpox outbreak in Belgium
DiseaseMpox
Virus strainMonkeypox virus (West African clade)
LocationBelgium
Index caseAntwerp, Belgium[1]
Arrival date19 May 2022 (1 year, 5 months and 1 week ago)
Date15 March 2023
Confirmed cases793[2]
Suspected cases‡1
Deaths
2
‡Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.

Background
These paragraphs are an excerpt from Mpox and 2022–2023 mpox outbreak.

Mpox (formerly known as monkeypox)[3] is an infectious viral disease that can occur in humans and some other animals.[4] Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes.[4] The illness is usually mild and most of those infected will recover within a few weeks without treatment.[5] The time from exposure to onset of symptoms ranges from five to twenty-one days and symptoms typically last from two to four weeks.[6] Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.[7]

The disease is caused by the monkeypox virus,[lower-alpha 1] a zoonotic virus in the genus Orthopoxvirus. The variola virus, the causative agent of the disease smallpox, is also in this genus.[4] Human-to-human transmission can occur through direct contact with infected skin or body fluids, including sexual contact.[4] People remain infectious from the onset of symptoms until all the lesions have scabbed and healed.[7] It may spread from infected animals by handling infected meat or via bites or scratches.[7] Diagnosis can be confirmed by PCR testing a lesion for the virus' DNA.[4]

An ongoing outbreak of mpox was confirmed on 6 May 2022, beginning with a British resident who, after travelling to Nigeria (where the disease is endemic), presented symptoms consistent with mpox on 29 April 2022. The resident returned to the United Kingdom on 4 May, creating the country's index case of the outbreak.[8] The origin of several of the cases of mpox in the United Kingdom is unknown. Some monitors saw community transmission taking place in the London area as of mid-May,[9] but it has been suggested that cases were already spreading in Europe in the previous months.[10]

Transmission
Stages of lesion development.

A large portion of those infected were believed to have not recently traveled to areas of Africa where mpox is normally found, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. It is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys and apes along with wild game or lotions derived from animals in Africa.[11]

In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. CDC has also warned clinicians to not rule out mpox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[12]

History
Mpox cases in Belgium  ()
     Deaths        Confirmed cases
MayMayJunJunJulJulAugAug
Last 15 daysLast 15 days
Date
Cases (rise)
Deaths (rise)
2022-05-18
1(n.a.)
2022-05-19
2(+1)
2022-05-20
3(+1)
2022-05-21
4(+1)
2022-05-22
4(=)
2022-05-23
4(=)
2022-05-24
4(=)
2022-05-25
4(=)
2022-05-26
6(+2)
2022-05-27
6(=)
2022-05-28
9(+3)
2022-05-29
9(=)
2022-05-30
9(=)
2022-05-31
10(+1)
2022-06-01
14(+4)
2022-06-02
15(+1)
2022-06-03
17(+2)
2022-06-04
18(+1)
2022-06-05
19(+1)
2022-06-06
20(+1)
2022-06-07
22(+2)
2022-06-08
24(+2)
2022-06-09
24(=)
2022-06-10
24(=)
2022-06-11
24(=)
2022-06-12
24(=)
2022-06-13
24(=)
2022-06-14
24(=)
2022-06-15
52(+28)
2022-06-16
52(=)
2022-06-17
62(+10)
2022-06-18
62(=)
2022-06-19
62(=)
2022-06-20
62(=)
2022-06-21
77(+15)
2022-06-22
77(=)
2022-06-23
77(=)
2022-06-24
77(=)
2022-06-25
77(=)
2022-06-26
77(=)
2022-06-27
77(=)
2022-06-28
117(+40)
2022-06-29
117(=)
2022-06-30
117(=)
2022-07-01
117(=)
2022-07-02
117(=)
2022-07-03
117(=)
2022-07-04
117(=)
2022-07-05
169(+52)
2022-07-06
169(=)
2022-07-07
169(=)
2022-07-08
169(=)
2022-07-09
169(=)
2022-07-10
169(=)
2022-07-11
169(=)
2022-07-12
224(+55)
2022-07-13
225(+1)
2022-07-14
225(=)
2022-07-15
225(=)
2022-07-16
225(=)
2022-07-17
225(=)
2022-07-18
311(+86)
2022-07-19
311(=)
2022-07-20
311(=)
2022-07-21
311(=)
2022-07-22
311(=)
2022-07-23
311(=)
2022-07-24
311(=)
2022-07-25
311(=)
2022-07-26
393(+82)
2022-07-27
393(=)
2022-07-28
393(=)
2022-07-29
393(=)
2022-07-30
393(=)
2022-07-31
393(=)
2022-08-01
482(+89)
2022-08-02
482(=)
2022-08-03
482(=)
2022-08-04
482(=)
2022-08-05
482(=)
2022-08-06
482(=)
2022-08-07
482(=)
2022-08-08
546(+64)
2022-08-09
546(=)
2022-08-10
546(=)

The first two known cases were detected in on 19 May 2022. The first infected person was diagnosed in Antwerp, and the second from a region called Flemish Brabant. Both had gone to the same party, and thus began the mpox outbreak in Belgium.[1] It is unknown what hospital they went to, although it is very likely that the first infected person went to an Antwerp hospital, and the second infected person went to a Flemish Brabant region hospital. There, they both tested positive for mpox, becoming the first cases in Belgium.

A day after both tested positive, there was another case reported in a man of unknown age who was relatively healthy but had bullous lesions on his hands.[13] More and more cases were reported in Belgium days later and more continue to be reported. As of 10 August, there are 546 cases and 1 suspected case.[2]

Vaccination response

On 5 July the Office of European Commissioner for Health, Stella Kyriakides, told Belga News Agency that 3,040 mpox vaccines were shipped to Belgium on 7 July. According to the Cypriot commissioner, these deliveries will "protect Belgian citizens and respond to this outbreak." She also praised the European Health Emergency Response and Preparedness Authority's (HERA) quick response. Kyriakides concluded that more doses will be delivered to Belgium in the following weeks.[14]

Responses and reactions

Hospitals have also begun making their own preparations to help control the current mpox outbreak, including screening patients, increasing decontamination and cleaning procedures,[15] and wearing appropriate safety gear (Personal protective equipment / Medical gown) when interacting with infected patients.

Belgium also introduced a mandatory 21-day quarantine for infected mpox patients in hopes of containing the disease in the country. Close contacts are not required to self-isolate but are encouraged to remain vigilant, especially if in contact with vulnerable people.[16]

See also

Notes
  1. The World Health Organization (the authority on disease names) announced the new name "mpox" in November 2022. But virus naming is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which is currently reviewing all orthopoxvirus species. As of March 2023, the official name of the virus remains "monkeypox virus".[3]

    References
    1. "Belgium detexts first two monkeypox cases". Reuters. 20 May 2022.
    2. "2022 Monkeypox Outbreak Global Map". USA CDC. Retrieved 17 June 2022.
    3. "WHO recommends new name for monkeypox disease" (Press release). World Health Organization (WHO). 28 November 2022. Retrieved 29 November 2022.
    4. "WHO Factsheet – Mpox (Monkeypox)". World Health Organization (WHO). 18 April 2023. Archived from the original on 21 April 2022. Retrieved 21 May 2023.
    5. "Monkeypox". GOV.UK. 24 May 2022. Archived from the original on 18 May 2022. Retrieved 28 May 2022.
    6. "Mpox Symptoms". U.S. Centers for Disease Control and Prevention (CDC). 2 February 2023. Archived from the original on 21 May 2023. Retrieved 21 May 2023.
    7. "Mpox (monkeypox)". World Health Organisation. 12 May 2023. Archived from the original on 23 May 2023. Retrieved 24 May 2023.
    8. "Monkeypox – United Kingdom of Great Britain and Northern Ireland". World Health Organization. 16 May 2022. Archived from the original on 17 May 2022. Retrieved 17 May 2022.
    9. Pinkstone, Joe (17 May 2022). "Monkeypox 'spreading in sexual networks'". The Telegraph. Archived from the original on 17 May 2022. Retrieved 17 May 2022.
    10. Nsofor, Ifeanyi (2 June 2022). "OPINION: Media coverage of monkeypox paints it as an African virus. That makes me mad". NPR. Retrieved 2 June 2022.
    11. Vargas, Ramon Antonio (2022-06-07). "US raises monkeypox alert level but says risk to public remains low". the Guardian. Retrieved 2022-06-09.
    12. "Monkeypox update: Where the outbreak stands now".
    13. "Third case of monkeypox reported in Belgium". Retrieved 20 May 2022.
    14. "Monkeypox vaccines arrive in Belgium". Retrieved 7 July 2022.
    15. Kurth, Andreas; Achenbach, John; Miller, Liljia; Mackay, Ian M.; Pauli, Georg; Nitsche, Andreas (January 2008). "Orthopoxvirus Detection in Environmental Specimens during Suspected Bioterror Attacks: Inhibitory Influences of Common Household Products". Applied and Environmental Microbiology. 74 (1): 32–37. doi:10.1128/AEM.01501-07. PMC 2223225. PMID 17965204.
    16. "Belgium introduces mandatory monkeypox quarantine as global cases rise". Retrieved 23 May 2022.
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