In view of the alert concerning clustered cases of infection by Monkeypox virus (MPXV) in several European countries including France, the French High Council for Public Health (HCSP) presents recommendations about the various treatments that are or could be available (antivirals, specific immunoglobulins, hyperimmune plasmas) against this infection in humans and their possible use.

MPXV is a virus whose main reservoir is represented by rodents on the African continent; humans are usually infected through contact with infected rodents or monkeys. The significant and sharp increase in the number of indigenous cases from April 2022 onwards in several non-endemic regions for MPXV and remote from each other, through human-to-human transmission, makes this virus an emerging biological pathogen.

The HCSP recommends as a priority the implementation of an adapted support treatment if necessary (treatment of a poorly tolerated fever, encephalitis, sepsis, cutaneous or respiratory bacterial superinfection).

Concerning the different treatments available (antivirals, specific immunoglobulins) against MPXV and the doctrine of recourse to them, and according to case-by-case expertise, the HCSP recommends the followings:

• not to systematically treat all confirmed cases with an antiviral or immunoglobulin;
• to discuss in a collegial manner (referring infectiologist, practitioner taking care of the patient and, if necessary, the ANSM and the National Reference Centre) the opportunity of a specific treatment towards the populations at risk for a severe presentation (immunocompromised including people living with HIV, pregnant women, young subjects);
• to prioritize specific therapies if their indication is deemed necessary:
• to use tecovirimat as first-line therapy, due to its oral availability and safety;
• to use brincidofovir as a second-line treatment, subject to availability (advantages: oral route, better tolerance than cidofovir);
• to use cidofovir as a third-line treatment, because of its disadvantages: injectable route, high renal and hematological toxicity, and potential carcinogenic, teratogenic and reprotoxic effects. This product is currently available on a compassionate basis;
• to reserve specific human immune globulins for special populations where antivirals cannot be used: pregnant women, young children under 13 kg.

These recommendations are completed by the proposal of precautionary / preventive measures to be implemented:

• in the context of the management of a possible suspected or confirmed case in a health facility for patients and health professionals,
• as well as at home.