Nigeria has the monkeypox virus. In 2017, it suddenly reappeared in the West African country after several decades of no cases. Since then, infections have been occurring again and again, accompanied by fever, headache, muscle and back pain and the characteristic, sometimes very painful spots and pustules on the skin. The monkeypox outbreak in Nigeria continues to this day. The virus has become endemic.
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Meanwhile, monkeypox is not just a problem in Nigeria. Health authorities around the world have reported cases of the virus since this spring, especially in Europe. Spain has now recorded more than 3100 infections, as Data from the United States CDC demonstrate. Great Britain has around 2,100 cases, France around 1,450. Germany is also affected: there they are Robert Koch Institute (RKI) a total of 2268 cases known.
Unlike Nigeria, Europe is unfamiliar with monkeypox. There is a lack of experience and mechanisms that countries can use. So far, there have only been isolated infections with the monkeypox virus in Europe, which were mainly brought in by travelers from African countries. The current international outbreak has larger dimensions. Therefore the The World Health Organization (WHO) declared monkeypox an “emergency of international concern” on Saturday, i.e. the highest alert level. But can monkeypox be contained at all? Or is this opportunity long gone?
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How Nigeria is fighting monkeypox
In order to slow down the monkeypox virus in Europe, what is needed first and foremost is a strategy. It can be helpful to take a look beyond national borders – for example to countries that have been dealing with the pathogen for years, such as Nigeria.
The most populous country in Africa reacted early to the international outbreak of monkeypox. In late May, the Nigerian Disease control agency NCDC activated a cross-departmental, national crisis management team: the Emergency Operations Center for Monkeypox (MPX-EOC). The committee is responsible for coordinating the various measures. This includes contact tracing.
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People with typical symptoms of monkeypox can be tested for the virus in Nigeria with a PCR test and are isolated before the test result. If the test is positive, the authorities inform contacts in the immediate vicinity of the infected person and impose a quarantine in order to be able to interrupt the chain of infection at an early stage, explained Lateefat Amao, head of MPX-EOC, in one Webseminar End of June. This approach has also gained in importance in the fight against the corona virus.
In addition, Nigeria has a digital national surveillance system, the Surveillance Outbreak Response Management and Analysis System, or “Sormas” for short. It enables real-time detection of infection cases, which helps health authorities to assess the infection process and react with appropriate measures. “Sormas” was developed by the Helmholtz Institute for Infection Research in Braunschweig, among others, to take action against Ebola. In the meantime, it has also been used against Covid-19.
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RKI: Danger situation in Germany is currently “low”
Nigeria’s strategy against monkeypox has paid off: according to the US disease control agency CDC, the country has only recorded around 100 infections so far this year. The number of cases is therefore many times smaller than in European countries such as Germany. So does this country also need a monkeypox expert council? A digital real-time reporting system?
In Germany, monkeypox is currently being neglected. Recently they had almost completely disappeared from public perception. Also because most infections are mild – i.e. there is apparently no relevant risk from the virus. This is considered a risk to the health of the population RKI currently as “low”.
So far, men who have sexual contact with other men have been infected with the pathogen. But five women are also among those affected. Infections in children are not known in Germany. The infection process is therefore still “strictly limited”, said Clemens Wendtner, chief physician for infectiology and tropical medicine at the Munich Clinic Schwabing.
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More cases preventable with precautionary measures
However, there is still no end in sight to monkeypox infections. The RKI expects further cases, but is convinced that the outbreak in Germany can be limited. “It will be late summer or early autumn before we see whether the efforts to limit the outbreak were successful,” RKI Vice President Lars Schaade told the newspapers of the Funke media group in early July. A prerequisite for flattening the infection curve is that cases are recognized in good time and precautionary measures implemented.
This means, for example, that anyone who has been infected with the monkeypox virus should avoid contact with others, go into isolation for at least 21 days as a precaution and inform close contacts about their infection. In case of suspicion, a doctor should be contacted to clarify an infection.
Vaccinations help against monkeypox
Another precaution is vaccination. With Imvanex, a regular smallpox vaccine is available in the EU that has been shown to protect against monkeypox. the Standing Committee on Vaccination (Stiko) recommends that all adults over the age of 18 who have been in contact with a person infected with monkeypox get vaccinated. This should be done up to 14 days after contact. Stiko has advocated a two-dose regimen spaced at least 28 days apart. Those who have been vaccinated against smallpox in the past only need one dose.
Stiko recommends monkeypox vaccination for high-risk groups
The Standing Committee on Vaccination recommends vaccination against monkeypox for certain people. Meanwhile, the number of cases in Germany continues to rise.
© Source: dpa
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Likewise, people who have an increased risk of infection should be vaccinated against monkeypox. For example, men who have sex with other men and often change partners, and staff in special laboratories who work with infectious samples.
Since the Imvanex vaccine is currently limited, Stiko advises primarily vaccinating those who have come into contact with it. People who have an increased risk of becoming seriously ill should always have priority. Because of the vaccine shortage, the panel has now also decided that only one dose should be administered initially. The second should be made up for at a later date.
Virus could become endemic
With the vaccine, Germany has an important tool against monkeypox at its disposal. One that Nigeria has had to do without so far. Now it’s a matter of using this tool correctly. How many monkeypox vaccinations have been carried out so far is unclear. There is a lack of data. Likewise, it is not possible to estimate how many people are even eligible for vaccination. The RKI assumes around 130,000 people.
In principle, the monkeypox virus can also become endemic in Germany.
Clemens Wendtner, Chief Physician for Infectious Diseases and Tropical Medicine at the Munich Clinic Schwabing
“A further spread of monkeypox should now be prevented as much as possible,” says the RKI on its Website clear. On the one hand, to avoid severe gradients; on the other hand, to prevent the virus from persisting permanently in Germany. “Should this happen, cases in particularly vulnerable groups (pregnant women, children, immunocompromised, older people) can also be expected in the medium term,” says the RKI. “In addition, there is always a certain risk that the virus will change and possibly become more ill.”
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“In principle, the monkeypox virus can also become endemic in Germany,” said infectiologist Wendtner, “if the number of cases continues to rise in the coming weeks and months and the virus spreads outside the MSM scene (Men who have sex with men, n.d. editor) widespread.” According to the current state of knowledge, however, the risk that monkeypox will really become endemic can be assessed as “low”.
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