As soon as the corona incidences are falling, reports of infections with the monkeypox virus are piling up. A look at the situation, the special features of the virus – and the possibilities of modern medicine.
Monkeypox, electron micrograph.
Foto: CDC/Cynthia S. Goldsmith
According to the Robert Koch Institute (RKI), Berlin, 113 people have been infected with the monkeypox virus in Germany, as of June 8, 2022. So far, it has occurred in Baden-Württemberg, Bavaria, Berlin, Brandenburg, Hamburg, Hesse, Lower Saxony, North Rhine- Westphalia and Saxony-Anhalt on diseases. “Further cases are to be expected in Germany,” writes the RKI. And the World Health Organization (WHO) has received reports of 1,226 cases. In order to assess the situation, a few details are important.
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What is monkey pox?
Monkeypox is caused by infection with the monkeypox virus, a virus from the orthopoxvirus genus. Other representatives are the real smallpox, but also the cowpox. Important to know: These are DNA viruses, not RNA viruses like SARS-CoV-2. If the genome is in the form of DNA, the risk of mutations occurring is significantly lower.
Virologists first described monkeypox in 1958. At that time, monkeys kept as experimental animals became ill. Skin changes were typical. In the course of worldwide efforts to eliminate smallpox, doctors examined the first human infection in 1970, in the Democratic Republic of the Congo. In the following years there were several outbreaks in African countries.
How is monkeypox transmitted?
Researchers are currently assuming that there was initially a transmission from animals to humans, for example through improperly cooked meat from wild animals or through injuries during the hunt.
Human-to-human transmission plays the most important role in Europe. According to the RKI, contact with bodily fluids or with typical skin changes are of particular importance. Even outside the body, the viruses remain biologically active for a period of time. It is currently unclear whether monkeypox is also transmitted through semen or vaginal secretions. Fine droplet transmissions are possible but do not appear to play the role of Covid-19 because they may not be possible over longer distances. Infected people can infect healthy people for two to four weeks.
What symptoms cause monkeypox virus infections?
The first symptoms appear five to 21 days after contact with viruses, mostly fever, headache, muscle and back pain and swollen lymph nodes. Such complaints are quite unspecific; they also occur with influenza infections. A few days later, the typical skin changes develop. They go through different stages from spots to nodules, blisters to pus blisters. They then fall off, although the skin material can still be infectious.
Statements on mortality are currently hardly possible. The WHO gives a mortality rate of three to six percent for earlier cases from African countries, and even up to eleven percent for children under the age of 16. The values cannot be transferred to the current situation for two reasons. Sick people in Europe and North America have significantly better medical care available. In addition, a milder, West African variant is currently circulating than during the first outbreaks.
Are there ways to treat the condition?
Doctors treat infections with the monkeypox virus only symptomatically. That means they recommend taking a painkiller for fever and pain. In addition, the European Medicines Agency (EMA) approved Tecovirimat in January 2022. The drug can be used against smallpox, monkeypox or cowpox. It is suitable for patients with a weakened immune system, for example, to reduce the risk of serious secondary diseases.
Can you get vaccinated against smallpox?
Good hand hygiene, as is common in Corona times, also reduces the risk of infection with monkeypox. And vaccines against smallpox also protect against monkeypox. The effectiveness should be at least 85%. However, vaccination programs were discontinued in the early 1980s. Younger people are therefore usually not vaccinated. At the end of May, the federal government announced that it had ordered 40,000 doses of vaccine from the German-Danish manufacturer Bavarian Nordic – primarily for people at risk due to a weakened immune system. Another 200,000 cans are to follow.
The Standing Committee on Vaccination (STIKO) now recommends that vulnerable groups should be vaccinated against monkeypox. This includes people aged 18 and over who have had close physical contact with infected people, laboratory employees who have had contact with samples from infected people without protective equipment, and homosexual men with changing partners. Reason for the last recommendation according to STIKO: The approximately 130 cases of monkeypox observed in Germany so far have only occurred in homosexual men. Therefore, this group should now be specially protected. But: In principle, the transmission risk for heterosexuals who have sex with infected people is just as great.
Are we facing a monkeypox pandemic?
Experts see the current situation as an epidemic, i.e. a stronger occurrence of infections that is limited in time and location. A pandemic, i.e. a spatially unlimited occurrence of infection, is very unlikely to occur for several reasons. There are already vaccines and therapies. In addition, it is possible to trace infections with the much slower disease dynamite.
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