FAQ
As of: 07/23/2022 5:08 p.m
What do we now know about monkeypox? How effective are the vaccinations? How can you protect yourself? The most important questions and answers.
By Veronika Simon and Vinetta Richter, SWR
How many infections have been registered?
The number of infections has increased in recent weeks. WHO Director-General Tedros Adhanom Ghebreyesus cited the number of more than 16,000 confirmed cases in more than 60 countries, many of which previously had virtually no monkeypox cases. According to the WHO, there were over 240 cases in six African countries where the virus has previously infected people. Because of the increase in cases the WHO declared a global health emergency.
80 percent of those affected worldwide are found in Spain, Great Britain, France and Germany. In Germany, the Robert Koch Institute (RKI) reported almost 2,300 cases on July 22nd.
Also the Robert Koch Institute has commented on the rising numbers. 57 percent of all cases were reported in Berlin. The outbreak is concentrated in a few large cities. The cases rose sharply up until the end of June, but since then the increase has leveled off significantly. The majority of those affected were male and between 18 and 78 years old. As far as is known, those affected do not become seriously ill. The RKI currently assesses the risk to the health of the general public as low.
It’s not the first time cases of monkeypox have surfaced in Europe or the US. There was also a documented case in Israel in 2018. However, all of these infections could be linked to travel to, or contact with animals imported from, West or Central Africa. The monkeypox virus is partly endemic in West and Central Africa, and there have been repeated outbreaks in the past.
According to Jimmy Whitworth, the current situation is not a reason to panic. He is Professor of International Public Health at the London School of Hygiene and Tropical Medicine. The current spread is highly unusual, but: “It will not trigger a nationwide epidemic, as was the case with Covid. But it is a serious outbreak of a serious disease.” And that’s why you have to act accordingly now.
Experts are now trying to identify chains of infection and other possible victims. Medical staff should be sensitized so that they recognize an infection with monkeypox as such. People with unusual skin rashes should be examined.
What about the vaccinations?
There is an effective vaccine. This is a further development of the vaccinia vaccine Imvanex, which was used against smallpox. Since the viruses are similar, it should also have an effectiveness of 85 percent against monkeypox.
The Federal Ministry of Health has now ordered 40,000 doses of this vaccine and delivered them to the federal states. People could get vaccinated as early as the first half of July. The EMA has now officially approved the vaccine to protect adults from monkeypox.
A so-called ring vaccination is particularly useful for the contact persons of an infected person. The smallpox vaccine is still effective up to seven days after infection with the monkeypox virus. Such vaccination can lead to a milder course of the disease. According to the WHO, vaccinations against smallpox, which were carried out worldwide until 1983, still provide protection.
There is now a newer, third-generation smallpox vaccine that appears to have fewer side effects. This vaccine has been approved, but according to the WHO it is not yet widely available.
There are several antiviral medications available to treat monkeypox that can relieve symptoms. One of them is Tecovirimat, which is also used to treat smallpox. Anyone who becomes infected should also isolate themselves for at least 21 days until any pustules and scabs fall off and heal. The RKI also recommends quarantine at home for close contacts.
How do you get infected?
The current cases in Europe involve human-to-human transmission. This is only possible with close contact – for example through skin-to-skin contact when hugging, massaging or having sex. This happens through contact with bodily fluids and the typical skin changes of monkeypox infected people. The virus concentration is particularly high in these pustules.
According to the RKI, cases are currently being registered in Germany in which skin-to-skin transmission is assumed. It can also be transmitted through items such as towels, bedding, clothing, or surfaces that have been used or touched by a person with monkeypox. Transmission via large droplets in the air we breathe is also possible – even before the infected person develops symptoms. This is particularly risky for people who live with infected people or who provide them with medical care. According to the RKI, transmission via aerosols (i.e. extremely small particles that can stay in the air for a long time) – as was observed with Corona – is “improbable according to the current state of knowledge”.
Although sexual transmission is currently a major factor in Europe, monkeypox is not a venereal disease in the traditional sense, says John Thornhill. He is Co-author of a study, which was published on July 21 in the New England Journal of Medicine. The transmission of the disease was examined in 528 cases and the scientists came to the conclusion that 95 percent of all cases are due to sexual contact.
Currently, men who have sex with other men are particularly affected. WHO chief Tedros is concerned that these men could be stigmatized in some countries and blamed for the outbreak. This could pose problems for containment efforts. The RKI emphasizes on its website that the risk is not limited to sexually active people or men who have sex with men. “Anyone who has close physical contact with an infectious person can become infected.”
What are the symptoms?
Not only are the pathogens closely related, the symptoms of smallpox and monkeypox are also similar: many affected people have a fever about one to two weeks after infection. In addition, her lymph nodes are swollen, along with headaches, back pain, muscle pain and general exhaustion.
The typical blister-like rash usually appears a few days after the onset of fever – in monkeypox mostly on the face, often on the hands, feet and mucous membranes of the mouth. These pustules can be very itchy or painful.
However, the course of a monkeypox infection can also be so mild that it goes undetected. This increases the risk of the virus being transmitted to other people.
According to the World Health Organization, people affected by monkeypox usually do not get as severely ill as was the case with real smallpox. These were deadlier and also more easily transmitted.
How dangerous is monkeypox?
According to experts, an infection with the monkeypox virus is a serious illness, even if it goes away on its own in most of those affected and leaves no permanent damage.
Children are particularly at risk; their mortality rate from infection is significantly higher than in older groups. Pregnant women are also at higher risk, as the virus can be transmitted to the unborn child and can lead to pregnancy complications or miscarriage.
One of the most common problems are bacterial infections that coexist with the monkeypox virus. These can lead to pneumonia or meningitis or blindness due to infection of the cornea.
How dangerous an infection with monkeypox is also depends on the type of virus: There are two types of the virus: the West African type and the Congo Basin type. Although infection with the West African type leads to serious illness in some people, the mortality rate here is lower: it is around one percent – in the Congo Basin type it can be up to ten percent. According to previous information, the recent cases in Great Britain are due to the less deadly West African virus type.
Where does monkey pox come from?
Monkeypox is caused by a comparatively large virus that is closely related to the variola virus. This was the causative agent of smallpox, which has been considered eradicated since 1980.
Compared to smallpox, monkeypox can affect many animal species, including various mammalian species such as rodents or monkeys. Most cases of monkeypox infections in humans are so-called zoonoses. This means that the viruses are transmitted from animals to humans. Transmissions of the virus are most common in forested areas of central and western Africa.
According to the RKI, monkeypox is one of the “re-emerging diseases”. This means that the disease is spreading again after it was already on the wane. In recent decades, outbreaks have increased, particularly in West and Central Africa. According to the African Union health organization, there have been several outbreaks of monkeypox infections during the corona pandemic. However, they hardly caused a stir during the pandemic and are also under control.