On Saturday, the World Health Organization (WHO) declared the monkeypox outbreak an "emergency of international concern" - the highest alert level it can declare. As of Saturday, more than 16,000 confirmed cases were registered in 75 countries and territories and five deaths so far.
In view of the situation, an expert calls for better arming against future epidemics. "Our world is becoming increasingly vulnerable to infectious disease outbreaks," said Josie Golding, chief epidemiologist at the British research institute Wellcome Trust, on Saturday.
"As monkeypox cases continue to rise and spread to more countries, we now face a dual challenge: an endemic disease in Africa that has been neglected for decades and a new outbreak affecting marginalized groups," she wrote. International cooperation must be strengthened.
Research must clarify why one sees new transmission patterns in monkeypox and what one can do about it. "We cannot afford to wait for diseases to escalate before intervening."
The WHO classification is intended to encourage the governments of member countries to take measures to contain the outbreak. The wide spread of the disease is extremely unusual. So far, monkeypox has been largely confined to six African countries. According to the WHO, Europe is the region of the world with a particularly high risk of infection, and Germany is also affected.
no The outbreak is currently largely focused on men who have sex with men. However, according to the health authority CDC, two cases in children have now been confirmed in the USA. Both were detected this week, CDC Deputy Chief of High-Risk Pathogens and Pathology Jennifer McQuiston said Friday night. There are now more than 2,800 confirmed cases in the United States.
In today's society, it's normal to be in contact with a lot of different people, McQuiston said. "And while this outbreak is spreading on a specific social network right now, we've made it clear from the start that there can be cases outside of those networks too, and that we need to be vigilant and ready to respond."
Monkeypox is an infectious disease originally transmitted from animals to humans primarily by viruses. In Africa, monkeypox has been identified in a wide variety of animals, primarily rodents and several species of monkeys. The virus can also be passed from person to person.
In 1970, monkeypox was first detected in humans in Zaire, now the Democratic Republic of the Congo—a region where smallpox had been eradicated two years earlier. In the spring of 2003, the first cases were reported outside of Africa, in the United States. Since May, they have also been spreading to other countries, especially in Western Europe, including Germany.
According to a study, 95 percent of monkeypox cases are the result of infection through sexual contact. However, monkeypox is not a sexually transmitted disease and can be transmitted through any type of close physical contact, study author John Thornhill explained.
However, the research suggests that most transmissions are linked to sexual activity - mainly between men who have sex with men. According to the study, 98 percent of those infected were gay or bisexual men. 41 percent were infected with the HI virus, the median age was 38 years.
The symptoms are similar to those of smallpox. These include fever, headache and muscle pain, chills and swollen lymph nodes. Sometimes very painful skin changes develop in the form of spots and pustules, which crust and fall off over time.
The rash mainly appears on the face, palms and soles of the feet. However, skin and mucous membrane changes in the mouth, genitals and eyes are also possible. The skin changes usually last between two and four weeks and heal on their own without treatment.
Humans can contract the virus through contact with the blood and other bodily fluids of sick animals. Transmission from person to person is only possible with close contact. The virus is transmitted through droplet infection, wounds, the contents of the blisters and scabs on the skin or body fluids such as saliva. According to a study, 95 percent of current monkeypox cases are due to sexual contact.
The cases reported in Germany almost exclusively concerned men who have sexual contact with other men. Only a handful of cases in women are known in this country. Pregnant women who have contracted monkeypox can pass the virus on to their unborn child. An infection of the baby is also possible at birth.
Although the disease itself is not completely harmless, the population should not be concerned, says Dr. Gerald Gass, Chairman of the Board of the German Hospital Society. There are mainly two reasons for this. Nevertheless, he defends the long quarantine period.
Source: WORLD / Fanny Fee Werther
Symptoms usually last two to four weeks. Infected people can infect others as long as they have symptoms. In contrast to human smallpox, which has been eradicated since 1980, monkeypox is usually much milder; most people recover within several weeks.
However, severe courses can also occur in some of those affected. In particular, newborns, children, pregnant women, the elderly and people with immune deficiencies can become seriously ill.
Possible complications include skin infections, pneumonia, confusion, and eye infections that can lead to vision loss. The amount of viruses to which a patient has been exposed also plays a role in the course of the disease.
First and foremost, symptoms are treated. A drug developed to treat so-called orthopox was recently approved in the EU for monkeypox as well. The general smallpox vaccine has also been shown to be 85 percent effective against monkeypox. However, vaccinations against smallpox have not been carried out for a long time, as the disease has been eradicated for over 40 years.
In Germany, vaccination with the smallpox vaccine Imvanex, which has been approved in the EU since 2013 and is better tolerated than older smallpox vaccines, is recommended for certain risk groups such as homosexual men with frequently changing partners. According to RKI estimates, around 130,000 people in Germany have an indication for vaccination against monkeypox. However, there is currently a lack of vaccine doses.
Monkeypox usually heals on its own. If necessary, medication can relieve symptoms such as fever and pain. The drug tecovirimat has been approved for patients with severe courses and those with immunodeficiency since January 2022.
According to the Freiburg virologist Hartmut Hengel, the spread of monkeypox is “significantly underestimated at the moment”. They have at least the potential "to give us headaches in the future," said the medical director of the Institute for Virology at the Freiburg University Hospital of the "Badische Zeitung". So far, only several thousand cases of monkeypox have been reported worldwide. “But it is wrong to deduce from this that what is happening is harmless – because you have to look to the future.” The virus is spread in 70 countries. "It has assumed forms of permanent circulation in some countries, including Europe."
"If you wanted to catch the matter, that would mean that you would have to organize consistent vaccination programs worldwide wherever the virus occurs," explained physician Hengel in the interview. "Of course, that's an enormous challenge." However, it is unclear whether the monkeypox virus will continue to be rampant primarily among men who have sex with men - or whether it will be able to free itself from this niche.
In Germany, 2268 cases of monkeypox from 16 federal states have been reported to the Robert Koch Institute (RKI) (as of July 22nd). One hotspot is Berlin, but 87 infections have also been reported from Baden-Württemberg to date.
According to the WHO, it is currently working with experts to find a new name. 30 scientists call for a "non-discriminatory" and "non-stigmatizing" name. The name would unequivocally indicate that the spread and origin of the virus can be traced back to the African continent. This is most evident in the use of photos of African patients to portray smallpox in many media.
Proposals for new names should be made as soon as possible, WHO chief Tedros Adhanom Ghebreyesus said at a press conference in Geneva in mid-July.
The name is also geographically misleading: the virus was first detected in monkeys in a laboratory in Denmark in 1958. However, according to current knowledge, it is more likely to be spread among small rodents. Monkeys are only considered intermediate hosts.
