Monkeypox has spread worldwide within a few months. The World Health Organization then declared an "emergency of international concern". What is known about monkeypox and how classification should help contain it.
Why does the WHO speak of an international emergency?
WHO Director-General Tedros Adhanom Ghebreyesus justified the decision with the strong and rapid spread of monkeypox, which is now affecting dozens of countries. This is unusual. So far, outbreaks have been largely limited to Africa. However, a committee of independent experts had been unable to agree on a piece of advice. The fact that Tedros nevertheless declared the highest alert level is intended to underline the urgency of the situation. "It's a very difficult decision," says Jürgen Rockstroh from the University Hospital Bonn. "That is also expressed in the shared vote of the committee members." The data situation is difficult, but the WHO has often been criticized for reacting too slowly to crises.
What does the classification mean?
The WHO classification has no direct practical implications. Above all, it is intended to encourage the governments of the member countries to take measures to contain the outbreak. They should, for example, sensitize doctors, take protective measures in suspected cases, educate the population and provide testing and vaccination capacities. "I do believe that there is a certain benefit for general handling," says Rockstroh. However, the states themselves decide whether to take measures and if so, which ones.
How has the outbreak developed so far?
According to the WHO, more than 16,000 cases of monkeypox were registered in 75 countries and territories over the weekend. The risk of transmission is therefore particularly high in Europe. In Germany, the Robert Koch Institute (RKI) spoke of 2268 cases on Friday. According to the WHO, there have been five deaths so far - according to Rockstroh, they all occurred in Africa. Two cases have recently been confirmed in children in the United States. Rockstroh says that a monkeypox outbreak like this has never been seen before. In some places, however, there are indications that the number of infections is leveling off. The expert does not believe that the pathogen has become more infectious.
How is the monkeypox virus transmitted?
The transmission routes between humans have not yet been conclusively clarified. According to the RKI, the prerequisite is usually close physical contact. The typical skin lesions contain particularly high virus concentrations. However, infections are sometimes also possible through saliva, large droplets and possibly also sperm. In addition, there may be contaminated clothing, bed linen and towels. In contrast to the corona virus, for example, the pathogen is not transmitted by aerosols, for example when breathing, speaking or coughing, as Rockstroh emphasizes.
After a study of more than 500 patients, researchers report that 95 percent were infected through sexual activity - but not 100 percent. According to the RKI, the portals of entry are often skin injuries and the mucous membranes, for example of the genitals, anus, mouth, nose and eyes. According to the RKI, infected people are contagious as long as they have symptoms – usually for two to four weeks. The incubation period is therefore mainly 5 to 21 days.
How does monkeypox infection manifest itself?
After analyzing 528 cases, while 95 percent of the patients had skin lesions, 64 percent had fewer than 10 such lesions. Only one lesion was found in around ten percent of those examined. The skin changes occurred most frequently in the anal and genital areas, followed by the trunk, arms and legs. "Single genital skin lesions and lesions on the palms and soles can easily lead to misdiagnoses like syphilis and other STDs, which in turn can delay detection," writes the team, which includes Rockstroh, in the New England Journal of Medicine. Medical staff must therefore be trained to recognize monkeypox. In case of suspicion, the diagnosis can be clarified by analysis, a smear of mucous membranes or smallpox lesions using a PCR test, says Rockstroh.
For many sufferers, the disease is extremely painful, depending on which area is affected by the skin changes. According to Rockstroh, about 10 percent of those affected are hospitalized - mostly because of severe pain. In general, the therapy is aimed at the respective symptoms.
How well can you protect yourself?
According to Rockstroh, the regular smallpox vaccine Imvanex, which has recently also been approved against monkeypox, offers protection of 85 percent. The vaccination also helps to prevent symptoms after an infection - if it is administered in good time. According to the WHO, 98 percent of those infected are men. Vaccination is particularly recommended in Germany for men who have sex with men and often change partners, because the registered infections have so far mainly affected this population group. For primary immunization, the vaccine is given twice at intervals of at least 28 days. However, there were only about 40,000 vaccine doses in Germany recently, and another 200,000 are expected for the third quarter.
Can the current outbreak still be contained?
Tedros emphasizes that the outbreak can still be stopped. "We have the tools." Rockstroh also believes that containment is possible: "The fact that the numbers in many countries are not so incredibly high and that regions where most of the infections are - i.e. Europe - are already showing flattening curves, at least in some cities, indicates that that measures such as quarantine and also starting vaccination are strategies that can potentially lead to containment."
