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Illustration of the monkeypox virus
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SPIEGEL:
Mr. Hoffmann, how many monkeypox patients have you treated?
Christian Hoffmann:
Well over 20 now. Today alone there were seven suspected cases.
It's not that many every day, but the number of cases is increasing and we're just getting started.
According to the Robert Koch Institute, there have been more than 400 cases in Germany so far, but I am sure that there are actually significantly more.
The number of unreported cases is probably very high.
SPIEGEL:
What symptoms do the patients come to you with?
Hoffmann:
Of course you often have very typical skin changes, smallpox, but these can sometimes be very subtle.
Sometimes it is even just a single small, inconspicuous patch of skin.
Many patients complain of fever, headaches and body aches, some have swollen lymph nodes.
When a patient says they probably have a sexually transmitted disease and also a fever, that's a real red flag to me now and immediately suspects monkeypox.
SPIEGEL:
How difficult is it to make the diagnosis?
Hoffmann:
I think the biggest problem right now is that many doctors just don't think about monkeypox.
Therefore, many diagnoses are currently not made.
Of course, one can sometimes mistakenly suspect syphilis at first, with which there are also noticeable skin changes.
Or maybe herpes or shingles if you have smallpox in the vesicle stage.
But if the patient has had a lot of sexual contacts in the last few weeks and especially if he also has a fever, then you should definitely consider monkeypox and have a smallpox swab tested by PCR.
Then the diagnosis is easy.
MIRROR:
What can you pay attention to yourself?
When should you go to the doctor?
Hoffmann:
You shouldn't panic now and constantly check yourself for smallpox.
But the combination of skin changes, fever and a lot of sexual contact is a warning sign.
Then you should go to the doctor really quickly and isolate yourself so that you don't spread the virus further.
SPIEGEL:
It is said that an infection with the West African clade of the monkeypox virus, i.e. with the variant that is currently spreading to so many countries outside of Africa, is rather mild.
Can you confirm?
Hoffmann:
It has not been clearly proven that the West African clade is less dangerous.
According to the World Health Organization (WHO), one of the more than 2,100 cases of monkeypox reported since the beginning of the year has died so far.
But about one in five comes to our hospital because they fear a serious course.
There is always the danger that necrosis will form on the smallpox, meaning that tissue will die.
We have some patients with smallpox on the genitals so widespread that there is concern about these important organs.
SPIEGEL:
The monkeypox virus seems to be spreading particularly rapidly among men who have sex with men.
Do your patients also belong to this group?
Hoffmann:
Yes, and I would even say that a clear risk group can be identified among men who have sex with men: those who really have many different and risky sexual contacts.
Many patients have also had other STDs in recent months.
Contact tracing is often impossible.
However, that does not mean that the virus could not spread to other population groups in the future.
SPIEGEL:
Many patients apparently became infected at two festivals, on Gran Canaria and in Antwerp.
Are your patients included?
Hoffmann:
In the beginning it was like that.
But now we've arrived at the second or third generation of infections, and now it's often no longer possible to reconstruct that precisely.
SPIEGEL:
Do you also have patients who were not infected through sex but through other means?
Hoffmann:
Not yet.
There are reports of household transmissions, but we haven't seen them yet.
Most skin lesions are in the genital area, so I think we can assume sexual contact as a source of infection in all of our cases.
In about ten patients, however, we have already detected the virus in the throat.
And of course that worries us a bit.
It is conceivable that in some cases monkeypox can also be transmitted by droplet or aerosol infection, perhaps even by patients who have no symptoms at all.
In any case, this virus is much less contagious than Sars-CoV-2, otherwise there would certainly be significantly more infections.
SPIEGEL:
Do you think the monkeypox virus will establish itself here and also become endemic outside of Africa?
Hoffmann:
I assume so.
I think monkeypox will establish itself as a sexually transmitted disease outside of Africa, including in Germany.
I'm afraid the time when the virus could have been stopped completely is over.
MIRROR:
Are you sure?
Not many have dared to make this prediction.
Hoffmann:
I'm relatively sure about that, but of course I can also be wrong.
However, I ask myself: How is this virus supposed to go away again?
There's just a lot of sex on this planet.
Events like those in Gran Canaria and Antwerp, where there may have been hundreds of infections, will continue to take place.
As long as no one has been vaccinated, these are ideal conditions for spreading such a virus.
SPIEGEL: To
what extent will monkeypox spread in the future to other population groups than those currently affected?
Hoffmann:
That's difficult to say.
I am assuming that other population groups will also be affected in the future.
But if the virus gets into a population where there are not that many close contacts, then the chains of infection will probably die out relatively quickly.
The monkeypox virus only has two, three, maybe four weeks to spread.
If a straight couple goes to the swingers' club and gets infected there, that couple is probably a dead end for the virus if they aren't off somewhere again the next weekend.
SPIEGEL:
Many older people assume that the smallpox vaccination they received as small children also protects them from monkeypox.
Can you confirm?
Hoffman:
No.
We now have several older men in our practice who have nevertheless contracted monkeypox.
In one case, the infection has now significantly worsened.
This shows that smallpox vaccination, which is usually more than 50 years old, does not offer protection that can really be relied on.
SPIEGEL:
The federal government has ordered 40,000 doses of modern smallpox vaccine.
Will you take part in the planned vaccination campaign?
Hoffmann:
Yes, I hope that we can start with the vaccinations this week.
However, we do not yet know how well the vaccinations will protect against infection, and the vaccination strategy has not yet been decided.
I think it will be difficult to immunize the contact persons of the infected with so-called ring vaccinations, simply because they are often difficult to identify.
That is why we will probably vaccinate as many people as possible who have a lot of risky sexual contacts and who have already been infected with other sexually transmitted diseases.
However, I do not know whether the vaccine is sufficient for all these people.
In our practice alone, over 1000 people are being treated who urgently need the vaccination.
SPIEGEL:
The monkeypox virus was brought to Europe from Nigeria, where there has been a major outbreak of the disease for several years.
Could something like this be prevented in the future?
Hoffmann:
In any case, we can no longer turn a blind eye when an infectious disease is spreading somewhere in a distant country.
Our lifestyle is now such that a stupid coincidence is enough, the virus is in the right place at the right time, and it's already spreading here and affecting us.
The world has become small.
We were lucky this time: the virus is not overly dangerous, it is currently spreading in a limited risk population and there is even a vaccine.
But it won't be the last virus.
And the next one might be more dangerous.
SPIEGEL:
How will things continue now?
Hoffmann:
In the next few weeks, the number of cases will certainly increase again significantly.
Monkeypox has become a huge topic in the gay community.
Many are afraid of the disease and of stigmatization - if, for example, as a teacher or educator you suddenly have to be in quarantine for three weeks, you have to explain yourself.
Many are already behaving very sensibly.
I am optimistic that we can now contain the outbreak with vaccinations, quarantine of those affected and also with temporary changes in behavior so far that the monkeypox will only flare up every now and then.