Enlarge image
A nurse prepares a test to detect monkeypox: 'Our world is becoming increasingly vulnerable to infectious disease outbreaks'
Photo: Carlos Luján / EUROPA PRESS / picture alliance / dpa
What is monkey pox?
Monkeypox is an infectious disease originally transmitted from animals to humans primarily by viruses.
In Africa, monkeypox has been documented in a wide variety of animals, most notably rodents and several species of monkeys, with the monkey serving only as an intermediate host.
The virus can also be passed on from person to person through close physical contact.
Monkeypox causes skin rashes and pustules, especially on the face, hands and feet, fever and inflammation in the genital and anal regions.
The mortality rate for the variant currently circulating outside of Africa is estimated to be low.
Six people have died during the current outbreak.
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 of this year they have also been spreading to other countries;
especially in the USA and Western Europe, including Germany.
How does the WHO act?
The World Health Organization (WHO) declared the monkeypox outbreak an "emergency of international concern" about two weeks ago - the highest alert level that it can declare.
So far, it has only been proclaimed six times - most recently in January 2020 due to the rapid spread of the then novel coronavirus Sars-CoV-2 - this happens in the event of a "serious, sudden, unusual and unexpected" health problem that can spread to other countries.
At an emergency meeting on monkeypox in June, the experts advised WHO Secretary-General Tedros Adhanom Ghebreyesus not to declare the highest alert level.
Since then, however, the cases of infection have continued to spread.
Tedros said the monkeypox outbreak was "focused on men who have sex with men, especially those with multiple sex partners."
Accordingly, the spread can be stopped “with the right strategies”.
The WHO chief called on all countries to take measures to protect those affected.
What are the implications of the WHO classification?
Initially, this has no practical consequences.
The classification as an “emergency of international concern” is intended to encourage the governments of the member countries to take measures to contain the outbreak.
They are intended to sensitize doctors and clinics, take protective measures in suspected cases and educate the population on how to protect themselves from infection.
The USA has now reacted and declared a national emergency on Thursday after the number of infections there had increased to 6,600.
This should allow funds to be released to fight the virus.
Depending on the disease, the WHO sets up emergency committees, which are staffed with different experts.
In addition to Covid-19, there has also been an emergency situation due to polio outbreaks since 2020 (since 2014).
Completed emergencies included outbreaks of H1N1 swine flu (2010), Zika virus (2016), and Ebola (2014-2016 and 2019).
What measures must the Germans expect now?
For the time being, the general population does not have to prepare for such measures as with the corona pandemic in the case of monkeypox.
While the corona virus spreads through aerosols with virus particles that infected people expel when they breathe, speak or cough, according to the current state of knowledge, monkeypox infections usually occur through close contact, for example in families, and above all through sexual contact.
What is the current status of distribution?
The WHO sees “a clear risk” of further international spread.
So far, 2887 cases of monkeypox have been reported in Germany (as of August 5).
"According to current knowledge, the transmissions in this outbreak primarily take place in the context of sexual activities, currently especially among men who have sexual contact with other men," writes the Robert Koch Institute (RKI).
So far, only six female cases have been reported in Germany, and all of the cases, with the exception of two young people, are adults.
In Europe, alongside Germany with the Berlin hotspot, Spain, Great Britain and France are also most affected.
Six people have died from monkeypox in the past seven days, two in Spain, one in Peru, one in India, one in Ghana and one in Brazil.
Pre-existing conditions or an immune deficiency were found in almost all of the fatalities.
What symptoms can occur?
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 mostly 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.
How exactly is the disease transmitted?
more on the subject
Scarce vaccines: Stiko recommends one dose of monkeypox vaccination first
Doctor about monkeypox: »The time when you could have stopped the virus completely is over« An interview by Veronika Hackenbroch
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.
In rare cases, people can also become infected via surfaces, such as shared towels or bed linen.
The cases reported in Germany almost exclusively concerned men who had 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.
According to the CDC, two cases in children have now been confirmed in the United States.
The case of a nine-year-old in the Netherlands caused a stir because, despite all efforts, it was not possible to find out where he had been infected.
This is another indication that the monkeypox outbreak could be spiraling out of control.
How dangerous is monkeypox?
Symptoms usually last two to four weeks.
Infected people can infect others as long as they have symptoms and the smallpox scabs have not completely healed.
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, encephalitis, meningitis or sepsis, 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.
Is there a therapy or vaccination?
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.
How are researchers reacting to the outbreak?
“Our world is becoming increasingly vulnerable to infectious disease outbreaks,” said Josie Golding, chief epidemiologist at the Wellcome Trust.
The classification should remind government leaders of the current weaknesses of the global community to meet such challenges.
"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.”
abl/kry/AFP/dpa
