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In the laboratory of the Imvanex manufacturer Bavarian Nordic in Martinsried near Munich
Photo: Lukas Barth / REUTERS
Fever, headache and muscle pain and a rash that often starts on the face and then spreads to other parts of the body - according to the World Health Organization (WHO), dozens of cases of monkeypox have been confirmed since the beginning of May in countries where the virus does not normally occur.
Although most people recover from an infection within a few weeks, the question arises as to how the pathogen can be contained.
Vaccination is one of the building blocks.
According to Health Minister Karl Lauterbach (SPD), Germany has ordered "up to 40,000 doses" of smallpox vaccine in case monkeypox spreads further.
According to Ralf Bartenschlager, President of the Society for Virology, these could be tight.
"Nevertheless, this is a good start, especially for vaccinations in the area of known infection clusters, which will probably allow the outbreak to be clearly narrowed down," says Barenschläger, who works at Heidelberg University Hospital.
“We don't know how the outbreak is developing.
Therefore, you should start with these vaccinations quickly.
Otherwise, if the pathogen spreads further, it will become more and more difficult to contain it.«
Vaccination unlikely for the general population
The head of the Standing Vaccination Commission (Stiko), Thomas Mertens, told the Rheinische Post on Wednesday that preventive vaccination of risk groups should be examined.
“We are currently thinking about it and it could possibly make sense.” Mertens said of a possible vaccination of the entire population: “It is currently very unlikely.” Above all, people with frequently changing sexual contacts are considered a risk group.
The infections reported so far have mainly affected men who have sex with men.
Lauterbach said on Tuesday the ordered vaccine, called Imvanex, is also approved for monkeypox in the United States, where it's marketed under the name Jynneos.
It is about being prepared for any vaccinations that may be necessary for contact persons of infected people.
This is already happening in the UK.
You have to see how far you can get with it, said Bartenschlager.
“Two doses 28 days apart are required per person.” So it takes a few weeks for adequate immunity to develop.
In this respect, a certain lead time is required for the vaccination.
There is also the question of how quickly the cans can be delivered.
"We're working against the clock here again." It should also be borne in mind that there are many events in early summer where the virus could spread.
Manufacturer sees no problems
The manufacturer of the monkeypox vaccine Imvanex assumes that it can supply sufficient vaccine.
"We believe that we can meet global demand without further investments in our production facilities," said a spokesman for Bavarian Nordic on Wednesday.
The production of 30 million cans per year is currently possible.
The company is headquartered in Denmark, where production also takes place.
However, the vector vaccine was developed in the German branch in Martinsried near Munich.
Bartenschlager said the data on the Imvanex vaccine, which has so far only been approved for human smallpox in the EU, is sparse.
Assumptions about possible protective effects even in people who are already infected are based on small case numbers and animal experiments - but one can assume good effectiveness.
Before it can be used in Germany, the European Medicines Agency (EMA) must extend the approval to include monkeypox.
However, it is also possible to use it off-label, i.e. at the doctor's discretion, without waiting for official approval.
Older people benefit from compulsory smallpox vaccination
There are no approved vaccines specifically against monkeypox in Europe.
However, experts assume that conventional smallpox vaccines offer some protection.
Much of the elderly population is immunized against the variola virus, which causes smallpox.
First vaccinations were mandatory in the Federal Republic of Germany until 1976 and until 1982 in the GDR.
Compulsory vaccination was part of a worldwide campaign started by the World Health Organization (WHO) in 1967 and ended in 1980 as a rare success against infectious diseases: Since then, smallpox, also known as smallpox, has been considered eradicated;
the last natural fall was recorded three years earlier.
The disease, which raged for thousands of years and claimed the lives of three out of ten infected people, according to the CDC, is closely linked to the beginning of vaccination history.
The first well-documented successful vaccination against smallpox was done by the English country doctor Edward Jenner in 1796: he first administered cowpox viruses to a boy, a pathogen related to smallpox that causes less serious illness.
The word vaccine is derived from the Latin vacca for cow.
Even after the smallpox was eradicated, people were again aware of the danger of smallpox: due to the attack on the World Trade Center in the USA, many countries stocked up on smallpox vaccine for fear of bioterrorism.
Real human pox viruses capable of replication are stored in the USA and Russia, as the virologist Norbert Nowotny from the Institute of Virology at the University of Veterinary Medicine in Vienna said.
»In retrospect, however, one has to admit that the fears of bioterrorism after 2001 were irrational.
After all, using smallpox as a weapon would be totally uncontrollable.”
100 million doses in stock - probably useless
The federal government has stored about 100 million doses of smallpox vaccine, according to a report for the Bundestag health committee.
However, due to the expected side effects, this vaccine is not suitable for use against monkeypox, said Federal Health Minister Lauterbach.
"The older smallpox vaccine has many side effects, and it also contains reproductive viruses that could spread in the body of immunocompromised people," said Stefan Kaufmann, director emeritus at the Max Planck Institute for Infection Biology in Berlin.
According to the Viennese specialist in vaccination and travel medicine, Herwig Kollaritsch, about a quarter of the population would no longer be vaccinated today due to contraindications such as immune deficiencies.
There is also a newer smallpox vaccine.
The basis is a further development by the microbiologist Anton Mayr in Bavaria in the 1960s: A vaccine virus weakened in the laboratory is used to generate an immune response against smallpox, said Kollaritsch.
Experts speak briefly of MVA vaccination (MVA: Modified Vaccinia Virus Ankara).
Imvanex "would be nonsense for the general public"
“This vaccine was used for a time in the 1960s, but never on a large scale.
It is better tolerated, the virus can no longer reproduce," said Kollaritsch, who is a member of the Austrian counterpart to the Standing Vaccination Commission (Stiko).
In contrast to the first smallpox vaccination, no vaccination scar forms.
With the vaccine, however, he sees the problem of a fairly uncertain vaccination effectiveness in practice in view of the eradicated disease.
"But one can assume protection with a probability bordering on certainty."
The MVA vaccine Imvanex has been approved in the EU for adults against smallpox since 2013.
The WHO recently pointed out that the drug is not available across the board.
Kollaritsch therefore sees the newer vaccine as an instrument to vaccinate people who are at high risk of being exposed to the pathogen.
As an example, he cites the staff of special isolation wards that care for infected people.
'For the general public this vaccination would be nonsense.
Monkeypox is much more harmless than smallpox and of much lesser importance in terms of epidemiological infection.
We also have to consider that there is very good therapy available for those who are infected," says the expert.
Isolation instead of vaccination
Virologist Nowotny also emphasized: “There is a huge difference between monkeypox and corona.
It won't be a pandemic this time.
I assume that the spook will be over in a few weeks to a few months.” The monkeypox pathogen is a DNA virus – which means it is much slower than Sars-CoV-2 and hardly mutates.
Variants will therefore not be seen so quickly.
He also doesn't assume that vaccines have to be specially adapted for monkeypox, Nowotny said.
The mortality rate for the West African strain of monkeypox, which has so far been proven to be common in Europe, is one percent in the literature.
"In Western countries, however, lower values can be assumed." In addition, the pathogen spreads much more slowly than, for example, Sars-CoV-2.
According to the Robert Koch Institute (RKI), monkeypox is transmitted from person to person through close physical contact.
The overall risk from the disease is estimated by health authorities to be moderate for people with multiple sexual partners and low for the general population.
According to the RKI, in most cases the symptoms go away on their own within a few weeks, but in some people they could lead to medical complications and death.
The RKI stated that according to current knowledge, close contact is required for pathogen transmission, "so it can currently be assumed that the outbreak will remain limited".
Isolation or quarantine is recommended for infected people and their close contacts.
From an expert's point of view, contacts of infected people must be traced exactly, which is not that easy in detail: According to the RKI, the incubation period is 5 to 21 days.
ak/dpa
