Monkeypox infections in twelve countries – Knowledge

In view of this unusual series of outbreaks, experts are at least certain of one thing: monkeypox cannot be compared to Covid-19, and a pandemic with millions of sufferers is not to be expected. The virus does not spread quickly and effectively enough for this. But compared to what has been observed over the past decades, the current development is very unusual. Since 1970, monkeypox has been recorded in a total of twelve countries in West and Central Africa. Suddenly, in just a few days, cases were added in as many other states. 92 confirmed infections from twelve countries were reported to the World Health Organization between May 13th and 22nd. States affected include the UK, Spain, Portugal, Italy, the US, Canada and Germany.

Three cases are currently known in Germany, one patient is being treated in Munich and two others are being treated in Berlin. The condition of all three patients was described as stable. The attending physician Clemens Wendtner from the Schwabing hospital reported on the Munich patient: “The patient is still doing well, he has relatively few symptoms.” The 26-year-old has skin lesions in several places, but does not have a fever and does not suffer from shortness of breath. The young man was accommodated in a single room with an upstream lock. “There is negative pressure in the patient room, so that no air can escape to the outside in an uncontrolled manner. The exhaust air is also cleaned using a virus-proof filter system,” says Wendtner, who heads the clinic’s infectiology department.

So far, the infections have not claimed any lives. The mortality rate for the virus strain identified so far is estimated at around one percent. “But you have to keep in mind that this data from Africa cannot necessarily be transferred to the healthcare system in Europe or the USA; mortality would be lower here,” says Wendtner. Most sufferers can hope for a mild course, the symptoms will subside on their own after about two to three weeks. Like other experts before, Wendtner also said: “This is a disease that, in my opinion, does not have the potential to massively endanger the population”.

Why the containment of infections can succeed

At least in theory, monkeypox should be easier to contain than Covid-19. Adam Kucharski, infection epidemiologist at the London School of Hygiene & Tropical Medicine, pointed out on Twitter that the simple epidemiological measures of isolation and contact tracing could be very effective, especially in the case of monkeypox. The virus is usually only transmitted after the symptoms have started. In addition, the time between infection and the onset of symptoms is comparatively long at seven to 21 days. This opens up a window of opportunity for contact tracing – and also for their vaccinations.

A vaccine called Imvanex has been approved in Europe since 2013. It was developed against human smallpox, which has already been eradicated, but is also effective against monkeypox. According to the US disease control agency CDC, it can still be administered even after an infection. If it is injected within four days of infection, it can prevent the onset of symptoms.

It is currently being discussed whether and, if so, how this vaccine should be used. The WHO is currently still consulting with experts on a possible vaccination recommendation. Wendtner calls the vaccination of contact persons “quite sensible in order to quickly contain the infection process. This should be discussed and consented to promptly as a voluntary vaccination offer in the current early wave of infections”. The scientist suggests that the vaccination offer could be made available for risk groups with immunosuppression, for example HIV patients without adequate drug disease control, but also for tumor patients. Great Britain already offers the vaccination to contacts of infected people.

However, the WHO has warned that global vaccine stocks are limited. According to Wendtner, Germany has not secured any significant contingents of this vaccine in recent years, although it was developed and produced at Bavarian Nordic in Martinsried just outside of Munich. Instead, the Federal Republic relied on the old smallpox vaccine of the first and second generation, which is much less well tolerated and is therefore hardly suitable for the selective vaccination of groups of people at risk of monkeypox.

Even if there is likely to be great interest in the vaccines in the countries currently affected, Piero Olliaro, infection specialist at the University of Oxford, warns: “We also have to make sure that these products are available and affordable for the endemic countries and not for use in countries be hoarded with high income.”

There is still no clarity about the possible reasons for the current infections. One reason could be the declining immunity in the population. By 1980, a majority of people were vaccinated against the human form of smallpox. According to the WHO, the immunization, recognizable by the round scar on the upper arm, was about 85 percent effective against monkeypox. But since the eradication of classic smallpox, more and more people lack this protection. In the meantime, around 70 percent of the world’s population no longer has any immune protection against monkeypox, researchers estimated in the specialist journal in 2020 vaccine.

It is also possible that the virus has changed. However, there is still a lack of data to be able to reliably assess this. The fact that many people are traveling and partying again after the restrictions imposed by the pandemic may also have contributed to the development.

A quick end to the outbreak wave is not yet in sight. The WHO says it is very likely that further cases will also occur in other countries and other population groups in the coming days.

At the same time, she confirmed that the diseases were predominantly – but not exclusively – observed among homosexual and bisexual men. According to media reports, Spain is investigating whether a festival on the holiday island of Gran Canaria, which is mainly attended by homosexual men, could have played a role in the spread of the disease. About 80,000 visitors took part in the event called “Maspalomas Pride” from May 5th to 15th. But it’s still just a suspicion.

Jeremy Farrar, infection specialist and director of the British Wellcome Trust, warned that it was immensely important to ensure the trust of the affected groups. “We must not associate these diseases with a stigma, as in previous cases. In addition to the suffering of those affected, this would also mean that infections remain hidden,” said Farrar of the SZ: “We are risking a much larger outbreak than we have been up to now to have.” He also added: “Monkeypox is not Covid-19.”

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