What we know about symptoms, vaccination and contagion

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Will: Pamela Dorhofer

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Monkeypox under the electron microscope.  (Best possible image quality).  A case of monkeypox has also been detected in Germany for the first time.
Monkeypox under the electron microscope. (Best possible image quality). A case of monkeypox has also been detected in Germany for the first time. © Essbauer/dpa

In Europe and worldwide, more and more people are currently infected with monkeypox. The World Health Organization and the Robert Koch Institute have been notified.

LONDON – Several people have contracted monkeypox in the UK. The first case was discovered on May 7 in a traveler returning from Nigeria. However, six other people appear to have been infected in the UK with no known contact with anyone who has previously been to West or Central Africa (where the virus is most prevalent).

According to the Epidemiological Bulletin of the Robert Koch Institute (RKI), there are two cases in a family and four cases in men who have had sexual contact with other men (a possible route of infection). As RKI reports, it is believed that these six people were infected in London and investigations have begun. In the meantime, there is also the first case in Germany.

The World Health Organization is alarmed: monkeypox is multiplying

According to the World Health Organization (WHO), all those affected contracted the West African variant of the monkeypox virus. There is also a dominant variant in the Congo Basin. Even though there have been only a few cases so far, health authorities are at least vigilant, as this is the first known transmission of the pathogen unrelated to Africa.

All documented cases outside of Africa have so far been attributed to travelers or contact with infected imported animals. In 2003, for example, there was an epidemic in the United States caused by prairie dogs. It turned out that they had contracted rodents imported from Africa before they were sold.

Don’t Underestimate Monkeypox: ‘Potentially Global Danger’

As the scientific magazine Spektrum.de writes, the number of infections and epidemics is increasing significantly for “reasons which are not yet clear”, “which is why monkeypox is considered a potential global danger “. According to the RKI, an increasing number of cases have been reported in Nigeria especially since 2017. The report on Spektrum.de says African experts have warned that monkeypox could grow from an infectious disease prevalent in the region to a “globally relevant disease”.

Britain’s cases are seen as an indication that the virus is changing its behavior. A research team from the American University of Nigeria reportedly suggested in a 2020 publication that the monkeypox virus may occupy the “ecological and immunological niche” once occupied by the smallpox virus.

Rodents are the main propagators: contagion by droplet infection

Rodents (and to a lesser extent monkeys) are suspected to be the main reservoirs of pathogens, especially squirrels, rats and dormice. Like many other infectious diseases, monkeypox is a zoonosis. They were first found in humans in 1970 in a boy in the Democratic Republic of Congo (then Zaire). Since then, most cases have been reported in tropical rainforest areas of 11 African countries. According to the WHO, the true number of infections is not known.

You can become infected through contact with infected animals or by eating them, but human-to-human transmission is also possible: through blood and other bodily fluids, through infection through droplets, through fluid from pustules and scabs or by contaminated materials such as used towels. The incubation period is 10 to 14 days on average.

Monkeypox viruses cause skin lesions and fever

Monkeypox is caused by viruses of the genus Orthopoxvirus, they are related to classic smallpox, eradicated since 1980, but the disease is milder. Early symptoms include sudden onset of fever up to 40 degrees, severe headache and body aches, sore throat, cough, exhaustion and swollen lymph nodes.

After about one to three days, the typical skin changes appear, which appear as spots, nodules, blisters and pustules, crust over and eventually fall off. The face, palms and soles of the feet are particularly affected, less frequently the genitals, the conjunctiva and the cornea. In severe cases, there is a risk of blindness. The disease usually heals in two to four weeks.

Sudden fever up to 40 degrees
Severe headaches and body aches
Sore throat
Cough
exhaustion
Swollen lymph nodes
Skin changes in the form of spots, nodules, blisters and pustules

No smallpox vaccine in Germany

In addition to immunocompromised patients, younger people and children are particularly at risk of severe developments. In pregnant women, the infection can lead to miscarriage. Even though the RKI rates the overall prognosis as “favourable”, monkeypox can be fatal, the proportion is estimated at two to ten percent, with the West African variant being the mildest.

The fact that those under 40 are often more seriously ill than older people could be related to the fact that these cohorts no longer received a smallpox vaccine. With the eradication of smallpox, the global immunization program came to a halt. The live classical smallpox vaccine also provides some protection against monkeypox. There is currently no approved smallpox vaccine in Germany.

Danger for the weak population: possible symptoms can be treated

Treatment is usually aimed at relieving symptoms or preventing secondary bacterial infections. Tecovirimat, a monkeypox drug developed in the United States, was also approved in the European Union in January 2022. However, it is not yet widely available.

Arboviruses are also spreading and the WHO warns of another possible pandemic.

The RKI warns that “in case of a suspicious clinical picture”, monkeypox infection should at least be included in the diagnostic considerations, especially for those returning from a trip from (West) Africa, but also for all other people with unclear smallpox. – like skin changes. However, the British health authority UK Health Security Agency assumes that the risk to the population has so far been low. (Pamela Dorhofer)

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