Monkeypox infections in twelve countries

Sun 22nd May, 2022

Experts are at least certain of one thing in view of this unusual series of outbreaks: monkeypox cannot be compared with Covid-19, and a pandemic with millions of sufferers is not to be expected. The virus does not spread quickly or effectively enough for that. But compared to what has been observed in past decades, the current trend is very unusual. Since 1970, monkeypox has been recorded in a total of twelve countries in West and Central Africa. Now, suddenly, in the course of just a few days, cases have been added in as many more countries. 92 confirmed infections from twelve countries were reported to the World Health Organization (WHO) between May 13 and May 22. The affected countries include Great Britain, Spain, Portugal, Italy, the USA, Canada and Germany.

Currently, three cases are known in Germany, with one patient being treated in Munich and two others in Berlin. The condition of all three sufferers has been described as stable. About the Munich patient, attending physician Clemens Wendtner of Schwabing Hospital reported, "The patient is still doing well, he has relatively few symptoms." He said the 26-year-old had skin lesions in several places, but was not feverish or suffering from respiratory distress. The young man is in a single room with an upstream airlock, he said. "There is negative pressure in the patient room so that no air can escape uncontrolled to the outside. The exhaust air is additionally purified by a virus-tight filter system," says Wendtner, who heads the clinic's infectious diseases department.

So far, the infections have not claimed any lives. With the strain of virus identified so far, the mortality rate is estimated at about one percent. "However, one must keep in mind that these data from Africa are not necessarily transferable to the health care system in Europe or the U.S.; in our country, the mortality rate would tend to be lower," Wendtner qualifies. Most of those who contract the disease can hope for a mild course; the symptoms subside on their own after about two to three weeks. Like other experts before him, Wendtner said: "This is a disease that, in my opinion, does not have the potential to pose a massive threat to the population.

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

In Europe, a vaccine called Imvanex has been licensed since 2013, which was developed against human smallpox, which has already been eradicated, but is also effective against monkeypox. According to the U.S. Centers for Disease Control (CDC), it can still be administered even after infection. If it is injected within four days of infection, it could prevent the onset of symptoms, it said.

Discussions are currently underway as to 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 achieve a rapid containment of the infection. This should be discussed and consented to as a voluntary vaccination offer in the currently still early infection wave". The vaccination offer could be made to risk groups with immunosuppression, for example HIV patients without sufficient drug disease control, but also to tumor patients, the scientist suggests. Great Britain already offers vaccination to contacts of infected people.

However, the WHO has since warned that global vaccine stocks are limited. According to Wendtner, Germany has also failed to secure substantial quotas of this vaccine in recent years, even though it was developed and is produced just outside Munich, at Bavarian Nordic in Martinsried. Instead, the Federal Republic has relied on the old first- and second-generation smallpox vaccine, which is much less well tolerated and therefore hardly suitable for selective vaccination of vulnerable groups of people with monkeypox.

Although interest in the vaccines is likely to be high in currently affected countries, Piero Olliaro, an infectious disease specialist at the University of Oxford, cautions, "We also need to ensure that these products are available and affordable for endemic countries and not hoarded for use in high-income countries."

There is no clarity yet on the possible causes of the current infections. One cause could be declining immunity in the population. Until 1980, most people were vaccinated against the human form of smallpox. The immunization, recognizable by the round scar on the upper arm, was about 85 percent effective against monkeypox, according to the WHO. But since the eradication of classical smallpox, more and more people lack this protection. By now, about 70 percent of the world's population may no longer have immune protection against monkeypox, researchers estimated in 2020 in the journal Vaccine.

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

Meanwhile, a rapid end to the outbreak wave is not yet in sight. WHO calls it highly likely that more cases will emerge in other countries and other populations in the coming days.

At the same time, it confirmed that the illnesses have been observed predominantly - but not exclusively - among homosexual and bisexual men. According to media reports, Spain is investigating whether a festival on the vacation island of Gran Canaria, attended mainly by homosexual men, may have played a role in the spread of the diseases. The event, called "Maspalomas Pride," was attended by about 80,000 visitors from May 5 to 15. However, it is still only a matter of suspicion.

Jeremy Farrar, an infectious disease specialist and director of the U.K.-based Wellcome Trust, cautioned that it is immensely important to secure the trust of affected groups. "We must not associate a stigma with these diseases as in previous cases. This would lead to infections remaining hidden, in addition to the suffering of those affected," Farrar told SZ: "By doing so, we risk a much bigger outbreak than we have so far." He also added, "Monkeypox is not Covid-19."

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