The first case of monkeypox, originally from Africa, was confirmed in Germany. As the Bundeswehr Institute for Microbiology announced on Friday in Munich, the virus was unequivocally detected in a patient on Thursday. The patient, who is doing relatively well according to the treating hospital, showed the characteristic skin changes.
The Charité infectiologist Leif Sander described monkeypox on Twitter as less pathogenic than smallpox, but it was “nevertheless a serious and in some cases fatal disease”.
The first reported monkeypox patient in Germany is a 26-year-old from Brazil. This was announced by the Bavarian Ministry of Health on Friday. He traveled from Portugal via Spain to Germany and has been in the Bavarian capital for about a week. He had previously been to Düsseldorf and Frankfurt am Main.
The patient is now being isolated in a ward at the Munich Clinic Schwabing, the ministry said. “Further close contacts are currently being identified by the health department of the city of Munich,” said Bavarian Health Minister Klaus Holetschek. “They are explained in detail and informed about possible symptoms, hygiene measures and transmission routes.”
After detecting the first case of monkeypox in Germany, Federal Health Minister Karl Lauterbach (SPD) assumes that the outbreak can be contained. “It was only a matter of time before monkeypox was also detected in Germany,” said Lauterbach on Friday in Berlin. He does not assume that there are many unreported cases in Germany.
The reports from Great Britain and other countries as well as quick information from the Robert Koch Institute (RKI) have “sensitized” doctors and patients in Germany. “Based on the knowledge available so far, we assume that the virus is not so easily transmitted and that this outbreak can be contained,” emphasized the minister. “But that can only succeed if you act quickly.” The virus is now being analyzed more closely and it is being checked whether it could be a more contagious variant.
According to the British Health Security Agency, the first signs of monkeypox can be: fever, headache, muscle and back pain, swollen lymph nodes, chills and exhaustion. A rash can develop, which often spreads to other parts of the body, starting from the face. The rash looks different depending on the phase and can resemble chickenpox and syphilis.
The disease is named monkeypox after the pathogen was first detected in monkeys in 1958. According to experts, monkeypox probably originated from rodents such as squirrels and rats. The virus then spread to monkeys and humans, for example by eating meat from infected animals. Transmission between people can happen through close contact, for example through body fluids and the rash. Smear infections on surfaces are also possible.
Transmission via the respiratory tract is more limited to shorter distances and larger droplets, says Fabian Leendertz, founding director of the Helmholtz Institute for One Health (HIOH) in Greifswald.
The RKI gives the incubation period for monkeypox as seven to 21 days. Compared to human smallpox, which was eradicated in 1980, monkeypox would usually be much milder. Most sufferers would recover within a few weeks. However, severe courses can also occur in some of those affected.
There is a greater danger for children under the age of 16: According to observations, up to eleven percent of infected children died here. This observation relates to the Central African virus variant. The West African variant is apparently less contagious. The recently reported cases in Great Britain are assigned to the West African tribe.
Based on the large number of cases in other Western countries, Norbert Brockmeyer, President of the German STI Society, assumes that the virus has been circulating unnoticed for a while: “Who still thinks of smallpox today?” Because of the increased attention According to recent reports from Great Britain, a new awareness of infection and thus increased evidence can now be expected.
According to Norbert Brockmeyer, people who have sexual contact with many different people are most at risk. In principle, the virus can also be transmitted through close physical contact.
Brockmeyer also believes caution is advisable in the general population. “But there must be no hysteria. The monkeypox will be easy to control.”
Several agencies should now know about and be informed about monkeypox: HIV specialist practices, centers specializing in sexually transmitted diseases, the public health service and general practitioners. In addition, of course, there is also the general public, so that one thinks of this disease when unusual skin changes occur.
Other experts see no reason to panic either. “The cases of contact tracing can be isolated well, and there are also drugs and effective vaccines that can be used if necessary,” says Fabian Leendertz. The virologist Gerd Sutter from the Ludwig Maximilians University in Munich estimates the risk of a major epidemic in Germany or Europe to be low. “The possibility of the virus entering animal reservoirs in Europe also seems unlikely.”
One possible reason for the surge in cases could be increased travel after most coronavirus restrictions were lifted, said Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine. According to Anne Rimoin, an epidemiologist at UCLA in California, the end of smallpox vaccines, which also protect against monkeypox, has led to a rise in monkeypox cases in areas where the disease is endemic.
From a scientific point of view, it is now necessary to check how contagious the virus is and whether it is a mutated, more contagious variant. “Unfortunately, we have a huge population in Germany that has not been vaccinated against smallpox – especially in the sexually active age,” said Norbert Brockmeyer from the German STI Society. The potential for infections caused by the pathogen is therefore significantly greater than it was 20 years ago. Depending on further developments, smallpox vaccinations should be considered.
“There are still major gaps in knowledge about the types of transmission,” Charlotte Hammer, an infectiologist from Downing College Cambridge in the UK, told the Science Media Center (SMC). RKI project group leader Fabian Leendertz added: “We urgently need good epidemiological data to understand whether and how the cases are related”.
Now it is important to analyze the monkeypox virus. This is to provide clues as to its origin. It can also be used to find out whether the pathogen has changed. “I would already call this an epidemic, but it is very unlikely that this epidemic will last long,” says Fabian Leendertz. The cases are well defined.
In view of the cases of monkeypox in several countries, some of which affect gay men, the German Aidshilfe warns against false conclusions and stigmatization. “Of course, there are superficial similarities between monkeypox and HIV back then – it’s another disease from Africa that also affects gay men. But the comparison doesn’t fit in many other respects,” said AIDS spokesman Holger Wicht of the German Press Agency.
In contrast to HIV, the virus that causes monkeypox was known longer in the 1980s, and the disease also healed on its own. “It is very important to us that panic and unreasonable fears do not arise here.” However, there are still uncertainties when assessing the severity of the disease: It is unclear, for example, how well immunocompromised people – this can include, for example, HIV-infected people who have not been treated for many years – get the disease cope.
After the experience with HIV, one fears the stigmatization of gay men and people from Africa, said Wicht. He also recalled the exclusions and finger pointing at the beginning of the Corona pandemic, which were directed against people from Asia – and against people who were perceived as Asian.
The Robert Koch Institute (RKI) was also criticized in this context, which, like the British health authority UK Health Security Agency (UKHSA), had issued a warning to men who have sex with men.
Aidshilfe spokesman Wicht emphasized that the issue should be approached with reason and education rather than fear, as with other sexually transmitted infections. The target group is addressed and informed in coordination with the RKI.
Infections with the virus are now being reported from more and more countries. The World Health Organization (WHO) called for a follow-up of all contacts of those affected. Countries with reported or suspected cases include Australia, Canada, the US, France, Spain, Portugal, the UK, Italy and Belgium. Dozens of suspected and confirmed cases of monkeypox have been reported since early May.
Following mounting evidence of monkeypox infection, Britain has reportedly bought smallpox vaccine, which is said to offer some protection against the disease. The BBC reported on Friday, citing the British government. It was initially unclear how much vaccine was purchased and who should be vaccinated with it. A spokeswoman for the British health authority said the vaccine should be offered to people at higher risk of infection. The risk to the general population remains very low, it said.
Nine cases of monkeypox have been recorded in England in the past few weeks. Even if the smallpox vaccine is not specifically tailored to the monkeypox virus, it should offer some protection – especially against more serious diseases. Routine vaccination against smallpox in Britain was phased out in the 1970s, according to the BBC, when the disease was declared eradicated in the country.