So far 21 cases in Germany: a large part of the monkeypox outbreak remains a mystery

Already 21 cases in Germany
Much about the outbreak of monkeypox is still a mystery

by Kai Stubel

The number of monkeypox cases outside Africa is increasing. There are now more than 400 worldwide. The sudden appearance continues to baffle researchers. German professional associations are now urging quick action – before it becomes impossible to get rid of the virus.

The monkeypox virus appears to appear out of nowhere in many countries, although for several years it was only native to West and Central Africa. According to the Global Health Research Network, there are now more than 430 confirmed cases in non-endemic countries, according to the Robert Koch Institute (RKI), so far there are 21 infected people in six federal states in Germany. Many questions remain open – including whether the pathogen can be contained again.

Several medical and scientific professional associations in Germany wrote in a joint statement that “the current infection process is dynamic with an increasing number of cases.” It is “difficult” to assess the extent of the outbreak, and the same is true for tracing contact chains due to the long incubation period of one to three weeks. And trade unions are urging “rapid and consistent action” – such as target group education, isolation of infections, and quarantining of close contacts and suspected cases.

What’s new in the global outbreak of monkeypox: Most cases outside Africa have no direct travel link to an endemic area. The virus is native to West and Central Africa, and according to the World Health Organization, more than 1,200 cases have been reported in the Democratic Republic of the Congo alone since the beginning of the year, and 58 infected people have died. In Nigeria, where the virus may have entered the UK a few weeks ago, it is already circulating in an ongoing outbreak since 2017. It is known that different types of animals can contract monkeypox, but it is not known exactly which animal caused the outbreak in Nigeria .

No evidence of genetic adaptation.

Researchers around the world are also concerned about why the virus’s behavior is different from previous outbreaks. Virologist Thomas Mittenletter, head of the Friedrich Loeffler Institute, said in an interview with NTV. Other experts point out that the monkeypox genome is not as easy to analyze as the SARS-CoV-2 genome, for example, because it is about six times larger. The genomes of the smallpox virus are full of mystery, Elliott Lefkowitz, a computational virologist at the University of Alabama, told Nature.

It’s also unclear whether the current cases outside Africa are due to a single returnee from Africa, which the researchers believe is most likely – or whether they also stem from earlier records. The World Health Organization (WHO) currently assumes undetected transmission over a longer period of time due to the simultaneous and sudden emergence of the virus in several countries.

But there are still many unanswered questions about the transmission path. Until now, contact with pests – blisters and blisters – as well as body fluids and droplets from the breath of infected people or animals have been considered potential routes of transmission. However, since the virus has recently spread mainly among men who have had sex with other men, it is also possible that monkeypox has adapted to sexual transmission.

Already “transfers within the family”

In the currently known non-endemic cases, men are most often affected, but women are also sometimes affected, according to data from World Health. German trade unions assert that there have indeed been “transmissions within the family”. They also warned against “entering the animal kingdom”. The main concern is that monkeypox virus also takes root in animals outside of Africa, where it can repeatedly lead to new outbreaks in humans. “There will certainly not be a new pandemic,” smallpox expert Gerd Sutter told Spiegel. “But I’m afraid monkeypox will settle here.”

Lucky in disguise: According to current knowledge, international cases of monkeypox are the Western variant of the virus in Africa, which is considered milder. According to the RKI, symptoms, which include a prominent rash, usually go away on their own within a few weeks, but can lead to medical complications and, very rarely, death in some people. However, no deaths from the virus have so far been reported outside Africa.

For the West African variant, a case fatality rate of about one percent is assumed, according to other sources at three to four percent. However, the data comes from Africa, where the population is much younger. According to the World Health Organization, the few deaths in West Africa since 2017 are mainly related to young people or infection with untreated HIV. The monkeypox type in Central Africa is considered more dangerous, with a mortality rate of about ten percent. But recently, according to the World Health Organization, the Democratic Republic of the Congo has reported a case fatality rate of just three percent.

Circular vaccination could be the solution

Most experts currently assume that the current outbreak of monkeypox can be contained. Virologist Mettenleiter also pointed out to about existing drugs and vaccines – so in emergency situations, “circular vaccination” is possible to reduce transmission. The federal government has already ordered doses of the monkeypox vaccine, and according to Health Minister Karl Lauterbach, about 40,000 doses could be delivered in June, and another 200,000 later this year.

The intended vaccine, Imvanex, is a vaccine developed against human smallpox that, according to the World Health Organization, is also 85 percent effective against monkeypox. The United States began distributing the vaccine on Monday last week. So far, the World Health Organization sees no need for mass vaccination.

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