- High alert for Mpox - what does that mean?
The World Health Organization (WHO) has declared a "Public Health Emergency of International Concern" (PHEIC) due to the increasing spread of a specific strain of the Mpox virus in Africa. This is the highest alert level, which was also temporarily activated due to the COVID-19 pandemic.
Is a similar development to that of Corona expected?
No. The transmission routes of both viruses differ significantly - and so does their infectivity. Sars-Cov-2 is mainly transmitted through tiny droplets in the air, i.e., the respiratory tract. In contrast, skin-to-skin contact is the main transmission route for Mpox.
This primarily involves close skin-to-skin contact during sex or close hugging, massaging, and kissing, as explained by the Robert Koch Institute (RKI). The risk of infection is particularly high in infected individuals with rashes, wounds, or scabs.
However, Corona is only contagious for a relatively short period - unlike Mpox, where individuals remain infectious until all wounds have healed and a new layer of skin has formed, which can take several weeks according to the RKI.
Mpox transmission is also possible, albeit less frequently, through sex toys, bedding, and towels or surfaces touched by an infected person. In close proximity to an infected person, transmission via droplets is also possible, as stated by the RKI.
What about vaccines?
A protective vaccine is available. It reduces the risk of an outbreak and mitigates the course of the disease. However, there are supply issues with such vaccines in Africa and other countries in the global South.
The German vaccination commission Stiko currently recommends the use of vaccines only for certain risk groups.
Studies on new vaccine candidates are underway, for example, at the company Biontech. The currently approved vaccines were originally developed to protect against smallpox.
Are Mpox and Monkeypox the same?
Yes. Mpox is the shortened form of the English word Monkeypox for Monkeypox. The virus was first described in monkeys, hence the name.
The WHO has established the new name because the term Monkeypox could be perceived as racist and stigmatizing, and various institutions have been asked to rename the disease.
In general, the WHO no longer names diseases after animals or countries where they are discovered to prevent discriminations.
Where does the pathogen come from?
The Mpox virus (MPXV) is related to the classic poxviruses (Variola virus) and cowpox viruses. It has various rodents in West and Central Africa as natural hosts. Monkeys and humans are actually so-called dead-end hosts, to which the pathogens are less well adapted.
The virus has two genetic clades (I and II). The international Mpox situation since May 2022 is due to clade IIb. Infections with clade I viruses have been observed exclusively in West and Central Africa so far.
This year, more than 14,000 suspected cases and more than 500 deaths have been reported from the Democratic Republic of Congo and other African countries - more than in the entire previous year.
Experts believe this could only be the tip of the iceberg because not enough testing is being done and not all infected individuals are seeking medical attention.
What is the situation in Germany?
According to the RKI, there are currently no known cases of clade I in Germany. Currently, there is no increased risk from clade I viruses in Germany, it was stated. The RKI is closely monitoring the situation and will adjust its recommendations if necessary.
From the Klade IIb, the RKI has already recorded around 3,800 cases nationwide, with the majority (around 3,700) occurring from early summer to autumn 2022. Since summer 2023, case numbers have been consistently reported at a low level - in the single to low double-digit range per month.
No deaths have been registered in Germany so far.
What's the situation worldwide?
Sweden has just reported its first confirmed case of the Ib clade outside the African continent, according to government figures. The affected person had previously been in Africa.
The development is being closely monitored, but special infection control measures for the general public are not currently necessary, it was stated.
The European health authority ECDC expects more cases to be reported. However, the likelihood of sustained transmission in Europe is very low, provided imported cases are quickly diagnosed and control measures are implemented.
What are the symptoms?
Unlike smallpox, which was declared eradicated in 1980, Mpox infections in humans are generally milder and resolve on their own, according to RKI information. However, severe courses and, rarely, deaths can also occur, especially in children and people with weakened immune systems.
Symptoms include pimples, blisters, rash, or wounds in the genital or anal area, as well as on other parts of the body such as hands, feet, chest, face, or in the mouth, as explained by the RKI. The skin changes can be very painful. Additionally, general symptoms of illness such as fever, headache, muscle and back pain, chills, or fatigue are common.
Symptoms usually appear 4 to 21 days after contact with infected individuals.
Treatment is primarily aimed at alleviating symptoms.
Wasn't there already a "Health Emergency" due to Mpox?
Yes. The WHO had already declared an emergency due to Mpox in July 2022, with Clade-IIb cases in dozens of countries, including Germany. The emergency was lifted in May 2023, as outbreaks in most countries - also thanks to vaccinations - were brought under control.
The central African viral variant (Clade I) now causing concern apparently causes more severe illness courses than the West African variant (Clade IIb). However, the current data situation does not yet provide secure information on this.
Moreover, in 2023, the Ib clade has been increasingly detected in the east of the Democratic Republic of the Congo, which, according to WHO estimates, indicates a further adaptation of the virus to humans.
What does the highest alert level mean?
There are no concrete consequences. The WHO aims to use this step to encourage increased vigilance among authorities worldwide and hopes for more financial support for containment measures in Africa.
Have there been any reactions yet?
The WHO hopes for more support for the affected African countries, for example in purchasing vaccines.
China's reaction was to tighten entry controls for people from affected countries. Those entering from states with virus cases, who have had contact with Mpox or show corresponding symptoms, should report to customs, it was stated. The WHO recommends against closing borders in response to the virus.
The scientific community is actively researching vaccines to mitigate the impact of Mpox, particularly for individuals in high-risk groups. Currently, a protective vaccine is available that reduces the risk of an outbreak and alleviates the disease's course.
The transmission of Mpox primarily occurs through close skin-to-skin contact, such as during sexual activities or prolonged close contact, as outlined by the Robert Koch Institute (RKI). In contrast, Sars-Cov-2, the virus responsible for COVID-19, is mainly transmitted via tiny droplets in the air.
