What does the Mpox alert mean for Germany?
Due to the rapid increase in the number of Mpox cases in Africa, possibly due to a particularly dangerous subvariant of the virus, the WHO has declared an "international emergency". Experts consider it possible for the disease to spread to Europe, but they warn against panic.
For the second time since 2022, the World Health Organization (WHO) has declared the highest level of alarm due to the spread of the Mpox virus. It is predominantly a subvariant of the pathogen that may be more easily transmitted and lead to more severe illnesses. German experts consider this step necessary to contain further spread in a timely manner. However, they currently assess the risk for Europe as low.
Currently, Mpox is spreading mainly in the Democratic Republic of Congo and its neighboring countries. A total of at least 13 African countries are now affected. The Africa Centres for Disease Control and Prevention (CDC) has reported over 17,000 suspected cases so far this year, with 2,863 confirmed cases and 517 deaths. However, this is "just the tip of the iceberg, considering the many weaknesses in monitoring, laboratory testing, and contact tracing," as stated in a press release from August 13.
Mpox is transmitted by an orthopoxvirus of the same name. Frequent symptoms include skin rash or mucous membrane damage that can last for two to four weeks. Affected individuals often also experience fever, headache, muscle and back pain, fatigue, and swollen lymph nodes.
Possibly More Dangerous Variant
There are two types of the Mpox virus: the Congo Basin type (Clade I) and the West African type (Clade II), which also spread to Europe in 2022. Clade refers to a group of viral variants with a common ancestor. Currently, Clade I is predominantly circulating, which appears to have higher infectivity and mortality than the other type based on current knowledge. Scientists and authorities are paying particular attention to the subvariant Ib discovered in September 2023, as it may be particularly dangerous.
However, it is not yet sufficiently researched whether this is actually the case. "Due to the still unsatisfactory data situation in Africa, especially due to limited access to medical care and limited laboratory diagnostic capacities, it is still difficult to make statements about the mortality and infectivity of Clade I compared to Clade II," says Christina Frank. She is a scientific employee and epidemiologist at the Department of Gastrointestinal Infections, Zoonoses, and Tropical Infections at the Robert Koch Institute (RKI).
Unproven Speculations
Marion Koopmans, director of the Pandemic and Catastrophe Center at Erasmus University in Rotterdam, criticizes unproven claims in the media. There are speculations about more efficient transmission, but this could be due to the fact that in the region where the subvariant is occurring, transmission seems to be occurring primarily through sexual contacts. Roman Woelfel, senior physician and head of the Institute of Microbiology of the German Armed Forces in Munich, also suspects this. From the global Mpox outbreak in 2022, we know how quickly it can spread through sexual contacts, he says.
Generally, people most commonly contract monkeypox by touching an infected person who has lesions, scabs, bodily fluids, or skin-to-skin contact. However, it can also be transmitted through contact with infected animals or contaminated objects. There is a high risk in households with infected individuals.
Currently, there is no reliable scientific evidence to suggest that this is a "deadlier" variant, says Woelfel. The mortality rate of monkeypox in children has historically been very high in Africa. High infection rates are currently being observed in children in Central Africa. "Without better availability of diagnostics in affected countries, it will be difficult to accurately assess the actual number of cases and, consequently, the case fatality rate in children," he adds.
Low risk for Europe
All experts agree that while the spread of monkeypox in Europe is possible, the likelihood is relatively low. This is due, in part, to the limited number of travelers and direct flights to Europe, says Woelfel. "Moreover, we have sufficient diagnostic laboratories for monkeypox in Europe and Germany. A monkeypox case can therefore be rapidly detected and contained through measures such as isolation, quarantine, and vaccinations."
Since direct contact is necessary, the virus is theoretically easy to stop if diagnosed and recognized, says Marion Koopmans. However, as the spread cannot be ruled out, she calls for the situation to be monitored outside of Africa as well, and for new cases to be typed. This is the least that should be done, she says.
African countries urgently need help
However, the WHO's declaration is particularly important for the currently affected countries in Africa. It can enable further measures to be taken or intensified in affected countries, such as regarding vaccine availability and the expansion of diagnostic capacities, explains Klaus Jansen. In the Democratic Republic of Congo, there have been many cases of monkeypox over the years, but there have been insufficient funds for diagnostic capacities, public health measures, treatment, and vaccination, says Marion Koopmans.
There is no need to develop a new vaccine, as with the Covid pandemic. A substance against the classic smallpox virus is also approved for protection against infection with the monkeypox virus and is recommended by the RKI, among others. The drug (Imvanex) is manufactured by the Danish company Bavarian Nordic and is available in most industrialized countries. However, the vaccine is expensive, with the price per dose estimated at 100 to 150 euros in Europe.
In the countries of the global South, there is still no adequate supply of vaccines, says Roman Woelfel. "Through swift and decisive action by the international community and the use of available and required vaccines, the current outbreak of monkeypox could likely be contained."
The Africa CDC called on the global community on August 13th to secure two million doses of vaccine. A first small step is the announcement by the EU agency for emergency response and resilience (HERA) to procure and donate 175,420 doses of Imvanex. Manufacturer Bavarian Nordic is also providing an additional 40,000 doses for free. Furthermore, HERA plans to grant the Africa CDC a subsidy of 3.5 million euros in early autumn to enhance access to Mpox diagnostics and genetic sequencing in the region.
Given the ongoing spread of the Mpox virus, particularly the potentially more dangerous subvariant Ib, the World Health Organization (WHO) has urged global cooperation to provide aid to African countries. Specifically, the Africa Centres for Disease Control and Prevention (CDC) has requested two million doses of the Imvanex vaccine, with the EU agency for emergency response and resilience (HERA) pledging to donate 175,420 doses and Bavarian Nordic providing an additional 40,000 doses for free. The WHO's efforts to coordinate international assistance are aimed at expanding diagnostic capacities, improving public health measures, and ensuring vaccine distribution in affected African nations.
