After several cases of monkeypox in Great Britain, the Robert Koch Institute urges increased vigilance. Because even if this is not the first outbreak outside of Africa, there is a special feature. But what are the symptoms and how dangerous is the viral infection anyway?

What is monkey pox?

Monkeypox is a viral disease. The monkeypoxviruses belong to a subfamily of the common poxviruses. Similar to conventional smallpox, blisters often form on the body during the course of an infection. The incubation period is usually two weeks.

How is monkeypox transmitted?

Although monkeypox occurs in monkeys, rodents are believed to be carriers. Since the end of smallpox vaccination in 1980, there have been repeated cases of infected people, especially in Africa, since large parts of the continent’s population no longer have vaccination protection. Humans can become infected through animal bites, but also through contact with secretions, droplet infections or the consumption of monkey meat. Human-to-human transmission is also possible. It occurs through contact with bodily fluids or crusts. The Robert Koch Institute (RKI) describes infection chains of up to six people. Sexual transmission is also possible. In principle, however, the risk of infection is low; according to the British health authority UK Health Security Agency (UKHSA), only symptomatic patients are contagious if they come into close contact.

What are the symptoms?

The viral disease usually causes only mild symptoms. According to the UKHSA, the first signs of illness include: fever, headache, muscle and back pain, swollen lymph nodes, chills and exhaustion. A rash may develop, which often spreads from the face to other parts of the body. The rash looks different depending on the stage and can resemble chickenpox and syphilis.

How dangerous is the disease?

According to the RKI, an infection is usually milder than conventional smallpox. But severe courses and deaths are also possible. Risk groups include children and immunocompromised people. In some cases, permanent damage such as blindness or scars can occur. However, most infected people recover within a few weeks.

What outbreaks are known?

Outbreaks in humans have increased in West and Central Africa in recent years. According to the World Health Organization (WHO), there were 558 suspected cases of monkeypox in Nigeria between September 2017 and the end of April 2022, of which 241 have been confirmed. During this period, there were eight deaths from monkeypox.

Cases outside of Africa are rare and, according to a specialist article by the RKI, have only been detected in three other countries: the USA, Israel and Great Britain. A major outbreak in the United States in 2003 infected over 30 people in several states. The virus was brought in with the transport of 800 small mammals from Ghana. Those affected are said not to have been infected directly from these animals, but through contact with prairie dogs that had been kept close to the Ghanaian animals before they were sold on. No cases are known from Germany.

What makes the current cases in the UK special?

There were already three cases in Great Britain at the end of 2018, and another in 2021. With the current caseload in the country, seven people have been shown to be infected with monkeypox. First, a case from May 7 became known, which apparently goes back to a traveler returning from Nigeria. Four of the seven sufferers are said to be men who have had sex with other men. They are said to have been infected in London. It is believed that the virus spreads more easily in this group. What is special is that some of the seven cases are not related. Sometimes it is unclear where those affected were infected. So far, this has not existed outside of Africa.

Is that a cause for concern?

According to the UKHSA, this cluster of cases is unusual. However, the risk to the public is low. It is considered extremely unlikely that the outbreak will develop into an epidemic. However, Nigerian virologist Oyewale Tomori warns in an interview that there is currently no global system to control the spread of monkeypox.

What to do if you suspect

Like smallpox, monkeypox is notifiable in Germany. The RKI calls on doctors in Germany to be vigilant. Monkeypox should be considered as a possible cause in unclear smallpox-like skin lesions, even if those affected have not traveled to certain areas. According to the RKI, men who have sex with men should “immediately seek medical care” if they have any unusual skin changes. The RKI, for example, offers molecular diagnostics for identifying monkeypox. The British infection control agency is also calling on homosexual and bisexual men in particular to look out for rashes and injuries on their bodies, especially in the genital area. The WHO recommends isolation if an infection is detected.

What treatment options are there?

There is currently no specific treatment for monkeypox infection. However, there are ways to counteract the symptoms of the disease with medication. In the early stages of an infection, the course can be weakened by administering the smallpox vaccine, according to the science magazine “Spektrum”. There is also a live vaccine that can be administered in the United States for targeted vaccination against possible future outbreaks. This is not permitted in Germany.

(This article was first published on Wednesday, May 18, 2022.)

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