The WHO has classified the monkeypox outbreak as a “public health emergency of international concern”. What does that mean?
The WHO declared the highest warning level on July 23, 2022 and classifies the spread of this virus as a global threat that requires international coordination. Monkeypox has spread rapidly since May 2022 and has now been detected in over 70 countries – over 80 percent of the confirmed cases occurred in Europe.
associated with it recommendations for states how what is happening could be contained and controlled. This includes, for example, isolating and treating sick people, tracking contact persons, and vaccinating people with an increased risk of infection. In Germany, these aspects are regulated by the Robert Koch Institute.
Who should be vaccinated against monkeypox?
Die Standing Committee on Vaccination published a vaccination recommendation for vulnerable groups on June 9, 2022. It is currently valid with reservations and still has to go through a mandatory commenting procedure with the federal states and specialist groups.
Vaccination with the smallpox vaccine approved in the EU can be useful for the following people from the age of 18:
In contact with infected people. Anyone who has been in close physical contact with a sick person through non-intact skin, mucous membranes or touching the face should be vaccinated as a preventive measure. Sex is considered close physical contact, but so is dealing in a shared household. The preventive vaccination is also an option for medical professionals who were not adequately protected when they came into contact with a sick person or for laboratory workers who accidentally had unprotected contact with laboratory samples containing active monkeypox material.
Men who have same-sex sexual contact with changing partners. In Germany, according to official statements, monkeypox infections have primarily occurred in this group.
Personal in Speziallaboratorien. People who work with infectious laboratory samples in the laboratory should consider vaccination after a risk assessment by the responsible safety officer.
How does the vaccination work?
Vaccination should be given as early as possible in a 14-day period after contact with a person who has monkeypox. Primary immunization is usually two doses of vaccine given at least 28 days apart. Anyone who has previously been vaccinated against smallpox can get by with just one vaccine dose.
According to the Robert Koch Institute, people who have been vaccinated against smallpox are likely to have some protection against monkeypox infection. In the Federal Republic of Germany, the obligation to have the first vaccination was lifted in 1976, in the GDR in 1982. This means that the majority of the population under the age of 50 was no longer vaccinated against smallpox. According to the RKI, a single vaccination with the approved vaccine called Imvanex or Jynneos is currently sufficient for people who have already been vaccinated against smallpox in the past.
What applies in times of scarce vaccines?
The vaccine used against monkeypox is currently in short supply. For the approximately 130,000 people in Germany for whom vaccination would be an option, there were loud calls in mid-July RKI only about 40,000 vaccine doses available. They should now be distributed as best as possible.
Stiko strongly advises using all available doses for the first vaccination and waiting for the second vaccination until enough vaccine is available. Background: Studies have shown that basic protection against monkeypox already exists after the first vaccination. It lasts about two years. The second vaccine dose serves to prolong the vaccine protection.
At present, only the vaccine called Jynneos, which is approved in the USA, is available in Germany. It is identical to the Imvanex vaccine, which is approved in the EU.
Is vaccination necessary after an infection?
According to the RKI, no vaccination is necessary for the time being for anyone who has currently had a monkeypox infection. The immune protection that came about as a result of the disease lasted for several years.
How do I recognize monkeypox?
The first symptoms are often fever, headache, muscle and back pain and swollen lymph nodes, chills or exhaustion Robert Koch Institute (RKI) with. Some infected people initially showed no symptoms. A few days later, a characteristic and sometimes very painful rash develops, in which the pustules eventually crust and fall off.
The rash is usually concentrated on the face, palms and soles of the feet. Skin and mucous membrane changes could also occur on the mouth, eyes, genitals and excretory sites.
How severe is the disease?
In contrast to smallpox, which has been considered eradicated since 1980, monkeypox in humans is usually much milder, according to the RKI. Most people recovered within two to four weeks. The disease often goes away on its own without treatment.
However, severe courses can also occur with complications such as encephalitis, bacterial skin infections, conjunctivitis, corneal and pneumonia. Scars and permanent damage to the cornea, including loss of vision, may remain in some of those affected. Deaths are also known from Africa.
How is monkeypox transmitted?
About animals. Humans can become infected primarily by handling diseased animals and their meat if it is not sufficiently heated. Infections from person to person have so far been considered rare, the transmissibility of the virus as moderate.
From human to human. According to the Robert Koch Institute, infection from person to person is only possible with close physical contact with infected people. The virus often gets into the body through the smallest skin injuries – as well as through mucous membranes, such as in the eyes, mouth, nose, genitals, anus. Infections can also occur during sexual activities. In addition, transmissions from pregnant women to the unborn child have been described, or from parents to children during and after birth. It is currently not entirely certain whether monkeypox could be transmitted via semen or vaginal secretions – but according to the RKI it seems possible.
About objects. The virus can also be transmitted through objects if an infected person has had contact with them – such as clothing, bed linen, cutlery, sex toys. The RKI points out that the virus can survive on surfaces and fabrics for days and even months.
Under the microscope: monkeypox viruses (left) and virus particles (right). © picture alliance/dpa/Russell Regner/CDC/AP
How can the risk of transmission through sex be reduced?
If you have changing sex partners, you can reduce their number – she advises Federal Center for Health Education. Condoms also reduce the risk of infection because they prevent direct contact with the mucous membranes in the anus and vagina. However, condoms did not protect if skin changes were touched on other parts of the body.
Anyone suffering from monkeypox should refrain from any form of sex – whether oral, anal or vaginal. Recoverers should use a condom during sex for eight weeks after all rashes have cleared and the scabs have fallen off, as the virus could be present in semen for a while.
Who belongs to the risk group for severe courses?
According to the RKI, newborns, children, pregnant women, the elderly and people with weakened immune systems in particular could become seriously ill with monkeypox. Healthcare workers are also at increased risk when they come into contact with sick people.
When and how long is the virus contagious?
Between 5 and 21 days can elapse between infection and the onset of the disease. According to the RKI, the current data indicate that a shorter incubation period of only 2 to 4 days is also possible. According to the RKI, other people can be infected if the first non-specific symptoms such as fever and headache appear and the typical rash is not yet visible. Particularly high virus concentrations are found later in the smallpox-like skin changes.
People with monkeypox are contagious as long as they have symptoms—usually two to four weeks.
Should sick people isolate themselves?
Yes. For at least 21 days and at least until the scabs fall off – isolation at home is generally recommended, sometimes ordered by authorities. Even direct contacts are recommended to isolate themselves at home for 21 days. Sick people should avoid contact with pets, as they too could become infected with the pathogen.