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A typical symptom of Mpox is a skin rash that can be painful. (Archive photo) © Moses Sawasawa/AP
The WHO has once again declared the highest alert level for Mpox. The reason is a new, probably more dangerous variant. However, the risk of infection in Europe is currently still very low.
Berlin – The World Health Organization (WHO) has declared a “Public Health Emergency of International Concern” (PHEIC) due to the increasing spread of a certain Mpox virus variant in Africa. It had also temporarily declared this highest alert level because of the Sars-CoV-2 pandemic.
Is there a risk of a similar development as at the beginning of Corona?
No. The transmission route of both viruses differs considerably – and so does their infectious potential. Sars-Cov-2 is mainly transmitted via tiny droplets in the air, i.e. the respiratory tract. With Mpox, however, skin-to-skin contact is the main transmission route.
This mainly involves close skin-to-skin contact during sex or close hugging, massaging and kissing, as the Robert Koch Institute (RKI) explains. The risk of infection is particularly high in infected people with rashes, wounds or scabs.
However, Corona is only transmissible over a relatively short period of time – people with Mpox, on the other hand, are no longer contagious until all wounds have healed and a new layer of skin has formed. According to the RKI, this can take several weeks.
Mpox transmission is also possible – less frequently – via sex toys, bed linen and towels or a surface touched by an infected person. In the immediate vicinity of an infected person, transmission via droplets can also be possible, according to the RKI.
What about vaccines?
A vaccination is available. It reduces the risk of an outbreak and mitigates the course of the disease. However, in Africa and other countries in the global south, there are problems with the supply of such vaccines.
The German vaccination commission Stiko currently recommends its use only for certain risk groups.
Studies are underway on new vaccine candidates at companies such as Biontech. The currently approved vaccines were originally developed to protect against human smallpox.
Are Mpox and monkeypox the same thing?
Yes. Mpox is short for monkeypox. The virus was first described in monkeys, hence the name.
The WHO chose the new name because the term monkeypox could be perceived as racist and stigmatizing and various agencies had asked for the disease to be renamed.
In general, the WHO no longer names diseases after animals or countries in which they are discovered in order to prevent discrimination.
Where does the pathogen come from?
The Mpox virus (MPXV) is related to the classic pox viruses (variola virus) and the cowpox viruses. Its natural hosts are various rodents in West and Central Africa. Monkeys and humans are actually so-called false hosts to which the pathogens are less well adapted.
The virus has two genetic clades (I and II). The international Mpox event since May 2022 is due to clade IIb. Infections with the clade I virus, on the other hand, have so far only been observed in West and Central Africa.
So far this year, more than 14,000 suspected cases of Mpox and more than 500 deaths have been reported from the Democratic Republic of Congo and other African countries – more than in the whole of last year.
According to experts, this may be just the tip of the iceberg because not enough testing is being done and not all infected people are going to see doctors.
What is the situation in Germany?
According to the RKI, there are currently no known cases of Clade I in Germany. There is currently no increased risk from Clade I viruses in Germany, it said. However, the RKI is monitoring the situation very closely and will adapt its recommendations if necessary.
The RKI has already recorded around 3,800 cases of clade IIb nationwide, the majority of them (around 3,700) from early summer to autumn 2022. Since summer 2023, case numbers have been continuously reported at a low level – in the single to low double-digit range per month.
Deaths have not yet been registered in Germany.
What is the situation worldwide?
According to government information, Sweden has just had the first confirmed Mpox case of clade Ib outside the African continent. The affected person had previously been in Africa.
The development will continue to be closely monitored and special infection protection measures for the general public are not necessary for the time being, it said.
The European health authority ECDC expects further registered cases. However, the probability of sustained transmission in Europe is very low, provided imported cases are diagnosed quickly and control measures are implemented.
What are the symptoms?
In contrast to smallpox, which was declared eradicated in 1980, Mpox infections in humans are generally much milder and heal on their own, according to the RKI. However, severe cases and – rarely – deaths can occur, particularly in children and people with weakened immune systems.
Mpox is currently spreading more and more in Africa. A child is being treated here. (Archive photo) © Zanem Nety Zaidi/XinHua/dpa
The symptoms include pimples, blisters, rashes or some kind of wound in the genital or anal area as well as in other places such as hands, feet, chest, face or mouth, as the RKI explains. The skin changes can therefore be very painful. In addition, there are often general symptoms of illness such as fever, headache, muscle and back pain, chills or fatigue.
Symptoms usually appear 4 to 21 days after contact with sick people.
The therapy is primarily designed to alleviate symptoms.
Wasn’t there already a “health emergency” because of Mpox?
Yes. The WHO had already declared an emergency due to Mpox in July 2022. There had been clade IIb cases in dozens of countries, including Germany. The emergency was lifted in May 2023 because the outbreaks were brought under control in most countries – also thanks to vaccinations.
Mpox virus particles (red) multiply in the cells of the body. (Archive image) © -/National Institute of Allergy and Infectious Diseases/dpa
The Central African virus variant (clade I), which is now causing concern, appears to cause more severe disease courses than the West African virus variant (clade IIb). However, the data currently do not provide any reliable information on this.
In addition, clade Ib was increasingly detected in the east of the Democratic Republic of Congo in 2023, which, according to WHO assessment, indicates further adaptation of the virus to humans.
What does the highest alert level do?
There are no concrete consequences. The WHO wants to use this step to make authorities around the world more vigilant. It also hopes for more financial support for containment measures in Africa.
Have there been any initial reactions?
The WHO hopes for more support for the affected African countries, for example in the purchase of vaccines.
