"A real risk" - WHO warns against too much composure

Monkeypox - in May 2022, in the middle of the corona pandemic, that was bad news that triggered fear worldwide. A new threat while the world still grapples with the devastating coronavirus? The World Health Organization (WHO) in Geneva triggered the highest alert level with the declaration of an international health emergency in July.

In the meantime, the worst fears are off the table, the number of cases has fallen drastically. The WHO now fears fatal composure: new outbreaks are possible at any time, warns WHO monkeypox expert Rosamund Lewis. "We could have a variant of the virus in three years that is significantly less contained - that's a real risk," she said.

As of early January 2023, the WHO registered almost 84,000 confirmed cases worldwide, including 75 deaths, although it is certain that many times that number went unreported. The number of new infections reported weekly has fallen by a good 90 percent since July.

In Germany, too, the situation has calmed down significantly after a peak in the summer with more than 400 confirmed cases reported per week. Since mid-October, only single-digit numbers of cases have been reported to the Robert Koch Institute (RKI) or no cases at all. The RKI speaks of around 3680 people affected in this country for the entire outbreak (as of January 3, 2023). One hotspot was Berlin.

Monkeypox, now called Mpox instead of Monkeypox by the WHO, is a viral disease. Patients usually have fever, headache and muscle pain and a rash with pustules. Until 2022, cases were practically only known from West and Central Africa, where people became infected through contact with infected animals. The virus probably comes from small mammals such as sun or chipmunks or giant hamster rats. Human-to-human transmission has only been known for a few years. In 2022, it was mainly men who had frequent sexual contact with different partners who were infected. The virus is related to the classic human pox virus and the cowpox virus.

"The challenge will be that countries maintain surveillance and laboratory capacity even though it looks like the issue is off the table," says Lewis. It is known how new outbreaks can be stopped: by isolating the infected, observing their contacts and vaccinations. But that only works if cases are detected early, worldwide. Although the WHO European region has set itself the goal of eradicating human-borne monkeypox, the Standing Vaccination Commission (Stiko) in Berlin doubts that this is still possible outside of Africa.

Lewis therefore demands: "On the clinical front, awareness of possible cases of monkeypox must be increased." In people with fever and rash, monkeypox should always be considered in addition to measles, chickenpox, scabies, syphilis or herpes. Clinics that specialize in HIV and STDs should routinely test for monkeypox.

There are three vaccines that reduce the risk of contagion by at least 78 percent, Lewis says. The Stiko in Berlin is appealing to groups at risk to take the second vaccination, which is necessary for long-term protection, after the first vaccination dose. After an initial shortage, there is now enough vaccine.

The big problem: That's true for Germany and other richer countries, but not for the rest of the world. The great inequality alarms the WHO. The disease is largely under control in Europe, North America and, to a lesser extent, South America, but not in Africa, says Lewis. Because the disease can only be detected with a PCR test, which is not available in many places, many cases have gone undetected. According to the African Union, Nigeria, the Democratic Republic of the Congo and Ghana are particularly affected. Where the virus circulates unchecked, it can mutate and produce significantly more contagious variants.

That's why Lewis is calling for more investment: to find the origin of the virus in Africa's wildlife, to research how it is transmitted to humans, and to develop rapid tests and more vaccines. "We need effective vaccines at a good price that are available everywhere," says Lewis. "We have to ask ourselves: do we want to get this under control once and for all, or do we want to deal with this for decades?"

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