With monkeypox, a virus has been making headlines again this week. Again there is the first confirmed case in Munich. Does the pathogen have the potential to trigger the next pandemic directly after Corona? FOCUS Online answers the most important questions.

Since Friday there has also been the first confirmed case of monkeypox in Germany. In most cases, the viral infection causes only mild symptoms with a bumpy rash and goes away on its own. In rare cases, however, severe courses can also occur, and in individual cases the infection can be fatal. Smallpox has actually been considered eradicated for around 40 years – but because the global vaccination campaign was several decades ago, large parts of the world’s population no longer had vaccination protection, explains the Robert Koch Institute (RKI).

Experts assume that the virus subsequently spread again, especially in West and Central Africa – and has now also been introduced to the other continents by travelers returning. The World Health Organization (WHO) has reported increasing cases of monkeypox in Nigeria since 2017. There, the virus is considered to be widespread in rodents. Infection usually occurs from animal to human.

There have certainly been enough reports in the past two years about viruses that can spread from animals to humans and then be passed from person to person. Accordingly, many people react sensitively to the monkeypox news. However, epidemiologists and physicians currently see no reason to panic – and no potential for a new pandemic.

Monkeypox is “a serious and in some cases fatal disease,” explains infectiologist Leif-Erik Sander from the Berlin Charité. But monkeypox is both less pathogenic than normal smallpox and not as contagious as Corona, so that it is not likely to spread on a large scale. However, the outbreak shows “how much infectious diseases pose a constant threat in a globalized world, for which we need to be better prepared”.

Fabian Leendertz, founding director of the Helmholtz Institute for One Health (HIOH) in Greifswald and head of the Epidemiology of Highly Pathogenic Pathogens project group at the RKI, also believes that the risk from the animal virus is limited. With the observed frequency, it is already an epidemic. However, it is “very unlikely” that it will last long.

Gerd Sutter’s assessment is similar. He holds the chair for virology at the Institute for Infectious Medicine and Zoonoses at the Ludwig Maximilian University in Munich (LMU). “The risk of a major epidemic in Germany or Europe can be assessed as low and the possibility of the virus entering animal reservoirs in Europe also seems unlikely.”

Nevertheless, experts expect the number of cases to continue to rise – also because the incubation period is relatively long at ten to 14 days. The President of the German STI Society, Norbert Brockmeyer, assumes that the pathogen has been circulating unnoticed for a while. STI stands for Sexually Transmitted Infections.

Health Minister Karl Lauterbach (SPD) also said on Friday that it was only a matter of time before monkeypox was also detected in Germany. Great Britain reported the first cases in Europe in early May. On Wednesday, Spain and Portugal were the first to register infections, followed shortly afterwards by positive tests in Italy and Sweden. As a result, doctors and patients in Germany have also been made aware, explained Lauterbach. The RKI issued a corresponding message on Wednesday.

The Minister of Health does not believe that there is already a large number of undetected infections at this point in time. “Based on the knowledge available so far, we assume that the virus is not so easily transmitted and that this outbreak can be limited.” There are two variants of the pathogen – for the time being it can be assumed that the West African variant, which is less severe, is currently causing the disease circulate, not the Congo variant. The virus will be analyzed in more detail for clarification, said the Minister of Health.

Epidemiologist Fabian Leendertz from the Helmholtz Institute also believes that this is exactly what is happening. Mainly to understand whether and how the recorded cases are related and to check whether the pathogen has changed – for example in the direction of better transmissibility.

According to the physician Brockmeyer, people who have sexual contact with many different people are most at risk of infection. This is because transmission takes place primarily via direct and close contact or contact with contaminated materials. Transmission via droplets in the air is also possible over shorter distances – which is probably very rare.

The German Aidshilfe warned against wrong conclusions and stigmatization in view of the cases in gay men. “Of course there are superficial similarities between monkeypox and HIV back then – it’s another disease from Africa that also affects gay men. But the comparison doesn’t fit in many other respects,” said AIDS spokesman Holger Wicht.

In contrast to HIV, the virus that causes monkeypox was known longer in the 1980s, and the disease heals on its own. “It is very important to us that panic and unreasonable fears do not arise here.” There are still uncertainties when assessing the severity of the disease, for example about how well immunocompromised people – this can include, for example, HIV-infected people who have not been treated for many years – cope with the disease.

The disease is called monkeypox after the pathogen was first detected in monkeys in a Danish laboratory in 1958. Experts suspect that the virus actually circulates in squirrels and rodents, while monkeys and humans are considered false hosts. This means that although they can be infected, the virus cannot develop in them.

According to the treating hospital, the first monkeypox patient reported in Germany is doing relatively well. The young man “went into medical care very responsibly immediately after the onset of symptoms to protect others from infection,” said Clemens Wendtner, chief physician of infectiology at the Munich Clinic Schwabing, on Friday. With slight swallowing difficulties and an elevated temperature, he has only minor symptoms and does not yet need any special medication.

The patient will remain in the hospital because it is assumed that it will be infectious for three to four weeks, explained Wendtner, who also treated the first known corona patient in Germany at the beginning of 2020.