After Great Britain, Spain and Portugal, Germany is now also reporting the first case of monkeypox in humans. The Robert Koch Institute warns doctors to be vigilant, the WHO calls for contact tracing. What is behind the rare viral infection? An overview.

Now also in Germany: The number of people infected with monkeypox is increasing. For the first time in Germany, the Bundeswehr Institute for Microbiology in Munich has unequivocally identified the monkeypox virus in a patient with characteristic skin changes.

After the virus infection first appeared in Great Britain in early May, Sweden, Spain, Portugal, Italy, France and the USA reported the first cases. The first case in Australia was added on Friday.

Experts around the world are alert, but not alarmed at this time. Now there is a first genome analysis of the local virus from Portugal. The Charité virologist Leif Erik Sander shares his good news on Twitter: The studies show “that it is the West African clade. This is potentially more favorable because it has so far been less severe or fatal than the Congo Basin clade”.

The World Health Organization (WHO) called for rigorous contact tracing of monkeypox patients on Wednesday. Clinics and the population would have to be made aware of the need for an unusual skin rash to be examined by specialist staff. If monkeypox is suspected, patients should be isolated immediately. Health workers should also take the usual hygiene precautions to protect themselves from infection in the event of droplet infections, writes the WHO in a statement.

What is behind the suddenly increasing number of cases? Where does the virus come from? And how is it expressed? FOCUS Online answers the most important questions.

Monkeypox is a so-called zoonosis. That is, the virus is transmitted from animals to humans. “Infections can be transmitted through contact with the secretions of infected animals,” explains the Robert Koch Institute (RKI). It has now been observed for the first time that an infected person has infected other people with the virus.

In this case, the transmission probably takes place via a droplet or smear infection on contact with body fluids or crusts. In addition, sexual transmission of the smallpox virus is possible, writes the RKI. However, compared to influenza viruses, monkeypox is less infectious.

Contrary to what the name might suggest, monkeypox is not only transmitted by primates, but mainly by rodents such as rats, which carry the pathogen. Experts suspect that the causative agent of monkeypox circulates in rodents, while monkeys are so-called false hosts – reports the “Tagesschau”. False hosts are a suboptimal host organism for the virus. The false host can be infected, but the virus cannot develop in it.

The viral disease usually causes only mild symptoms, but can also have severe courses. The infection often begins with a rash. Soon after, red patches form, which spread from the face all over the body and can become red, fluid-filled bumps. The rash can look different depending on the stage of the disease and can resemble chickenpox or syphilis.

According to the UK Health Security Agency (UKHSA), the disease also manifests itself through the following side effects:

So far, several European countries have reported cases of monkeypox. Great Britain recorded the first case in early May, and monkeypox has now also been registered in Spain, Portugal, Italy, France and Sweden as well as the USA and Australia.

According to the health authorities, eight people in the Spanish capital Madrid were infected with the virus by Thursday. According to media reports, 20 people were already infected in Portugal at the time. Italy, the next country in Europe to report the first monkeypox case on Thursday. According to the National Institute for Infectious Diseases (INMI), a young man tested positive after a trip to the Canary Islands. He reported to a hospital in Rome and was immediately isolated afterwards. He was said to be in good condition. There is also a suspicion of two other people – they are also in quarantine.

And Sweden also recorded its first case on Thursday. As the local health authority announced, one person in the greater Stockholm area is infected. The US health authority CDC reported the first case in the United States on Wednesday. In Canada, too, health authorities are already investigating dozens of suspected cases, reports the “Süddeutsche Zeitung”.

The first was reported on Friday. Due to the high number of cases in other countries, the Robert Koch Institute (RKI) is making doctors in Germany aware of the virus infection. Monkeypox should therefore also be considered as a possible cause in the case of unclear smallpox-like skin changes if those affected have not traveled to certain areas in Africa.

Homosexual men who have recently had sexual intercourse with other men should also seek medical care as soon as possible if they notice any unusual skin changes, the authority writes in a report on its website.

Since 1980, smallpox has actually been considered eradicated in humans worldwide since a major vaccination campaign. As the RKI explains, large parts of the world’s population no longer have vaccination protection. The virus was able to spread again, especially in West and Central Africa. The first person affected in Great Britain had also entered the country from Nigeria. According to the WHO, monkeypox has increased in people in Nigeria since 2017. There are already 558 reported suspected cases here, 241 have been confirmed and eight people have died.

As the “Tagesschau” reports, monkeypox in humans has only been identified three times outside of Africa: in 2003 in the USA and in 2018 in the United Kingdom and Israel. More than 30 people were infected in the United States at the time after the virus was introduced by transporting 800 small mammals from Ghana. Contrary to what was initially assumed, those affected are said not to have contracted the animals directly, but through contact with prairie dogs that were kept near the infected animals.

The probability of infection with monkeypox is generally considered to be rather low. The virus is usually only transmitted from animals to humans through direct contact. According to experts, the newly observed human-to-human transmissions also take place via a droplet or smear infection.

There is currently no specific vaccine against monkeypox, as smallpox is believed to be virtually eradicated. According to general practitioner Christoph Specht, a general smallpox vaccination also reliably protects against monkeypox, although the two are not related to each other – this is what the doctor says in an interview with RTL. This would give a kind of immunity to the majority of the population. Since the smallpox vaccination was mandatory until 1976 (in the GDR even until 1982), all those born before that could assume good protection, the doctor reassured.

How likely is it that the virus will spread in this country? You have to keep an eye on whether the severity of the symptoms changes due to the possible new transmission path from person to person, said Specht on RTL.

“The current outbreak indicates a change in human-to-human transmission,” wrote Leif Sander, head of the Infectious Diseases Clinic at the Berlin Charité, on Thursday. The declining population immunity since the end of smallpox vaccination probably contributes to this. The scientist describes monkeypox as less pathogenic than smallpox, but it is “nevertheless a serious and in some cases fatal disease”. However, Sander sees “certainly no reason to panic” at the moment: However, the outbreak shows “how much infectious diseases pose a constant threat in a globalized world, for which we have to prepare better”.