Gesundheit für Mensch, Tier & Pflanze

Monkeypox

monkeypox virus

Profile

Monkeypox is a viral disease that resembles smallpox in humans and whose causative viruses are also related to the smallpox viruses. It is a zoonosis, meaning that the viral disease can be transmitted from animals to humans and vice versa. The disease in humans is similar to smallpox, but fatal courses are rare; monkeypox is usually cured after a good three weeks.

Occurrence

Mainly Central and West Africa

Pathogen reservoir

Rodents

Infection route

Through secretions and droplet infection, usually from contact with infected animals; human-to-human transmission is possible with close contact

Incubation period

5-21 days

Symptomatology

High fever, severe headache, sore throat, cough, malaise, occasionally diarrhea. In the second stage of the disease, a smallpox-like exanthema (skin rash) may appear. Fatal courses are rare, usually monkeypox is healed after a good three weeks.

Therapy

The symptoms are treated. The drug Tecovirimat has been approved for the treatment of smallpox, monkeypox and cowpox in the EU since January 2022. The approval is granted under "exceptional circumstances" due to the rarity of the diseases.

Prevention

Vaccination against smallpox has also protected against monkeypox. However, since smallpox has been eradicated and vaccination against smallpox has therefore been discontinued for some time, fewer and fewer people are protected. This could be a significant factor in why monkeypox is spreading more. Vaccination is possible and approved, but not yet available to the general public, according to WHO.

Situation in Austria

20 cases of monkeypox has been confirmed in Austria. The disease is notifiable.

In Europe, cases have been reported in nine member states so far, according to the European Center for Disease Control and Prevention (ECDC).

The World Health Organization (WHO) is calling on health care providers to consider monkeypox as a differential diagnosis if symptoms are present. If monkeypox is suspected, patients should be isolated and contacts followed up. Those who have corresponding symptoms themselves should be examined by specialists in infectious diseases, and men who have sex with men with changing partners should be especially vigilant.

Information from the WHO on monkeypox

Specialized information

Human Medicine

Monkeypox virus is one of the orthopox viruses. The disease in humans is similar to smallpox; symptoms include high fever, severe headache, sore throat, cough, malaise, and occasionally diarrhea. In the second stage of the disease, a smallpox-like exanthema (skin rash) may appear. Fatal cases are rare; monkeypox is usually cured after a good three weeks.

Monkeypox is usually introduced into Europe by travelers or transmitted by introduced animals in isolated cases. In the current cases in Europe, the exact route of infection is unknown, but presumably transmission occurred within the population, i.e. from person to person. This has not yet occurred outside of Africa. Human-to-human transmission has been detected more frequently recently. That's one reason why the disease is now under increased scrutiny. In its May 23 Rapid Risk Assessment, the EU health agency ECDC rates the likelihood of further spread in the group of people with many changing sexual partners as high. Whether or how many cases with a severe course are to be expected cannot be reliably estimated at this time. The ECDC estimates the probability of such courses in the majority of the population as low. All EU countries are called upon to identify and isolate cases as quickly as possible and to follow up on close contacts. For this purpose, diagnostic capacities should be created and a functioning system for contact tracing should be established. Health care and laboratory personnel should wear appropriate protective equipment (gloves, FFP2 mask, waterproof overgarments) when monkeypox is suspected.

WHO encourages health facilities to consider monkeypox as a differential diagnosis when symptoms are present. If monkeypox is suspected, patients should be isolated and contacts followed up. Especially men who have sex with men with changing partners should be attentive.

Ministry of Health: Case definition, recommendation for official procedure in case of contact with monkeypox.

WHO: Information on monkeypox

Risk assessment of the ECDC on monkeypox in Europe

RKI: Information on monkeypox

Veterinary Medicine

Monkeypox is a notifiable animal disease under the Animal Diseases Act.

The monkeypox virus is endemic to West and Central Africa. Here it circulates mainly in small mammals. Rodents in particular are the reservoir of the pathogen for primates and humans. Primates and humans are actually false hosts.

Monkeypox has been detected in many rodents in Africa: in rats such as the hamster rats popular as pets, the Gambian giant hamster rat(Cricetomys gambianus), in other Cricetomys species, in red-nosed rats(Oenomys hypoxanthus) and proboscis rats (Petrodromus sp.) as well as in striped grass mice(Lemniscomys sp.), in dormice (dormice, African Lorrain's milk Graphiurus lorraineus), in squirrels (e.g., in African chipmunks Funisciurus sp. and sun squirrels(Heliosciurus sp.), and in shrews. The exact host range is not yet known. Many of these rodent species, which are also readily exported to other continents as zoo or pet animals, can - if infected with the pathogen - transmit it to other animal species but also to humans (e.g., in 2003 in the USA to prairie dogs and humans).

Transmission of infection from pets and zoo animals to humans can occur through direct contact (bites, secretions, respiratory droplets, skin-to-skin contact with smallpox lesions). Contact via the environment, e.g., through virus-containing shed skin crusts during cage cleaning, is also possible. Particularly high concentrations of pathogens are found in typical smallpox lesions. Smallpox viruses can persist in the environment for a very long time in the shed skin crusts.

To date, no endemic occurrence of monkeypox in animals - especially rodents - has been detected in either the Americas or Europe. In any case, pets and zoo animals imported from Africa should be examined by a veterinarian for the skin lesions typical of smallpox and kept in quarantine for a short time before being brought together with other animals. Specialized personnel in zoos and pet shops should be aware of the risk of monkeypox infection upon first contact with these animals imported from Africa and implement protective and hygienic measures accordingly: These include wearing disposable gloves, disposable masks, disposable work coats, hand disinfection, avoidance of stirring up dust when cleaning cages, proper disposal of bedding material.

EFSA: Information on monkeypox

Diagnostic

Suspect samples can be sent to AGES:

Human:

Institute for Medical Microbiology and Hygiene Vienna
Währingerstraße 25a, 1096 Vienna
E-mail: humanmed.wien@ages.at
Phone: +43 50 555-37111

Veterinary:

Institute for Veterinary Investigations Mödling
Robert Koch-Gasse 17, 2340 Mödling
E-mail: vetmed.moedling@ages.at
Phone: +43 50 555-38112

Last updated: 19.05.2022

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