MONKEYPOX

From animal to human
In areas where monkeypox is widespread (endemic), transmission to humans occurs primarily through contact with infected animals or their excretions and through the consumption of meat from infected animals that is not sufficiently heated.

From person to person
Person-to-person transmission is rare and usually occurs in close contact (e.g. also in the context of sexual contact). The monkeypox (typical skin blisters and pustules) contains particularly high viral loads. In particular, infection is possible if the skin is in contact (e.g. with skin or mucous membranes that are not intact) with the fluid contained in the monkeypox or the scab (crust) on the skin. In the case of ulcers or wounds in the mouth, the virus can be transmitted not only through direct contact but also via the saliva of the affected people. Whether monkeypox can be spread by sperm or vaginal secretions is not definitely known yet, but it seems possible.

Even when the first non-specific symptoms occur, people can become infected with very close contact through air or saliva droplets.

Via clothing or objects
The virus can also be transmitted via clothing, bed linen, towels or objects such as dinnerware and smartphones that have been in contact with an infected person.

Infection occurs when the virus reaches the mucous membranes of the eye, mouth, nose, genitals or anus. The airways may also be an entry point. In addition, the virus can penetrate the body through minor skin injuries. In pregnant women, the virus can be transmitted via the placenta to the unborn child. Infected parents can infect the child through skin contact during or after birth.

Newborn babies, children, pregnant women, elderly people and people with a weakened immune system are particularly at risk of developing a severe case of monkeypox.

Isolation is usually mandated for people with a proven monkeypox infection. Please observe the requirements of the health authority. During isolation at home you should consider the following measures, amongst others:

• You should avoid any kind of close contact, especially sexual contact with other people until the rash has subsided and the last scab has dropped off. This can take up to four weeks.
• In particular, people at risk should not live in the same household as you if possible. This includes people with a weakened immune system, pregnant women, children under 12 years of age and elderly people.
• If you live with other people, you should stay in a separate room if possible, ideally with access to a private bathroom.
• Where possible, do not share bedding, towels or other items, such as crockery, with other people. Bed linen should not be shaken in order to avoid the release of virus particles into the air. Laundry should be washed at a minimum temperature of 60°C with an all-purpose laundry detergent.
• Ensure good hand hygiene. Wash your hands thoroughly with soap and water.
• Surfaces that are frequently touched, such as bedside tables, smartphones or tablets, should be cleaned carefully at least once a day.
• Bathroom and toilet surfaces should be cleaned after each use.
• Avoid direct contact with pets to avoid human-to-animal transmission.
• In the event of a deterioration in your health, inform your doctor immediately so that you can be given an appropriate therapy. The drug Tecovirimat is approved for the targeted treatment of monkeypox.

Since infection with monkeypox is only possible following close contact with infected people as well as via shared objects and surfaces, contact with the person suffering the disease or their contacts should be avoided.

If there has been close contact with an infected person, the local health authority should be contacted (https://tools.rki.de/plztool/).

Vaccination
Vaccines designed to protect against human smallpox also protect against monkeypox. Since 2013, a smallpox vaccine has been approved in the EU and therefore in Germany, which is better tolerated than older smallpox vaccines. This can be used by people over 18 years of age. Vaccination is recommended by the Standing Vaccination Commission (STIKO), especially for people who have had close contact with a person suffering from the disease or the corresponding laboratory samples (post-exposure prophylaxis). Vaccination should take place as soon as possible after contact, no later than after 14 days. In addition, vaccination is currently recommended for men who have same-sex sexual contact with frequently changing partners as well as for employees in special laboratories. General vaccination is not recommended. Detailed vaccination recommendations can be found at the Robert Koch Institute.

Answers to frequently asked questions – generally understandable, reliable and based on current knowledge – can be found on the web page https://bzga-k.de/affenpocken.

Information and advice is also available from your local health authority. Since monkeypox must be reported, they have information on the current situation and experience in dealing with the disease.

For further (specialist) information, please visit the Robert Koch Institute (RKI) website at https://www.rki.de/DE/Content/InfAZ/A/Affenpocken/Affenpocken.html.