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HEALTH

Germany reports first monkeypox case

Germany and France on Friday reported their first cases of monkeypox, joining a number of other European and North American nations in detecting the disease endemic in parts of Africa.

A doctor in Germany wears a stethoscope.
A doctor in Germany wears a stethoscope. Photo: picture alliance/dpa/dpa-Zentralbild | Soeren Stache

What’s happening?

Monkeypox was identified in a 29-year-old man in the Ile-de-France region, which includes Paris, who had not recently returned from a country where the virus is circulating, France’s health authorities said Friday.

Separately, the German armed forces’ microbiology institute said it has confirmed the virus in a patient who developed skin lesions – a symptom of the disease.

With the growing number of detected cases in several European countries, Germany’s health agency Robert Koch Institute has urged people returning from West Africa, and in particular gay men, to see their doctors quickly if they notice any chances on their skin.

The rare disease – which is not usually fatal – often manifests itself through fever, muscle aches, swollen lymph nodes, chills, exhaustion and a chickenpox-like rash on the hands and face.

The virus can be transmitted through contact with skin lesions and droplets of a contaminated person, as well as through shared items such as bedding and towels.

The World Health Organization (WHO) has said it was looking closely at the issue and in particular that some of the cases in the UK appeared to have been transmitted within the gay community.

Cases of monkeypox have also been detected in Italy, Portugal, Spain and Sweden as well as in the United States and Canada, leading to fears that the disease – normally concentrated in Central and West Africa – may be spreading.

Why is it called monkeypox?

The virus was first identified in 1958 in laboratory monkeys – which is where the name comes from – but rodents are now considered the probable main animal host.

It is mainly observed in isolated areas of central and western Africa, the World Health Organisation (WHO) said, with the first case in humans reported in 1970 in the Democratic Republic of Congo.

How is it transmitted?

Monkeypox is most often transmitted to humans by infected rodents or primates through direct contact with blood, body fluids, or skin or mucous membrane lesions of these animals. 

As we mentioned above, human-to-human transmission occurs primarily through respiratory droplet particles during prolonged contact. But contamination can come from close contact with skin lesions of an infected individual or from objects, such as bedding, recently contaminated with biological fluids or materials from a patient’s lesions.

More severe cases are related to the length of time patients are exposed to the virus, their state of health, and whether the virus leads to other health complications. 

Young children are more sensitive to this virus.

Can it be treated?

There is no specific treatment or preventive vaccine against monkeypox – and the huge majority of patients recover fully with appropriate care.

Smallpox vaccination was effective in the past at also providing protection from monkeypox, but with that disease considered eradicated, people are no longer vaccinated against it, which has allowed monkeypox to spread once again. 

Should we be worried?

Experts have said that we’re not going to see the virus reach epidemic levels.

“There is no evidence that human-to-human transmission alone can maintain monkeypox in the human population,” the WHO has said.

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HEALTH

‘Breaking point’: Why German pediatric wards are filling to capacity

Overcrowded patient rooms, days-long stays in the ER, transfer of sick babies to hospitals more than 100 kilometers away: the current wave of respiratory syncytial virus (RSV) infections in Germany is pushing children's hospitals to their limits. 

'Breaking point': Why German pediatric wards are filling to capacity

The German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi) said on Thursday that there was a “catastrophic situation” in children’s intensive care units. 

According to the physicians, a wave of respiratory syncytial virus (RSV) infections can be expected every year starting in the autumn. 

Yet this year “there are fewer and fewer pediatric hospital beds available overall” as well as a lack of nursing staff, Divi Secretary General Florian Hoffmann explained Wednesday on ZDF’s Morgenmagazin.

Because all beds were full in one case, a child was transferred from the Hannover Medical School (MHH) to Magdeburg on Friday night, a distance of around 150 kilometers. 

“My colleagues had called 21 clinics,” said Gesine Hansen, Medical Director of the MHH Clinic for Pediatric Pneumology, Allergology and Neonatology, told DPA. 

The child, who was about one-year old, had an RSV infection, which can be life-threatening, especially for babies and children with pre-existing conditions.

READ ALSO: 7 things to know about visiting a doctor in Germany

‘Catching up’

Some health experts have said that hospitals are now filled to capacity because children had minimal social contact during the pandemic and are now catching up on infections.

According to the Robert Koch Institute (RKI), an estimated 5.6 severe cases of RSV respiratory illness occur worldwide per 1,000 children in the twelve months after birth. 

Within the first year of life, 50 to 70 percent would typically have experienced at least one infection with RSV, and by the end of the second year of life, nearly all children should have experienced at least one infection. 

In the wake of protective measures against Covid-19, however, many such infections had temporarily failed to materialise. 

‘Breaking point’

According to Divi, hardly any clinics had a free crib or free pediatric intensive care bed in the past few days.

“Children have to lie in the emergency room for days,” Hoffmann said.

Yet the peak of the current wave of respiratory infections in children has by no means been reached, Hoffmann said. “The situation in practices and clinics will get even worse in the coming weeks.”

“We are at the breaking point,” said Matthias Keller, head of the Children’s Hospital Dritter Orden Passau already. The rooms are often double-occupied, he said. In some cases, there were too few monitors and not enough equipment for respiratory support.

READ ALSO: Flu season makes a comeback in Germany

A child with RSV being treated at the Olgahospital in Stuttgart. Photo: picture alliance/dpa | Marijan Murat

“Some patient rooms are like bed storage areas, where you really have to crawl over the beds to get to the sick child, because the parent bed is lined up with the patient bed,” said Keller, who is also chairman of the South German Society for Pediatric and Adolescent Medicine.

This has far-reaching consequences for other young children who need treatment. When an infant who has just been resuscitated is admitted to a children’s hospital that is actually fully occupied, a three-year-old has to wait there for the third day in a row for his urgently needed heart operation.

‘Responsibility of politicians’

A wave of infections usually lasts six to eight weeks. In Bavaria, Lower Saxony and Berlin, as well as North Rhine-Westphalia, clinics are reporting a “maximally tense situation,” reported Divi on Thursday.

The Düsseldorf University Hospital, for example, is experiencing a wave of influenza among its young patients in addition to the RSV wave, which is “causing massive problems primarily for children up to elementary school age,” said University Hospital spokesman Tobias Pott.

In the Rhineland, “all beds are completely full” at times, said Jörg Dötsch, president of the German Society for Pediatric and Adolescent Medicine. An ER waiting time of six to seven hours is not uncommon, he says. 

“It is very unpleasant when children and their families have to virtually camp out in the emergency room,” says Dötsch, who is also director of the Clinic for Pediatric and Adolescent Medicine at the University Hospital in Cologne. 

READ ALSO: Healthcare in Germany: How to get a faster appointment with a specialist doctor

What are the solutions?

At their meeting on Thursday in Hamburg, intensive care physicians and intensive care nurses will discuss approaches to solving the crisis. 

One solution may be to temporarily bring nursing staff from adult facilities into the children’s hospitals, says Hoffmann, who is also a senior physician at Dr. von Hauner’s Children’s Hospital at the University of Munich. 

But above all, he says, many more pediatric nursing staff need to be trained. “We need to strengthen nursing,” he explained. “Only then do we have a chance.”

Others said more money needed to be invested in pediatric medicine and vaccines, even if it is less profitable.

“The fact that children’s lives are currently in danger is the responsibility of politicians,” said Jakob Maske, spokesman for the Professional Association of Pediatricians and Adolescents.

“Nowadays medicine has to be profitable – not cure diseases, but make money.”

READ ALSO: How private investors are buying up healthcare practices in Germany

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