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EXPLAINED: How Germany wants to contain the monkeypox virus

Health experts recently raised the alarm about cases of a rare virus in Europe. Here's what Germany is doing to limit the spread of monkeypox and what to do if you suspect you have it.

A woman washes her hands at a clinic in Essen
A woman washes her hands at a clinic in Essen. Photo: picture alliance/dpa | Jonas Güttler

What is monkeypox and how is it transmitted?

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) that causes small lesions on the skin, headaches and fever. It’s similar to chickenpox or smallpox, though the illness tends to be less severe than smallpox.

The symptoms of the disease caused by the virus are generally mild and clear up in 2-4 weeks without treatment, but can occasionally result in more serious illness if the patient has a weaker immune system.

The disease is called monkeypox because it was first discovered in macaques – a type of monkey – in a Denmark laboratory in 1958. Around 12 years later, the first human cases were discovered in the Democratic Republic of Congo in West Africa.

Scientists believe that, rather than monkeys, the disease could have been transmitted to humans through close contact with rats or other rodents in sub-Saharan Africa. 

Since then, the disease has spread to other countries but has generally been contained within the West African region. In the past few weeks, however, cases have emerged in Europe and North America.  

Why are people concerned about it in Germany?

After the first case was discovered in the UK at the beginning of May, experts assumed that the virus was likely to be present in other European countries.

This prognosis turned out to be accurate, and Germany reported its first case of the virus on May 20th. Since then, six cases in total have been discovered in the Bundesrepublik, including one in Munich and three in Berlin. A further patient with the virus is currently being treated in isolation at Freiburg University Hospital, while authorities have reported evidence of infections in Saxony-Anhalt as well. 

The Health Ministry and Robert Koch Institute (RKI) have said they expect more cases to emerge as time goes on.

“We are in the early stages of this outbreak,” Lothar Wieler, the head of the RKI, said on Tuesday. 

Much is still unknown, he said, but the situation is being closely monitored. Samples from many more people are being analysed, and authorities are also looking for contacts of people with a proven infection. 


Is this another Covid pandemic? 

Thankfully, no. So far, around 250 cases of the virus have been reported to the World Health Organisation (WHO) in 16 countries worldwide. Though this figure is worrying, the WHO has said that the risk to the general public is still very low.

Speaking to journalists on the sidelines of German Doctors’ Day in Bremen, Health Minister Karl Lauterbach (SPD) emphasised that the developments should be taken seriously. But, he said, the difference between Covid-19 and monkeypox are vast.

“What we are currently experiencing with monkeypox is not the beginning of a new pandemic,” he told DPA. Since the pathogen is well known to health experts, countries are well-equipped to bring the situation under control with good contact tracing and caution, he added.

Lothar Wieler and Karl Lauterbach

Lothar Wieler, the head of the Robert Koch Institute (RKI) and Health Minister Karl Lauterbach (SPD) speak at a press conference about monkeypox on Tuesday, May 24th. Photo: picture alliance/dpa | Sina Schuldt

One major difference between Covid-19 and monkeypox is the way it is transmitted.

According to experts, monkeypox is much harder to transmit to another person than the coronavirus. While Covid-19 can be passed on through airborne droplets and particles, monkeypox infections generally occur after sustained and close physical contact with an infected person or animal.

Of the recent cases that have become known to the RKI, most had been infected at large events “that were connected with sexual activities”, Wieler explained.

What should people do if they suspect they have monkeypox?

On Tuesday, the RKI issued recommendations that anyone who suspects they have monkeypox should self-isolate for 21 days.

If people notice small, red lesions appearing on their skin, they should contact their doctor or local health authority, who may require tests to be carried out and will likely ask for information about contacts. 

The contacts of infected people should also isolate for 21 days, the RKI said.

Generally, monkeypox is most identifiable through changes to the skin. The illness starts with red lesions, which pass through different stages and eventually crust over after the incubation phase of the virus is complete. 

Other symptoms of the disease include headaches, fever, chills, muscular aches and exhaustion. 

Experts also say that prevention is better than cure. Richard Pebody, head of the pathogens team at WHO Europe, recommends regular hand-washing, good hygiene and safe sex as practices to prevent the spread of the illness. 

What is the Health Ministry doing to contain the virus? 

Germany wants to control the spread of monkeypox by tracing contacts and quickly isolating infected people. 

Speaking in Bremen on Tuesday, Lauterbach said that the situation required a “tough response” and that the spread of disease could be contained if outbreaks were caught early. 

Now that the RKI has formulated isolation guidelines for both contacts and infected people, these will are set to be passed onto the 16 German states in the form of a recommendation.

The states will then be responsible for implementing and enforcing the rules.

Woman self-isolates with monkeypox

A woman self-isolates at home. The RKI recommends 21 says of isolation for people with monkeypox. Photo: picture alliance/dpa | Sebastian Gollnow

In addition, health experts are currently investigating whether existing vaccines should be rolled out to certain segments of the population.

This is a view supported by Klaus Rheinhardt, the head of the German Medical Association. Rheinhardt said on Tuesday that he thought vulnerable groups should be inoculated with the smallpox vaccine, which is believed to be highly effective against monkeypox.

This could include people with illnesses that weaken their immune system. Experts believe that the majority of people who died after a monkeypox infection in West Africa were HIV patients. 

Germany currently has around 100 million doses of smallpox vaccines in storage. Smallpox vaccination was compulsory in West Germany until 1975 and in East Germany until 1982, but the vaccination campaigns were phased out shortly before the eradication of the virus. 

READ ALSO: Monkeypox: German health expert calls for isolation measures

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Who can get the monkeypox vaccine in Germany – and how?

The monkeypox virus continues to spread in Germany and the vaccines panel is recommending that three groups of people get a jab. Here's who can get one - and how.

Who can get the monkeypox vaccine in Germany - and how?

What’s the current monkeypox situation in Germany? 

The monkeypox virus is still spreading in Germany, with 2,982 confirmed cases of the disease recorded by the Robert Koch Institute (RKI) as of Tuesday.

The virus, which causes small lesions on the skin alongside flu-like symptoms, is primarily transmitted through close physical and sexual contact. The vast majority of cases have so far been found in gay men, though five women have also had the virus in Germany to date. 

On Tuesday, the RKI reported that a four-year old girl in Baden-Württemberg had contracted monkeypox from two adults in her household but was asymptomatic. Before that, two teenage boys aged 15 and 17 were also found to have picked up an infection. 

READ ALSO: Monkeypox in Germany: Two teens ‘among new infections’

With the number of cases rising globally, the World Health Organisation (WHO) has declared the situation an “emergency of international scope” – the highest alert level possible.

This is a sign for members of the WHO like Germany to implement containment and preparation measures, such as rolling out vaccination campaigns. For its part, the Robert Koch Institute (RKI) is tracking the cases and has put out an information sheet about the best practices for avoiding the measures and what to do in the case of an infection.

What should people do if they contract the virus?

If people think they have a monkeypox infection, the first thing they should do is seek the advice of a healthcare practitioner such as a GP or sexual health advice clinic. However, the RKI advises people to phone the clinic beforehand to let them know they believe they may have the virus.

In confirmed cases of monkeypox, people should self-isolate at home until the lesions on their skin scab over and peel over, but for a minimum of 21 days. They should avoid physical contact and sharing items like hand towels or bed sheets with others and should wear condoms during sex for at least eight weeks.

Healthy people with no pre-existing conditions are generally fine to remain at home with someone who has contracted monkeypox, but those with weakened immune systems, pregnant women, elderly people and children under the age of 12 should move out for the duration of the isolation. 

READ ALSO: EXPLAINED: How Germany wants to contain the monkeypox

What monkeypox vaccines are available? 

The smallpox vaccine Imvanex, which has been available in the EU since 2013, was approved for use against the monkeypox virus on July 22nd, 2022. 

People are generally protected against monkeypox for at least two years after their first dose of Imvanex, but doctors recommend a second dose after a four-week interval in order to make this protection permanent. 

The vaccine is generally seen as a preventative measure but can also be used up as a so-called post-exposure measure to lower the risk of getting ill after contracting the virus. In this case, the vaccination is most effective up to four days after exposure. 

Who are monkeypox vaccinations recommended for? 

So far, the Standing Vaccines Commission (STIKO) has recommended that two primary groups of people get a monkeypox jab: men who have multiple male sexual partners and people who work in infectious disease laboratories. 

As mentioned, the vaccine can also be used to ward off illness or prevent a severe course shortly after someone has been exposed to the virus. 

READ ALSO: German vaccine panel recommends monkeypox jab for risk groups

Nurse laboratory monkeypox PCR

A nurse sorts monkeypox test samples in a lab. Photo: picture alliance/dpa/EUROPA PRESS | Carlos Luján

Is there enough vaccine to go around?

Not currently.

In May, the German Health Ministry preemptively ordered 240,000 doses of the vaccine – but so far just 40,000 of these have been delivered. 

This is far too little to cater for the estimated 130,000 people who fall into one of the target groups for a jab.

The remaining doses are due to be delivered in August and September, though some pressure groups are already calling for more to be ordered. 

On Friday, the German Aids Federation (DAH) called on the government to secure at least one million doses of the monkeypox vaccine in order to help stamp out the virus in Germany. 

“The goal must be to reduce the number of infections as quickly as possible and to get the epidemic permanently under control,” explained Ulf Kristal of the DAH board.

This can only be done if as many people in risk groups as possible are vaccinated, he added. 

How can people book a jab?  

At the moment, this varies quite a bit from state to state, with some issuing the jabs via the local health authorities and others supplying the doses to specialist HIV clinics and hospitals.

In Saxony-Anhalt, Bremen and Hesse, vaccinations are primarily organised through the local health authorities, so this should be your first point of contact to enquire about a jab if you live in these states. In Frankfurt am Main, however, a handful of specialised HIV clinics are also carrying out vaccinations, according the FAZ newspaper. 

In Saarland, too, appointments should be booked through the health authorities, though they are carried out at Saarbrücken University Clinic. In Hamburg, jabs are being administered solely at infectious disease clinics.

UKE university clinic Hamburg

The main entrance to the University Clinic in Hamburg, where monkeypox patients have been treated for the disease. Photo: picture alliance/dpa | Axel Heimken

Berlin offers the most diverse range of vaccinations and, with 8,000, has the largest number of vaccine doses available. Vaccinations are given in HIV specialist practices, counselling centres for sexual health as well as in several hospitals. A list of vaccination centres has been compiled by the German Association of Outpatient Doctors for HIV Treatment. Neighbouring Brandenburg organises vaccinations through the local health authorities as well as through GP’s practices.

In three federal states, only hospitals are responsible for monkeypox vaccinations. In Saxony, hospitals in Chemnitz, Leipzig and Dresden have been vaccinating since the end of June. In northern Schleswig-Holstein, outpatient clinics in Kiel and Lübeck are responsible. Neighbouring Mecklenburg-Western Pomerania is administering its doses exclusively through the University Medical Centre Rostock.

Several federal states have opted to roll out monkeypox vaccinations through both HIV clinics and hospitals. These include Bavaria, which has more than 3,500 vaccination doses available, as well as Rhineland-Palatinate, Lower Saxony and North Rhine-Westphalia, for which a list of all vaccination centres was recently published.

What else should people know? 

The monkeypox vaccine is perfectly safe, but people can experience a few side effects for a day or two afterwards, including soreness on the vaccination arm, fever and headaches. 

People with HIV should talk to a specialist before getting the vaccine, because the effectiveness may vary depending on your Helper T cell count. 

For more information on the clinics offering jabs, the German Aids Federation has published a helpful Q&A along with a list of clinics in each of the federal states, which can be found here (in German).