Monkeypox is usually harmless. But not always. dr Hartmut Stocker, Chief Physician at the Clinic for Infectious Diseases at the St. Joseph Hospital in Berlin Tempelhof, on the most common complications, the protective effect of vaccination and the benefits of condoms.
Dr. Stocker, at your clinic you treat people suffering from monkeypox. What is your preliminary balance sheet? How seriously ill are your patients?
Stocker: Most patients do not require hospitalization. That’s the calming aspect. The risk of developing brain or pneumonia or dying of monkeypox cannot be determined from the data available to date. Fortunately, we don’t see any very serious courses of the disease or deaths, but we do see severe courses once more and once more.
Severe gradients express themselves as?
Stocker: One problem is the excruciating pain that smallpox causes, mainly at the entry points. Where the infection was transferred, it is often particularly bad. And the second is bacterial superinfections, mostly on the skin or soft tissue. This means that the smallpox breaks through the barrier of the skin and offers an entry point for bacteria at this point. For quite a few of those affected, antibiotic treatment is not sufficient and they have to be operated on so that the pus can drain off. The surgeon is often the best infectiologist here.
Let’s take a step back. Smallpox is visible and yet many people become infected. Is it possible that those affected are already infectious before the onset of symptoms?
Stocker: We will certainly be able to answer the important question of whether patients are already contagious before the clinical symptoms appear in the coming weeks and months. However, the assumption goes in this direction because the mucous membranes also contain virus-containing material. And someone who is covered with smallpox usually no longer has close contact with other people. Incidentally, there also seem to be some people who do not develop any symptoms at all and still carry and excrete the virus and are therefore very likely to be infectious. This was shown by a recent study of people being treated for other sexually transmitted diseases. The swab samples were also examined for the monkeypox virus and it was found that part of this cohort was positive. However, most cases are already symptomatic.
Are there any new insights into how the current outbreak came regarding?
Stocker: The disease was always there. And because up until now it has mainly been people in Africa who have been affected, it was not our focus. But it is the case with all infectious diseases that they jump from one area to another and suddenly spread explosively there. In this respect, the current outbreak is nothing special in terms of infection epidemiology. I would like to expressly emphasize that no one group of the population is ever to blame for this.
You’re referring to men who have sex with men?
Stocker: At the moment it is mainly MSM who are affected, but it must not be that gay men are being branded now. I remember the Middle Ages, when Jews were accused of spreading the plague by poisoning wells in order to legitimize their persecution. Instrumentalizing infectious diseases has never contained an outbreak in history, it’s just stupid. Viruses are always looking for their niches in the world. And it is reasonable to assume that the monkeypox virus will also spread to other population groups. Take HIV – it’s an absolutely heterosexual pandemic today.
Do you see a chance to use vaccines to control the outbreak so hopefully it doesn’t become a pandemic?
Stocker: We have the problem that there is far too little vaccine at the moment. This is really not due to a lack of political will, but simply to the production capacities and the available vaccine doses. If we might produce more and vaccinate more, that would certainly be a good chance to get the outbreak under control. However, there are still many question marks. We don’t even know yet whether the vaccine really protects once morest monkeypox, how many vaccine doses are necessary, how high the protection is and so on. Because the vaccine was developed for military use once morest smallpox, it was not evaluated on humans for monkeypox. There are good reasons to assume that it is effective, because in the case of smallpox it is usually the case that the vaccination has cross-activity, i.e. it also protects once morest related smallpox viruses such as the monkeypox virus. But the truth is, we don’t know.
Nevertheless, the demand for the vaccination seems to be enormous…
Stocker: The willingness to vaccinate is extremely high. Our phones haven’t been silent for weeks. We receive around 300 registrations for vaccinations every day by e-mail alone – but we only have 300 vaccine doses available at our clinic. You can imagine how difficult that is.
According to which criteria do you distribute?
Stocker: At the moment we are trying to make an offer to those who need the vaccination most urgently, i.e. above all immunosuppressed people. That’s one group. And in the other, lots are drawn according to a fair procedure. I think we solved that very well in Berlin. No practice is disadvantaged, no university clinic or center is preferred. We just don’t know when the vaccine will come. As I said, this is not a failure of politics. The Berlin Senate tried to find a solution very quickly and fought to get more vaccine doses – with success. The 8,200 cans in Berlin just aren’t nearly enough. We are extremely sorry. We need more of it and we will get more.
What happens if it turns out that the vaccination does not protect once morest monkeypox infections at all?
Stocker: Then you will have to think of a different strategy. But first we need reliable data. I can therefore only appeal to all those who have been vaccinated and those who are willing to be vaccinated to join the evaluation study that was developed by the Charité and is offered in all centers. Even those who have not yet been vaccinated should have themselves observed as part of the study – so that we can understand what the vaccination really does.
And what regarding other protective measures? Awareness campaigns or condoms?
Stocker: A lot is being done at the level of reconnaissance. The AIDS organizations have clearly positioned themselves here. Only recommendations are one thing, and the other is the reality of life. My advice would be: stay cautious and be aware that condoms may not prevent infection but may protect parts of your body that are particularly important to you from a particularly bad infection.
