September 2, 2024, 3:44 pm | Read time: 7 minutes

Cases of the Mpox virus are on the rise in the Democratic Republic of the Congo and other African countries. However, cases of the deadly virus have also occurred in other countries around the world. Who is particularly at risk, and how can you protect yourself from infection? Here is an overview.

What is Mpox and how dangerous is it?

Mpox is an infectious disease triggered by the Mpox virus (MPXV), which belongs to the Orthopoxvirus genus. There are two genetically distinct groups, known as clades, that are differentiated. This is what the Federal Foreign Office (AA) writes on its Mpox overview page.

Most commonly, Mpox manifests as a “mild febrile illness with a smallpox-like rash,” according to the report. This itchy rash usually occurs in the genital area and on the face. It also occurs on the palms of the hands and feet. Inflammation of the mucous membranes in the mouth and throat, as well as the genital and rectal areas, can also occur. Other possible symptoms include fever, headache, muscle, neck and back pain, chills, and swollen lymph nodes. In severe cases, the virus can lead to death.

Typically, the disease takes a mild course, with patients recovering within a few weeks. However, Mpox poses a life-threatening risk to children and people with an immune deficiency. According to the WHO, of the 384 deaths from Mpox in the Democratic Republic of the Congo between January and May 2024, 321 were children aged between one and 15 years old. 240 children, aged between one and five, also died.

Transmission

Transmission of the viruses can occur from animals to humans as well as from person to person. According to the Federal Foreign Office, rodents in particular are virus carriers, while monkeys and humans are false hosts. Mpox is transmitted through close contact with infected people, “but contact with wounds, bodily fluids, respiratory droplets or contaminated material can also lead to infection”, writes the AA.

Since 2022, the so-called MPXV clade IIb has spread worldwide; it is mainly transmitted through sexual contact. Particularly during sex between men. Since 2023, the virus variant Ib has been circulating, spreading primarily in the Democratic Republic of the Congo. It has also been spreading to its neighboring countries. According to the AA, this variant is characterized by “higher virulence as well as clinically more severe courses and increased mortality”.

PCR swabbing of blisters or skin crusts is how the disease is diagnosed. For high risk-groups in particular, there is treatment with the antiviral medication Tecovirimat.

Precautions and vaccination

The Federal Foreign Office recommends avoiding contact with individuals who are ill. As well as their skin lesions, wounds, bodily fluids, and respiratory droplets. This advice also extends to their personal items, hygiene products, and animals that may be infected. It is also recommended to avoid consuming bushmeat. The AA suggests protective measures like handwashing, mask-wearing, maintaining distance, and condom use during sexual activity.

Since 2022, the European Union has had access to a smallpox vaccine, Imvanex/Jynneos. The vaccine is also employed in the fight against Mpox. According to the Robert Koch Institute (RKI), the Standing Committee on Vaccination (Stiko) only recommends vaccination for certain groups of people. On the one hand, these are asymptomatic people over the age of 18 who have had close contact with a person infected with Mpox, for example, through sexual or family contact as post-exposure prophylaxis. This also includes medical personnel who have been in contact with the ill, their bedding, and laboratory samples. On the other hand, people with an increased risk of exposure and infection are recommended to receive the vaccination. This group encompasses men over 18 who engage in sexual activities with other men and have multiple partners, as well as laboratory staff in specialized settings at risk of infection. “Based on the current risk-benefit assessment, vaccination of other population groups is not necessary and not recommended,” says the RKI (unchanged since July 27, 2022).

In addition to vaccination, it is “above all important to identify cases and their contact persons at an early stage, to initiate isolation and quarantine measures, to promptly clarify possible suspected cases diagnostically, and to educate the affected risk groups and inform them about protective measures”, writes the RKI in another statement.

History

The RKI reports that MPX viruses are prevalent among rodents across West and Central Africa. They were first detected in humans in 1970, in a nine-month-old boy in the Democratic Republic of the Congo. Since then, there have been cases of Mpox in humans, particularly in West and Central African countries, including Nigeria, Cameroon, the Democratic Republic of the Congo, and the Republic of the Congo. East African countries such as Burundi, Rwanda, Uganda, and Kenya are new additions. In 2003, a case of Mpox was detected outside Africa for the first time. It is believed that the Mpox case in the USA originated from rodents infected in Ghana. This then led to the further spread of the virus. However, until 2022, only a handful of cases had been confirmed outside the African continent.

“Since May 2022, cases without a travel history to known endemic areas have been registered in various countries outside Africa, including Germany,” writes the RKI. This was followed by a large wave of infections. In 2023 and so far in 2024, however, there have been comparatively few cases of infection in Germany. These cases have predominantly impacted men who have sex with men, and they are associated with the Mpox clade IIb. Since 2023, there has also been an increase in clade I Mpox cases in Africa, and particularly in the Democratic Republic of the Congo.

Formerly called “monkeypox”, the disease has been officially referred to as “Mpox” by the WHO since November 2022. The background to this name is not the transmission by monkeys, but that the Mpox virus was first detected in laboratory monkeys in Denmark in 1958, according to “Welt“.

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How high is the current global risk?

On August 14, 2024, the World Health Organization (WHO) declared a “public health emergency of international concern” (PHEIC) due to the increasing number of Mpox cases in the Democratic Republic of Congo and an increasing number of other African countries. WHO Director-General Dr. Tedros Adhanom Ghebreyesus stated, “The emergence of a new clade of mpox, its rapid spread in the eastern DRC, and the reporting of cases in several neighboring countries are very worrying.” The WHO has indicated that there was a significant increase in reported cases in the Democratic Republic of the Congo last year. However, the current figures already exceed the total number from 2023: more than 15,600 cases and 537 deaths (as of August 14, 2024).

According to the Federal Foreign Office, however, there is “a low risk of spread outside the affected countries (…).” The WHO describes it in more detail in its global Mpox risk assessment from July 2024: The risk in countries that were not affected by Mpox before 2022 to 2024 is low. Countries that have historically had to deal with Mpox, as well as their neighboring countries, have a moderate risk. Likewise, the overall global risk for gay men, bisexual men, other men who have sex with men, transgender individuals, gender-diverse people, and sex workers is assessed as moderate. The risk for the general population in the African WHO region is also moderate. In contrast, the risk for the general population in the Democratic Republic of the Congo is considered high.