Joint statement on the monkeypox outbreak in Germany

30.05.2022 11:55

Joint statement from the medical-scientific societies DAIG, DGI, DGPI and GfV, the professional association dagnä and the DZIF in coordination with STIKO: Rapidly increasing numbers of infections caused by the monkeypox virus are being recorded on at least four continents. To limit the outbreak, rapid and consistent action is required. What is particularly important is target group-specific education and information (“awareness”), isolation of cases of infection, quarantine for close contacts and suspected cases, and risk minimization in interpersonal contacts. It must be quickly evaluated whether and how a vaccination can help limit the outbreak. Approved therapeutics should be made available for potentially severe disease courses.

background

Since the first case of monkeypox was diagnosed in London, additional cases have been added in rapid succession on four continents. The first case was diagnosed in Germany on May 19, 2022, and around 250 confirmed cases worldwide had been reported to the World Health Organization (WHO) by May 24, 2022. So far, the infections have mainly occurred in younger men who reported having sex with men, but there have also been intra-familial transmissions. In keeping with the poxvirus that comes from West Africa, the clinical course of the disease has so far been relatively mild. The transmission route is assumed to be direct skin or mucous membrane contact or droplet infection. The current infection situation is dynamic with increasing case numbers. Assessing the extent of the outbreak as well as tracing contact chains is challenging due to the long incubation period of 1-3 weeks.

Problem statement

To effectively contain the global outbreak, break the chains of infection and prevent entry into the animal kingdom outside of known endemic areas, decisive, rapid and coordinated action is required.

Proposed measures

• Outbreak management through non-pharmacological interventions

Due to the currently observed direct transmission from person to person, target group-specific and life-world-accepting education and information (“awareness” among those potentially affected and medical staff) is of crucial importance. In particular, people who have not been vaccinated against smallpox without a vaccination certificate or vaccination scars should avoid contact with changing sexual partners or sharing beds and clothing.

Those who are confirmed to be infected should remain in effective isolation for a period of 21 days. Inpatient hospital treatment solely for isolation reasons is not necessary; inpatient admissions should primarily be made for medical reasons in the event of severe clinical courses or impending complications.

Contact persons with a relevant risk of infection and suspected cases should go into quarantine during the incubation period or until the infection has been reliably ruled out.

Medical staff should wear suitable protective clothing (mask, gloves, gown) when caring for the above-mentioned groups of people.

• Vaccinations

A non-replicative smallpox vaccine (MVA-BN) is approved in the EU to protect against smallpox infections (variola major, orthopoxvirus) in adults. Based on animal data, this vaccine is also approved for the prevention of monkeypox in the United States and Canada. Clinical efficacy data in humans could not be sufficiently collected due to only sporadic cases of infection so far. A corresponding study has been running for some time. Data on tolerability are available, safety data and dosage recommendations in risk groups are available.

In birth cohorts not vaccinated against smallpox (e.g. birth cohorts from the early 1970s onwards), vaccination could make a relevant contribution to increasing protection against infection and disease. Particularly in the area of known infection clusters, vaccination could prevent infections or mitigate the course of the disease and significantly limit outbreaks.

This option should be examined promptly by the EMA (EU approval) and the STIKO (vaccination recommendation). At the same time, the availability should be checked and the procurement of vaccines in sufficient quantities as well as the organization and feasibility of vaccination recommendations should be prepared. Established infectious disease treatment centers and the public health service must be provided for possible implementation.

• Examination of therapeutic options

Although the cases to date are characterized by a known mild course of the West African monkeypox virus infection, therapeutic options should be available for vulnerable patient populations (e.g. relevant immunodeficiency). Tecovirimat, an antiviral drug, is currently approved in the EU for the treatment of monkeypox infection; an alternative is the unapproved antiviral drug brincidofovir. Availability of both must be ensured. Treatment should also take place via established infectious disease treatment centers.