Zoonoses: mpox virus is spreading

The WHO has just issued a warning about the mpox virus and declared a Public Health Emergency of International Concern (PHEIC). Prof.Johannes Bogner explains what this means, what the pathogen is, how people can become infected, and what treatment methods are available. A specialist in internal medicine, Prof. Bogner is Director of the Interdisciplinary Center for Clinical Infectious Diseases (KLIK) at LMU University Hospital.

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Prof. Bogner, how are these viruses transmitted and what danger do they pose for humans?

Transmission occurs through direct skin-to-skin and mucosal contact. The characteristic pox lesions are particularly contagious. Sexual transmission is the main driver of the current epidemic. As NO cases of airborne or aerosol transmission are known, they should not be feared. People who do not have unprotected intimate relations have no risk of infection, unless perhaps they are handling the lesions of infected patients without gloves. The danger for humans is limited. A recent paper in Nature Medicine reports that just 9 percent of people infected were bedridden. However, 59 percent had fever and malaise. Only in exceptional cases or in people with very weak immune systems can the disease be fatal.

What’s different about the new mpox variant (clade Ib)? And how does this affect contagion and the disease process?

The difference to clade 2 was identified through molecular genetic analysis and concerns a specific mutation in the so-called APOBEC3-mediated cytosine deamination gene. As a result of this mutation, transmission from human to human is easier than in the wild-type variants we’ve had before now.

How is the virus type identified in the lab?

A swab of a skin lesion is sent to a virological laboratory, where the virus is identified via a PCR test. When there is a positive result, a named-patient notification is sent to the public health office and a three-week quarantine is imposed on the patient.

As we speak, the virus is spreading rapidly in countries on the African continent in particular. A single case in Sweden was reported last week. Yet the likelihood of an epidemic or pandemic is currently deemed to be low. Is this also your view and why?

Worldwide spread of the disease through sexual contact (similarly to the mpox wave in 2022-2023) seems inevitable, even if individual countries are once again imposing entry bans. People will travel and people will have intimate contact. Accordingly, there is not much chance of arresting the spread of the disease. We know, however, how individuals can protect themselves: Avoid intimate or sexual contact with persons not known to you personally and without information on their infectious status or previous partners or even travel history.

Are there vaccines and drugs for prevention and treatment?

There is an effective vaccine. But this is not available through pharmacies as a matter of course. Indeed, vaccination does not even make sense for people not at risk of infection. We assume that vaccine production will be ramped up again. The vaccine is currently not available and – similarly to the wave in 2022 – will be used very selectively according to individual considerations. There is also an antiviral medication called Tecovirimat, which can be successfully administered in severe systemic cases.

Which centers in Munich, Bavaria, and Germany are equipped to treat patients?

Pretty much any center that is certified as a center for infectious diseases will be able to handle the treatment. This applies to the Center for Clinical Infectious Diseases at LMU University Hospital.

What does the WHO’s decision to declare a Public Health Emergency of International Concern mean for the health system in Germany, and also for LMU University Hospital in particular?

In the first instance, it basically just means that we ask every patient for their travel history, as we’ve already been doing anyway. In addition, we arrange a test for any patient with suspicious skin symptoms, no matter how slight, if that person has travelled to the Democratic Republic of the Congo or has had contact with a person who has been in that country. I’d like to point out that mpox is not a highly contagious or dangerous disease. It’s in no way comparable with Ebola or hemorrhagic fevers.

Which institutes at LMU are involved in researching such viruses: the Max von Pettenkofer Institute, LMU University Hospital with KLIK and the Division of Infectious Diseases and Tropical Medicine, the Gene Center Munich?

Mpox is of scientific interest for all the institutes and centers you mentioned. However, we would expect new studies to be undertaken in concert with other national and international partner institutes. The cooperation of LMU institutes in the German Center for Infection Research (DZIF) and the Network of University Medicine (NUM) means that useful joint projects can get off the ground in short order. As a result of the mpox pandemic of 2022-2023, the tropical institute and the outpatient department for infectious diseases have acquired considerable experience and expertise with the disease and the corresponding vaccination.

Source: LMU-Klinikum

Eva Grüner, Marica Grossegesse, Daniel Stern, Veronica Ober, Tabea M. Eser, Gabriele Reiling, Renate Stirner, Gerardo Ibarra, Nils Postel, Raffaele Conca, Christopher Dächert, Alba Grifoni, Alessandro Sette, Johannes Bogner, Ulrich Seybold, Julia Roider: Mpox-specific immune responses elicited by vaccination or infection in people living with HIV. Journal of Infectious Diseases, 2024.

Veronica Ober, Julia Roider, Johannes Bogner, Ulrich Seybold. Affenpocken in der Hausarztpraxis werde ich den ersten Fall erkennen? [Monkeypox in the doctor's office - will I recognize my first case?]. MMW Fortschritte in der Medizin, 2022.

Christian Hoffmann et al. Clinical characteristics of monkeypox virus infections among men with and without HIV: A large outbreak cohort in Germany. HIV Medicine 2023.