The 2022–2023 mpox outbreak in Germany is part of an ongoing global outbreak of human mpox caused by the West African clade of the

monkeypox virus ''Monkeypox virus'' (MPV, MPXV, or hMPXV) is a species of double-stranded DNA virus that causes monkeypox in humans and other mammals. Monkeypox virus is a zoonotic virus belonging to the '' orthopoxvirus'' genus, making it closely related to th ...

. At the beginning of September 2022,

Spain , image_flag = Bandera de España.svg , image_coat = Escudo de España (mazonado).svg , national_motto = '' Plus ultra'' ( Latin)(English: "Further Beyond") , national_anthem = (English: "Royal March") , ...

France France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of overseas regions and territories in the Americas and the Atlantic, Pacific and Indian Oceans. Its metropolitan ar ...

Germany Germany, officially the Federal Republic of Germany (FRG),, is a country in Central Europe. It is the most populous member state of the European Union. Germany lies between the Baltic and North Sea to the north and the Alps to the sou ...

and the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...

are the countries with most cumulative cases (in absolute numbers) in Europe.

Background

Detection in Europe

Development potential

German virologist

Christian Drosten Christian Heinrich Maria Drosten (, born 1972) is a German virologist whose research focus is on novel viruses ''( emergent viruses)''. During the COVID-19 pandemic, Drosten came to national prominence as an expert on the implications and actions ...

from the

Charité The Charité – Universitätsmedizin Berlin (Charité – Berlin University of Medicine) is one of Europe's largest university hospitals, affiliated with Humboldt University and Free University Berlin. With numerous Collaborative Research Ce ...

– who was the main medical adviser for the German federal government for measures against the

COVID-19 pandemic in Germany The COVID-19 pandemic in Germany has resulted in confirmed cases of COVID-19 and deaths. On 27 January 2020, the first case in Germany was confirmed near Munich, Bavaria. By mid February, the arising cluster of cases had been fully containe ...

and who warned early that the

SARS Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-1), the first identified strain of the SARS coronavirus species, '' s ...

virus potential needed to be investigated – warned in May 2023 that the Mpox disease could aggravate: "Wir wissen aus der Geschichte, dass andere Pockenvirus-Infektionen mit milden Verläufen begannen und sich dann in der Anpassung an den Menschen verstärkt haben" e know from history that other smallpox virus infections began with mild courses and then intensified as they adapted to humans

Transmission

History

On 20 May 2022, the first case of mpox was serologically detected in a man in

Munich Munich ( ; german: München ; bar, Minga ) is the capital and most populous city of the German state of Bavaria. With a population of 1,558,395 inhabitants as of 31 July 2020, it is the third-largest city in Germany, after Berlin and Ha ...

, who showed "characteristic skin changes" already the day before.

May & June 2022

Until the end of May 2022, 33 cases of mpox were confirmed, on 10 June the (cumulated) number of cases was 165, and as of 5 July the number rose to 1,242. As of 3 June 2022, the most affected federal state of Germany in terms of ''reported'' cases has been the

city-state A city-state is an independent sovereign city which serves as the center of political, economic, and cultural life over its contiguous territory. They have existed in many parts of the world since the dawn of history, including cities such as ...

Berlin Berlin is Capital of Germany, the capital and largest city of Germany, both by area and List of cities in Germany by population, by population. Its more than 3.85 million inhabitants make it the European Union's List of cities in the European U ...

− with 39 reported cases in Berlin and 65 in the whole country, and as of 28 June Berlin reported about two thirds of all cases (557 out of 838). The city-state planned to start vaccination during the week of 4 July.

July 2022

there were 1,054 cases reported for the whole country, albeit the

Robert Koch Institute The Robert Koch Institute (RKI) is a German federal government agency and research institute responsible for disease control and prevention. It is located in Berlin and Wernigerode. As an upper federal agency, it is subordinate to the Feder ...

(RKI) expounded that the situation was ''not worrisome'' ("nicht beunruhigend") for the general population. there were 761 reported cases in city-state of Berlin alone; one article criticized that vaccinations had not yet started in Berlin, although 8,000 vaccine doses of non-replicating smallpox vaccine were already in stock. Vaccination in Berlin were going to start in the week of 11 July. there were 1,490 reported cases in Germany. On 19, 2 July 033 (cumulative) cases were reported, with 1,140 cases in Berlin alone; on 22 July, the state of Berlin was applying for more vaccine allocations due to high demand. On 22 July 2022, the European Medicines Agency recommended the approval of Imvanex smallpox vaccine for the prevention of mpox disease, and the

European Commission The European Commission (EC) is the executive of the European Union (EU). It operates as a cabinet government, with 27 members of the Commission (informally known as "Commissioners") headed by a President. It includes an administrative body ...

subsequently approved it. (The vaccinations with Imvanex started earlier, depending on the federal state; in

Lower Saxony Lower Saxony (german: Niedersachsen ; nds, Neddersassen; stq, Läichsaksen) is a German state (') in northwestern Germany. It is the second-largest state by land area, with , and fourth-largest in population (8 million in 2021) among the 16 ...

they started on 3 July 2022 and in Berlin on 13 July.) Till July 2022, the Federal Republic has received 40,000 doses (of the Imvanex smallpox vaccine) and distributed them to the federal states. Another 200,000 vaccine doses are expected for September. At the end of July, the ''Deutsche Aidshilfe e.V.'' (de) appealed to the German government to order 1 million vaccine doses in order to enable the (full) vaccination of up to 500,000 people.

August 2022

Till 5 August 2022, 2887 confirmed cases were reported for the whole country and about half of the cases (1436) were reported from city-state of Berlin alone. In addition to the 9,500 vaccine doses Berlin already received, the federal government is expected give Berlin an additional 1,900 doses in the week of 8 August 2022. In Berlin where the highest number of reported new mpox infections occurred for a long time, this number has decreased significantly by mid-August. By 19 August 2022, 6417 vaccinations (including 90 second shots) against mpox had been administered at the 28 vaccination sites in Berlin.

Since September 2022

As of 9 September 2022, a total of 3530 cases of mpox have been reported to RKI, including 14 cases in females and 2 cases in children younger than 14 years. The weekly number of newly reported cases has been declining since early August. Since the number of cases reported each week has fallen to low numbers (quite persistently below 50), the RKI will provide information only once a week on Tuesday, starting in the second week of October 2022.

Intervention

Vaccination

On 30 June 2022 − with pre-publication on 21 June − the RKI recommended Imvanex smallpox vaccine for

post-exposure prophylaxis Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring. COVID-19 In 2021, the FDA has approved bamlaniv ...

(PEP), for people with high risk of infection and for people with risk of a severe course of the disease. Due to the limited resources of Imvanex there are priorisations. The Imvanex smallpox vaccine is administered subcutaneously. (Unlike the first and second generation

smallpox vaccine The smallpox vaccine is the first vaccine to be developed against a contagious disease. In 1796, British physician Edward Jenner demonstrated that an infection with the relatively mild cowpox virus conferred immunity against the deadly smallpox ...

s.) On 21 July, the

Standing Committee on Vaccination The Standing Committee on Vaccination at the Robert Koch Institute (german: Ständige Impfkommission am Robert-Koch-Institut, ), or STIKO (), is a scientific committee comprising 18 members at the Robert Koch Institute in Berlin, Germany that pr ...

(STIKO) recommended to use only one dose per person (instead of two) of the Imvanex smallpox vaccine for the time being − so that more people can be vaccinated. Since 19 August 2022, the European Medicines Agency (EMA) also allows

intradermal Intradermal injection, often abbreviated ID, is a shallow or superficial injection of a substance into the dermis, which is located between the epidermis and the hypodermis. For certain substances, administration via an ID route can result in a f ...

administration of the vaccine, which requires only one-fifth the dose amount (compared with subcutaneous administration) to induce similar antibody levels.

Isolation

The RKI recommends that persons with diagnosed mpox isolate themselves at home for at least 21 days. Isolation can be mandatory by ordinance of the "Gesundheitsamt" (local health authority). This mandatory isolation period can also apply to close contacts that are vaccinated and show no signs of infection.

Cumulative number of cases

In order to restrict the links for mere case numbers there are perhaps only some links for special days (like the end of a month or days that are not archived by the Wayback machine). The RKI reports data from Monday to Friday and German press relies on this data for the overall number, so there are no new cases on Saturday or Sunday. The data can be verified with the Internet Archive ("Wayback Machine") of the webpage from the RKI, see #RKI & CDC data. References: * GER
13 June30th7 July8th13th
5th,10th
18th,22nd25th
29th,30th1 Sept.9th16th21 Sept.23rd
Oct. 11th,
* UK: 2022–2023 mpox outbreak in the United Kingdom#History, rev. 8 July 2022 * U.S.: 2022–2023 mpox outbreak in the United States#Timeline, rev. 8 Oct. 2022 * FRA: 2022–2023 mpox outbreak in France#Cases, rev. 8 Oct. 2022 * Berlin
9 June13 June
June 28, 5 July, 19 July, 5 August, 17th, 26th,
31th21 Sept.27 Sept.
;Weekly new casesfrom Friday before day d up to (and incl.) Thursday till 7 October 2022 resp. from Tuesday before day d up to (and incl.) Monday since 4 October 2022 :Note: In early October 2022 change in the time period since RKI will now provide information only once a week on Tuesday.

External links

Our World in Data - Monkeypox
(ourworldindata.org)
Affenpocken in Deutschland: Erste klinische Beobachtungen
(www.aerzteblatt.de, 29 July 2022, in German) *
Monkeypox in Germany: Initial clinical observations
(English version)
INFORMATION SHEET For Vaccination against Monkeypox – IMVANEX / JYNNEOS with Smallpox Vaccine from Bavarian Nordic
(www.rki.de)

(www.berlin.de): Webpage contains the number of the telephone hotline of the "Beratungsstelle für sexuelle Gesundheit" (Sexual Health Counseling Center) of the municipality "Berlin-Mitte".
(According to a press report the center serves in its day-to-day work primarily "people without health insurance and people who wish to remain anonymous".)

RKI data (German numbers)

* Updated from Monday to Friday, published by the RKI *
Archive of "Internationaler Affenpocken-Ausbruch: Fallzahlen und Einschätzung der Situation in Deutschland"
(RKI) on the ''

Wayback Machine The Wayback Machine is a digital archive of the World Wide Web founded by the Internet Archive, a nonprofit based in San Francisco, California. Created in 1996 and launched to the public in 2001, it allows the user to go "back in time" and s ...

''
SurvStat@RKI 2.0
(survstat.rki.de) Web page for querying diseases and pathogens reported to the RKI, including

mpox Mpox (formerly known as monkeypox) is an infectious viral disease that can occur in humans and some other animals. Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The illness is usually mild ...

. Output option in English.

CDC data (world map)

2022 Monkeypox Outbreak Global Map
(www.cdc.gov)

Notes

References

Some of the sources are written in

German German(s) may refer to: * Germany (of or related to) **Germania (historical use) * Germans, citizens of Germany, people of German ancestry, or native speakers of the German language ** For citizens of Germany, see also German nationality law **Ger ...

, they can be translated with services like Google Translate and its alternatives. {{DEFAULTSORT:2022-2023 mpox outbreak in Germany

Mpox Mpox (formerly known as monkeypox) is an infectious viral disease that can occur in humans and some other animals. Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The illness is usually mild ...